The battleground of the stenotic branch pulmonary arteries: the surgical approach of “less is more”
The achievements of congenital cardiac surgery over the past two decades are remarkable. However success comes at a price and occasionally the “sacrificial lamb” in this discipline are the branch pulmonary arteries. This is not to suggest intentional “sacrifice” however the necessity to provide pulmonary blood flow particularly in single ventricle palliation requires manipulation and potential distortion of the branch pulmonary arteries (BPA’s). In a large randomized trial assessing initial surgical palliation for hypoplastic left heart syndrome, although antegrade pulmonary blood flow through a Sano shunt provided an early survival benefit over a systemic arterial-pulmonary shunt, re-intervention rates on the BPA’s were significantly higher in the Sano cohort (1).