Management of large aortopulmonary collateral arteries in patients with ventricular septal defect and pulmonary atresia: simultaneous ligation through median sternotomy during intracardiac repair.

Nine consecutive patients with ventricular septal defect (VSD) and pulmonary atresia associated with large aortopulmonary collateral arteries underwent primary repair with simultaneous ligation of these collateral arteries. The patients ranged from 1 year to 20 years old (average, 8.0 years). The average number of large aortopulmonary collateral arteries was 1.9 per patient. Arborization abnormality was found in 5 patients. The aortopulmonary collateral arteries were reached solely through a median sternotomy, with dissection of the posterior pericardium or anterior mediastinal pleura before or after the initiation of cardiopulmonary bypass. The immediate postoperative peak pressure ratio between the right and left ventricles was higher in patients with an arborization abnormality, but all ratios ranged from 0.60 to 0.87. There was 1 operative death. Postoperative transcatheter embolization for a residual large aortopulmonary collateral artery was required in 1 patient and pulmonary infarction of mild degree developed with spontaneous recovery in another. These results indicate the usefulness and safety of simultaneous ligation of large aortopulmonary collateral arteries through median sternotomy, even with an associated arborization abnormality.