Autologous pulmonary artery flap repair for aortopulmonary window with interrupted aortic arch and anomalous origin of the right coronary artery from the pulmonary artery

We describe a surgical technique using a pedicled autologous pulmonary artery wall flap for repair of aortopulmonary window in association with interrupted aortic arch and anomalous origin of the right coronary artery from the pulmonary artery. A 29-day-old infant underwent definitive repair in which the pulmonary artery flap was used to close the defect and to achieve wide rerouting of the right coronary artery to the reconstructed ascending aorta. The pulmonary artery was reconstructed with a fresh autologous pericardial patch, and the aortic arch was repaired by direct anastomosis. Postoperative CT demonstrated patency of the right coronary artery and satisfactory aortic configuration. This anatomical repair using autologous tissue may reduce the risk of coronary distortion and provide a favourable coronary geometry in selected patients. However, further follow-up is required to evaluate coronary growth and the long-term durability of the reconstructed vessels.