Left Pulmonary Artery Coarctoplasty by Using the Right Pulmonary Artery Flap Near the Arterial Duct Hsiao-En Tsai, MD, Shu-Chien Huang, MD, Shyh-Jye.

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Left Pulmonary Artery Coarctoplasty by Using the Right Pulmonary Artery Flap Near the Arterial Duct Hsiao-En Tsai, MD, Shu-Chien Huang, MD, Shyh-Jye Chen, MD, PhD, Chun-Min Fu, MD, Ing-Sh Chiu, MD, PhD The Annals of Thoracic Surgery Volume 92, Issue 3, Pages 1135-1137 (September 2011) DOI: 10.1016/j.athoracsur.2011.03.115 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A computed tomographic scan showed left pulmonary artery (LPA) stenosis near the site of pulmonary artery bifurcation. (A) A thin-slab oblique reformatted image; the tortuous patent ductus arteriosus (PDA) is noteworthy. (B) A model after three-dimensional reconstruction. (A = anterior; Ao = aorta; desc. = descending; H = head; L = left; LAA = left atrial appendage; MPA = main pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2011 92, 1135-1137DOI: (10.1016/j.athoracsur.2011.03.115) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Operative techniques of left pulmonary artery (LPA) coarctoplasty, plus central shunt creation in pulmonary artery ventricular septal defect patients with main pulmonary artery (MPA) atresia and proximal LPA stenosis. (a) Patent ductus arteriosus (PDA) division with excision of the ductal tissue near the pulmonary artery side. (a') Cephalic view of right pulmonary artery (RPA) flap creation along the dotted line. Another leftward incision was extended beyond the stenotic site. (b) Frontal view of RPA flap creation. After creation of the RPA flap, a linear incision was extended into the proximal LPA. The MPA will be opened along the dashed line for shunt creation. (c) The LPA coarctoplasty with RPA flap by performing V-Y plasty. A 4-mm Gore-Tex tube (W.L. Gore & Associates, Inc., Flagstaff, AZ) was interposed between the ascending aorta and the MPA. (Ao = aorta.) The Annals of Thoracic Surgery 2011 92, 1135-1137DOI: (10.1016/j.athoracsur.2011.03.115) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Angiogram before total correction (2 years after coarctoplasty). The size of the proximal left pulmonary artery (LPA) was comparable with that of the RPA. (Ao = aorta.) The Annals of Thoracic Surgery 2011 92, 1135-1137DOI: (10.1016/j.athoracsur.2011.03.115) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions