TY  - EJOU
AU  - Liu, Jinyang 
AU  - Jiang, Xianchao 
AU  - Wang, Runsi 
AU  - Li,  
AU  - Zhao, Ju 
AU  - Yan, Fuxia 
AU  - Yuan, Run 
AU  - Wang, Qiang 

TI  - 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
T2  - Structural and Congenital Heart Disease

PY  - 2021
VL  - 16
IS  - 3
SN  - 3071-1738

AB  - <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.
KW  - Histopathology; selective unifocalization; pulmonary atresia; major aortopulmonary collateral arteries

DO  - 10.32604/CHD.2021.014881