PMC10031123_01
(A) CTA and three-dimensional reconstruction revealed the absence of intrapericardial right pulmonary artery. (B-D) Cardiac catheterization revealed blood supply of upper right pulmonary artery comes from right subclavian artery and inferior right pulmonary artery was supplied by left subclavian artery.
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F1
The gap between the RPA at the hilum and MPA was estimated to be 18.5 mm (Figure 1A). We further performed cardiac catheterization for diagnostic purposes, which further revealed that blood supply of upper RPA comes from right subclavian artery, while inferior RPA was supplied by left subclavian artery through long collateral vessels (Figures 1B,D).
Technique of modified pulmonary artery flap angioplasty. (A) Extension flap was created using the anterior wall of main pulmonary artery and left pulmonary artery. (B) Distal incision for the extension flap terminated proximal to the left pulmonary artery hilum. (C) Incision was made along the inferior aspect of the right lower lobar branch to enlarge the right pulmonary artery hilum. (D) Inferior, anterior, and superior aspects of the neo-right pulmonary artery were reconstructed using a glutaraldehyde-treated autologous pericardial patch. (E) Anterior wall of main pulmonary artery and left pulmonary artery was reconstructed with a second treated autologous pericardial patch.
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F2
After transecting the left ductus, an extension flap was created using the anterior wall of MPA and LPA with the base of the flap located along the right lateral aspect of the MPA and slightly inferior to the level of the proximal LPA (Figure 2A). The distal incision for the extension flap terminated just proximal to the LPA hilum (Figures 2B; 3A). An incision was made along the inferior aspect of the right lower lobar branch to enlarge the RPA hilum (Figures 2C, 3B). The PA flap was then sutured to the distal segment of the opened RPA to construct the posterior aspect of the neo-RPA using running 7-0 polypropylene sutures (Prolene, Ethicon Inc, USA) (Figure 2C). The inferior, anterior, and superior aspects of the neo-RPA were reconstructed using a glutaraldehyde-treated autologous pericardial patch with a tongue extending into the right lower lobe according to the orientation of the vessel (Figures 2D, 3C). After completion of the RPA reconstruction, the anterior wall of MPA and LPA was reconstructed with a second treated autologous pericardial patch (Figures 2E, 3D.
Intraoperative pictures of modified pulmonary artery flap angioplasty corresponding to procedure diagram. (LPA, left pulmonary artery; MPA, main pulmonary artery; RPA, right pulmonary artery.
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F3
The distal incision for the extension flap terminated just proximal to the LPA hilum (Figures 2B; 3A). An incision was made along the inferior aspect of the right lower lobar branch to enlarge the RPA hilum (Figures 2C, 3B). The inferior, anterior, and superior aspects of the neo-RPA were reconstructed using a glutaraldehyde-treated autologous pericardial patch with a tongue extending into the right lower lobe according to the orientation of the vessel (Figures 2D, 3C). After completion of the RPA reconstruction, the anterior wall of MPA and LPA was reconstructed with a second treated autologous pericardial patch (Figures 2E, 3D.
Surgery eventually reconstructed the pulmonary artery with satisfactory morphology and diameters.
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F4
After finishing the procedure, we successfully reconstructed the PA with satisfactory morphology and diameters (Figure 4).
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