Surgical management of large bronchial collateral arteries with pulmonary stenosis or atresia.

Single or multiple large bronchial collateral arteries may provide all or some of the pulmonary arterial blood flow in patients with proximal atresia of the pulmonary artery, and even in patients with only pulmonary stenosis. At the time of corrective surgery such arteries must be ligated in order to provide favorable operating conditions, to avoid cardiac overdistention during repair, and to prevent left-to-right intrapulmonary shunting postoperatively. Their ligation and control require precise preoperative definition of their number, origin, and course, and special intraoperative methods for their exposure. Associated hypoplasia of the pulmonary arteries may be severe enough to preclude corrective operation, but these hypoplastic arteries may enlarge in response to increase of blood flow through them resulting from a surgically created shunt. Experience with 14 surgically managed cases of this type forms the basis for the report.