@Article{CHD.2021.014881,
AUTHOR = {Jinyang Liu, Xianchao Jiang, Runsi Wang, Li Li, Ju Zhao, Fuxia Yan, Run Yuan, Qiang Wang},
TITLE = {A Novel Perspective on Histopathology Provides Novel Insights into Surgical Effects in Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collateral Arteries: A Case-Series Study},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {16},
YEAR = {2021},
NUMBER = {3},
PAGES = {245--254},
URL = {http://www.techscience.com/schd/v16n3/41673},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Never had literatures characterized the relationship between the property of major aortopulmonary collateral arteries (MAPCAs) and outcomes of selective unifocalization of pulmonary atresia with ventricular septal defects and MAPCAs. <b>Methods:</b> This is a case-series study. Thirteen patients were included. Angiography-based assessment was conducted to determine whether collateral arteries should be unifocalized or treated with intraoperative ligature. Specimens were collected and stained by HE and ET+VG. <b>Results:</b> Twelve patients underwent one-stage unifocalization at a median age of 37 months (range: 6–228 months) and a median weight of 14.0 kg (range: 5.0–49.0 kg), which produced a favorable right ventricle to aortic systolic pressure ratio of no more than 0.5 except in one patient who died. Patients were divided into three groups: Group 1 (n = 6), had no native pulmonary arteries, and collateral arteries supplied all pulmonary blood; Group 2 (n = 6) presented dysplastic native pulmonary arteries on one or both sides, and in some lung lobes or segments, blood was supplied only by collateral arteries; Group 3 (n = 1) had well-developed left and right pulmonary arteries, and collateral arteries, and pulmonary arteries provided blood flow to the same segments. Pathological reports demonstrated two types of collateral arteries: Elastic arteries presented an arborization distribution similar to native pulmonary artery walls, while muscular arteries showed high resistance and distortion. We selectively unifocalized single-supply collateral arteries with morphologic features based on the arborization distribution. <b>Conclusions:</b> We found that there were two kinds of MAPCAs with different histology, and we performed selective UF for MAPCAs that might belong to the elastic artery. Selective unifocalization achieved a low right ventricle to aortic systolic pressure ratio and favorable surgical effects.},
DOI = {10.32604/CHD.2021.014881}
}