Creation of a One-Way Interatrial Communication in the Treatment of Critical Pulmonary Stenosis with Intact Ventricular Septum: A Case Report

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Abstract
In biventricular repair of pulmonary outflow tract obstruction with intact ventricular septum, the right ventricle is loaded with total pulmonary blood flow acutely as the right-to-left shunt is abolished by closure of the atrial septal defect (ASD). We designed a one-way interatrial communication by creation of an atrial septal flap to reduce the excessive volume load of the right ventricle. This procedure was successfully performed in a 3-year-old girl undergoing definitive biventricular repair for critical pulmonary stenosis associated with tricuspid stenosis and a small right ventricle. We believe that creation of a one-way interatrial communication might be a good alternative to adjustable ASD and/or bidirectional Glenn shunt in biventricular repair of critical pulmonary stenosis or pulmonary atresia with intact ventricular septum.

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