The surgical therapy for pulmonary artery--right ventricular discontinuity

The results of operations performed at the University of Michigan for conditions characterized by pulmonary artery-right ventricular discontinuity are reviewed. In 5 infants with increased pulmonary blood flow, pulmonary artery banding was performed with unsatisfactory results. Two survived operation but later died of complications related to the bands. Fourteen children received shunts for conditions involving reduced pulmonary blood flow; 13 survived and have either undergone subsequent total repair or are doing well and are awaiting total repair when possible. Twelve patients have undergone total repair; valveless cloth tube conduits were utilized in 4, and 2 remain well 11 years later. More recently, fresh, antibiotic-preserved aortic allografts have been utilized for the conduit. Six of 8 patients survived the operation, and there was 1 late death. The aortic wall of one graft became calcified after 4 years and had to be replaced, although the valve leaflets remained functional. Immediate success of the totally corrective operation depends on the pulmonary vascular resistance being less than 60% of the systemic. Long-term success depends on the fate of the conduit. From previous experience we think fresh allografts should be more durable than the sterilized allografts used by most other groups; however, we have found that even fresh allografts can calcify.