RESULTS OF SURGICAL TREATMENT FOR PULMONARY ATRESIA

Abstract

The results of surgical treatment in 27 patients with pulmonary atresia have been described. All the completed operations were anastomotic ones, but often no artery suitable for an anastomosis could be found. The operative mortality proved very high and more than 1/3 of the patients died, sometimes we think because the increased flow provided by the anastomosis was balanced by the loss from the almost inevitable division of many collateral arteries. This high mortality might suggest that there is no place for this type of operation, but 15% obtained extremely good results and another 22% good results. On present experience operation would seem justified only when the heart is not much enlarged and some pulmonary artery, however small, can be seen on radiography or angiocardiography. Generally the good results have been maintained for 6 to 11 years that have elapsed. Only one of these patients has died, from a cerebral abscess following subacute bacterial endocarditis: one other has developed tuberculosis of the lung. So far the anastomotic channel has not closed in any of these patients, but it is unlikely that this hazard can be avoided for much longer, since it is an important cause of relapse after operation for Fallot''s tetralogy. The present position cannot be regarded as satisfactory. Whether many patients will prove suitable for direct repair of the atresia at open operation is uncertain, but this possibility must be considered further.