Staged repair for bilateral ductus arteriosus with pulmonary atresia and non-confluent pulmonary artery--a case report

Staged operation was successfully performed in an infant with bilateral ductus arteriosus, and absence pulmonary artery. The first stage operation was performed at 2 months old of age. The left pulmonary artery was reconstructed using an equine pericardial roll sized 10 mm in diameter, and a 5 mm Dacron graft was anastomosed between the left subclavian artery and the roll as an aortopulmonary shunt. In the second stage, the same procedure was done on the right side at eight months of age. In the last stage, the patient underwent Rastelli procedure at 2 years old of age. The central pulmonary artery was created with a ring forced EPTFE graft above the ascending aorta, and a Carpentier-Edwards valved conduit (14 mm) was anastomosed between the right ventricle and the EPTFE graft. Post operative course was uneventful. We consider that the staged procedure including the pulmonary artery reconstruction and the aortopulmonary shunt on both sides is recommended in the case of absent central pulmonary artery in infant.