Pulmonary atresia with intact ventricular septum and ventriculocoronary communications: surgical significance.

Abstract:

:The first stage of a repair of pulmonary atresia with intact ventricular septum (type I) was attempted in a 2-day-old infant. At surgery, decompression of the hypertensive small right ventricle was followed by a sudden loss of myocardial contractility and death. Postmortem examination revealed a fistula with a large orifice in the right ventricular infundibulum that communicated directly with the left main coronary artery. Severe hypertensive changes indicative of abnormally high perfusion pressure were noted in the distal left coronary artery branches. The clinical course suggests that the effect of relieving right ventricular outflow obstruction was a reduction of left main coronary artery blood flow, resulting in fatal intraoperative myocardial ischemia. This unusual case draws attention to the anomalous ventriculocoronary communications often present in pulmonary atresia and their potential for limiting a successful surgical repair.

journal_name

Circulation

journal_title

Circulation

authors

O'Connor WN,Cottrill CM,Johnson GL,Noonan JA,Todd EP

doi

10.1161/01.cir.65.4.805

subject

Has Abstract

pub_date

1982-04-01 00:00:00

pages

805-9

issue

4

eissn

0009-7322

issn

1524-4539

journal_volume

65

pub_type

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