Construction of the right ventricular outflow tract in children with pulmonary atresia associated with ventricular septal defect

Background: It is difficult to build up the right ventricular outflow tract for pediatric patients with pulmonary atresia complicated by ventricular septal defect (VSD). This study was undertaken to evaluate the surgical procedures for the reconstruction of the right ventricular outflow tract (RVOT) in infants and young children. Methods: From June 1999 to December 2004, 81 patients with PA associated with VSD were treated by primary repair, palliative repair or staged repair. These patients were divided into 2 groups according to different surgical procedures. In group 1 (32 patients), 17 underwent biventricular primary repair and transannular patching with autologous pericardial flake. Group 11 (49 patients) underwent palliative repair including construction of the right ventricular outflow tract according to preoperative conditions. Fifteen patients underwent staged radical repair, during which transannular patching was performed with homovariant pericardial flake in 8 patients. Results: Four patients (12.5%) died after primary radical repair. Three patients died (6.1%) after palliative repair. But no death occurred for stage 11 radical repair. Follow-up for 3 months to 2 years showed satisfactory results. The oxygen saturation (SatO(2)) was 79%-87% for the palliative repair group, and the McGoon index was increased from 0.4-0.7 to 1.1-1.6. Conclusions: With the development of pulmonary artery and pulmonary artery confluence, RVOT construction by the palliative method includes transannular autologous pericardial patching, Gortex conduit, and pericardial rolling. By the radical procedure, the back wall of the traverse pulmonary artery trunk is anastomosed to the incision and homograft besides the transannular autologous pericardial patch.