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Archives of cardiovascular diseases
Volume 105, n° 12
pages 666-675 (décembre 2012)
Doi : 10.1016/j.acvd.2012.08.003
Received : 20 June 2012 ;  accepted : 17 August 2012
Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: Focus on the strategy of rehabilitation of the native pulmonary arteries
Prise en charge des atrésies pulmonaires avec communication inter-ventriculaire, hypoplasie des artères pulmonaires et collatérales : mise au point sur la stratégie de réhabilitation des artères pulmonaires
 

Figure 1




Figure 1 : 

Initial angiographic evaluation. A. Angiography showing the extremely hypoplastic native pulmonary arteries and the famous ‘sea-gull’ (arrow). Right and left pulmonary arteries are measured (a and b). The pulmonary distribution is apparently complete. B. Angiography showing one major aorto-pulmonary collateral artery, emerging from the right side of the thoracic aorta to the middle and lower right pulmonary lobe.


Figure 2




Figure 2 : 

Peroperative view of step 1. A and B. The arrow shows the hypoplastic main pulmonary arteries. The right and left pulmonary arteries are controlled and occluded by blue rubber loops. C. The main pulmonary artery is opened longitudinally (arrow). This incision will ultimately be extended to the infundibulum, as far as to obtain a sufficient opening of the right ventricle. D. An autologous pericardium patch is sutured to the edge of the arteriotomy and infundibulotomy.


Figure 3




Figure 3 : 

Example of incomplete pulmonary artery distribution. A. Angiography showing an incomplete distribution of the right pulmonary artery. Only the upper pulmonary lobes are perfused. B. Major aorto-pulmonary collateral artery perfusing the middle and lower right pulmonary lobes.


Figure 4




Figure 4 : 

Example of additional step in the rehabilitation of pulmonary artery procedure. A. Angioplasty and stenting of the right pulmonary artery. B. Angioplasty and stenting of the left pulmonary artery.


Figure 5




Figure 5 : 

Retrospective view of the rehabilitation procedure in patients with extremely hypoplastic pulmonary artery, ventricular septal defect and major aorto-pulmonary collateral arteries: one reported case. KT: catheterization.


Figure 6




Figure 6 : 

The ‘Timone Children’s Hospital pulmonary arteries rehabilitation programme’. Cath: catheterization; CT: computed tomography; Echo: echocardiography; MRI: magnetic resonance imaging; PA: pulmonary artery; RV: right ventricle; VSD: ventricular septal defect.

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