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CTSNet classification: 20

We thank Dr Kitagawa for his thoughtful and informative comments regarding our technique for repair of aortopulmonary window, which is described in the article entitled “Single-Stage Repair of Aortopulmonary Window With Interrupted Aortic Arch by Transection of the Aorta and Direct Reconstruction.”¹

With regard to the question concerning the origin of the right pulmonary artery in our last case, this artery arose from just behind the ascending aorta, as demonstrated in the 3-dimensional computed tomography scan (Figure 2 in our article). In the other cases, the right pulmonary artery could have arisen from the right posterolateral aspect of the ascending aorta from the operative findings. However, no computed tomography scan was obtained for these cases for us to show.

As we have described in this article, in our cases there was a large defect extending from the main pulmonary artery trunk to the right pulmonary artery, thus classes I and II by Richardson's classification. That is the greatest difference between our case and that described by Kitagawa and associates.² To avoid right pulmonary arterial stenosis, it was necessary to expose the right pulmonary artery as distally as possible during mobilization. The posterior division line between the aorta and pulmonary trunk was designed to enter the pulmonary arterial wall 2 to 3 mm in width, superiorly and inferiorly, apart from a presumptive borderline intending to reserve sufficient tissue for the reconstruction of posterior aortic wall without tension.

We completely agree with Kitagawa's concept that our techniques allow not only sufficient enlargement but also growth of reconstructed arteries. To achieve this purpose, our technique is similar to his technique. We find Kitagawa's results encouraging that our patients will also have good long-term results.

We believe that our method is one of the best methods to repair aortopulmonary window with a large defect with interrupted aortic arch. We understand that further follow-up is necessary for comparison to other techniques. Thanks again to Dr Kitagawa for drawing our attention to his article and for his informative comments.

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References 

1. Yoshida M, Yamaguchi M, Oshima Y, Oka S, Higuma T, Okita Y. Single-stage repair of aortopulmonary window with interrupted aortic arch by transection of the aorta and direct reconstruction. J Thorac Cardiovasc Surg. 2009;138:781–783
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2. Kitagawa T, Katoh I, Taki H, Wakisaka Y, Egawa Y, Takahashi Y, et al. New operative method for distal aortopulmonary septal defect. Ann Thorac Surg. 1991;51:680–682
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