Intrapulmonary reconstruction of pulmonary arteries using a heterologous pericardial roll

Pulmonary artery reconstruction using a handmade heterologous pericardial roll was achieved in 5 patients with severe hypoplasia of the intrapericardial pulmonary arteries and in 9 patients with critical hilar pulmonary stenosis occurring subsequent to previous construction of a systemic-pulmonary shunt. The pericardial roll was 12 to 16 mm in diameter and was anastomosed to the pulmonary arteries through divided interlobar fissures. At the opposite end, it was fixed anteriorly to the chest wall and connected to a prosthetic tube so as to obtain a blood supply from the systemic circulation. The flow through the roll measured intraoperatively was 95 ± 23 mL·kg−1·min−1. Postoperative catheterization showed that the mean pressure in the roll was 31 ± 18 mm Hg. Eleven patients have subsequently undergone anatomic repair using an external conduit after 8 ± 4 months. There were no operative deaths, but 1 patient died of esophageal bleeding after the definitive intracardiac repair. We conclude that this technique is a feasible surgical option as a part of staged operations leading to biventricular repair.