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ARTICLE

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

Jinyang Liu¹, Xianchao Jiang¹, Runsi Wang², Li Li³, Ju Zhao⁴, Fuxia Yan⁵, Run Yuan⁶, Qiang Wang^1,*

1 Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2 National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
3 Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
4 Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
5 Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
6 Department of Nutriology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

* Corresponding Author: Qiang Wang. Email:

Congenital Heart Disease 2021, 16(3), 245-254. https://doi.org/10.32604/CHD.2021.014881

Received 05 November 2020; Accepted 07 January 2021; Issue published 02 March 2021

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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