Abstract

Objective: It is a prospective study to assess the efficacy of midsternotomy single stage complete unifocalisation and repair for VSD, pulmonary atresia and MAPCAS.

Methods: From June 97 to March 98, 14 patients were treated with single stage unifocalisation and repair. The age ranged from 11 months to 11 years Through midsternotomy all the MAPCAS were dissected and looped. On CP Bypass MAPCAS were anastomosed to native PA or MAPCAS to MAPCAS and VSD was closed if possible and RV to PA continuity was established by homograft conduit.

Results: Total Number of MAPCAS were 31 and ranged from 1--5 per patient (Mean 2.2). 19 MAPCAS arose from descending aorta, 5 from left or right subclavian artery, 6 from arch, one from ascending aorta. Complete unifocalisation was achieved in all patients. VSD was closed in all patients except in two. One patient died on 7th P.O. Daydue to RV failure in whom VSD was left open. P.O RV/LV pressure ranged from 0.3--0.9 (Mean 0.65) and RV angios showed well functioning unifocalised MAPCAS as pulmonary arteries.

Conclusion: With single stage unifocalisation the number of operations, hospitalisation and cost are reduced. The patients will have normalisation of cardiovascular physiology early with good future growth of unifocalised neopulmonary arteries. Sub optional outcome with conventional multistage procedures warrant continued exploration of the benefits of early one stage correction. Early results are encouraging.