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The Annals of Thoracic Surgery, Vol 47, 877-879, Copyright © 1989 by The Society of Thoracic Surgeons

ARTICLES

Surgical management of aortopulmonary septal defect

TR Prasad, MS Valiathan, KG Shyamakrishnan and CG Venkitachalam
Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.

Fourteen patients with malseptation of the aortopulmonary trunk underwent operative repair from 1978 to 1988. Age ranged from 1 year to 35 years (mean age, 9.6 years). Five patients had type I, 6 had type II, and 3 had type III lesions. The hemodynamic disturbance in all patients was the consequence of a large left-to-right shunt (mean pulmonary/systemic flow ratio, 2.38:1) with increased pulmonary vascular resistance (mean value, 4.47 units/m2). Our initial surgical experience with closure under cardiopulmonary bypass through the transaortic route in 3 patients and the transpulmonary approach in two patients resulted in 3 deaths. In the 9 subsequent patients, division and repair of the defect in the great vessels yielded uniformly good results. During follow-up, which ranged from 3 months to 2 years, all 11 survivors had good clinical improvement and none showed residual defects on restudy. Pulmonary artery pressure and pulmonary vascular resistance decreased in all patients except 1.

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