Iimplantation of mechanical prosthesis in the pulmonary artery after radical correction of the common arterial trunk followed by xenopericardial conduit replacement: a case report

Herein, we report the successful surgical treatment of the case of a 13-year-old patient with combined pulmonary artery stenosis, critical stenosis of the xenopericardial conduit and aortic valve insufficiency after two previous operations (radical correction of the common arterial trunk during the neonatal period and replacement of the right ventricular excretory tract conduit with branch plasty at three years of age). According to echocardiography, the peak pressure gradient across the conduit was 110 mmHg, along with grade III aortic valve regurgitation. According to computerised tomography angiography, there was narrowing of the right pulmonary artery up to 3 mm distally along with total calcification of the conduit and branches of the pulmonary artery with an intimate fit to the chest wall. The trunk of the pulmonary artery was replaced with a valve-containing conduit CARBOMEDICS СARBO-SEAL No.25 (LivaNova PLC, London, United Kingdom); right pulmonary artery plasty was performed with a xenopericardial patch; aortic valve was replaced with CARBOMEDICS СARBO-SEAL No.23 (LivaNova PLC, London, United Kingdom), a mechanical prosthesis, and supracoronary prosthetics were used for the ascending aorta. The duration of cardiopulmonary bypass was 309 minutes, cross-clamp was 142 minutes and circulatory arrest was 49 minutes, with 26°C hypothermia. Extubation was performed 10 hours after surgery, and he spent 3 days in intensive care. The duration of hospitalisation was 26 days. He was examined after 6 months, and there were no complaints. The presented clinical case shows that implantation of a mechanical prosthesis is justified with repeated reoperations on the outflow tract of the right ventricle and the pulmonary trunk, and it may be the surgery of choice.