Surgical tactics in critical stenosis and atresia of the pulmonary artery with intact interventricular septum in infants under 1 year of age

: The article analyses experience in surgical treatment of critical stenosis and atresia of the pulmonary artery with an intact interventricular septum in 53 infants. The patients were divided into two groups: group A--26 patients with a hypoplastic cavity of the right ventricle (RV), and group B--27 patients with a normal RV cavity. In group A, 15 patients underwent transpulmonary valvulotomy in combination with subclavian-pulmonary anastomosis by means of a Gortex prosthesis, 6 were subjected to isolated transpulmonary valvulotomy, and 5 patients underwent reconstruction of the RV outlet tract under conditions of extracorporeal circulation. In group B, 3 patients were treated by transpulmonary valvulotomy and subclavian-pulmonary anastomosis with a Gortex prosthesis, 16 by isolated valvulotomy, and 8 patients by reconstruction of the RV outlet tract under extracorporeal circulation. Six (22.2%) patients in group B died; 18 (69.2%) patients in group A died. Experience shows that in patients with critical stenosis of the pulmonary artery without RV hypoplasia preference is given to transpulmonary valvulotomy with occlusion of the venae cavae or, in marked infundibular stenosis of the RV--to reconstructive operation on the RV outlet tract under conditions of extracorporeal circulation. Transpulmonary valvulotomy in combination with subclavian-pulmonary anastomosis is advisable in patients with atresia or critical stenosis of the pulmonary artery and RV hypoplasia.