[Rastelli operation for congenital heart disease complicated with peripheral pulmonary artery stenosis]

Peripheral pulmonary artery stenosis following the occlusion of ductus arteriosus is not rare in patients with pulmonary atresia. It is also seen after the creation of Blalock-Taussig shunt for various types of cyanotic congenital heart disease. Although pericardial patch enlargement for the pulmonary artery stenosis has been done at corrective surgery, the results were unsatisfactory because of restenosis. So, we proposed and performed a new method of pulmonary artery plasty using large rectangular heterogeneous pericardium, by which pulmonary artery could be widely enlarged from the pulmonary trunk to periphery of the stenosis. A 3-year-old female (case 1) was diagnosed with pulmonary atresia, ventricular septal defect, patent ductus arteriosus and coronary anomaly associated with left pulmonary artery stenosis. She previously received left Blalock-Taussig shunt. Another patient was a 4-year-old male (case 2) diagnosed with double-outlet right ventricle, pulmonary stenosis and patent ductus arteriosus. He also received right Blalock-Taussig shunt and had left pulmonary artery stenosis. Both patients received Rastelli operation with pulmonary artery plasty simultaneously. Rastelli operation was performed using composite graft consisted of valved heterogeneous pericardial roll and knitted Dacron graft. Post operative courses were uneventful and they were doing well one year after operation. We consider that the pulmonary artery plasty with rectangular heterogeneous pericardial patch is an effective surgical procedure to avoid restenosis compared with conventional pericardial patch enlargement or balloon pulmonary artery plasty.