About Pulmonary Artery Reconstruction Treatment

When you or your child has a heart-lung condition that impairs the circulation of blood between the heart and lungs, it is difficult to breathe properly, grow well, and have the energy for a full life.

Over the years, Stanford Medicine Children’s Health has developed a range of pulmonary artery reconstruction (PAR) procedures to care for you/your child with a complex heart defect or pulmonary artery abnormality.

During pulmonary artery reconstruction, we perform heart repairs (such as patching holes, realigning misplaced structures, or fixing inefficient valves), along with reconstruction of your/your child’s arteries and blood vessels in the lungs. PAR enables blood and oxygen to flow freely throughout the heart, lungs, and body.

Several procedures all in one

We aim to complete all of these repairs at once to save you/your child the need for future surgeries and empower you to feel healthy more quickly. Our unifocalization reconstruction procedure saves individuals with tetralogy of Fallot (ToF) with pulmonary atresia from having to undergo a series of three surgeries.

In ToF with pulmonary atresia—the most common condition treated with unifocalization—we are able to complete the reconstruction all at once nearly 70% of the time, depending on the pressure in the lungs mid-operation, measured after pulmonary arteries are reconstructed. If reconstruction brings lung pressure to normal, we proceed with heart repairs during the same surgical intervention.

Pioneers of unifocalization

Shortly after Frank Hanley, MD, developed the novel unifocalization technique for heart-lung reconstruction in the early 1990s, it became a flagship procedure in our Stanford Children’s Pulmonary Artery Reconstruction (PAR) Program. We’re known across the globe for our long-standing expertise in unifocalization. Today, we have an entire team of skilled heart surgeons who perform unifocalization with excellent results.

Treatments beyond unifocalization

We have expanded our program to offer even more PAR treatments. We now apply the techniques of unifocalization to other heart conditions with major aortopulmonary collateral arteries (MAPCAs), such as single ventricle conditions and transposition of the great arteries (TGA). And we perform other pulmonary artery reconstruction techniques, including procedures to open up narrow arteries in the lungs.

A great example of how we’ve taken our treatments beyond unifocalization is PARplant—an operation we’ve developed at Lucile Packard Children’s Hospital Stanford for children who otherwise may have been candidates for a heart transplant. We are the first in the world to perform this highly complex but life-changing operation, which combines two of our flagship surgical procedures at Stanford Children’s—pulmonary artery reconstruction and heart transplant. This novel surgery gives children who are good candidates for PARplant a better chance at survival that is significantly superior to that with a heart-lung transplant.

We look forward to meeting you and evaluating you/your child for a life-changing PAR procedure. By achieving close-to-normal circulation, we empower you/your child to experience a longer and better quality of life.

How unifocalization works

To understand unifocalization, you first need to understand the structure of the arteries and blood vessels in the lungs. Picture an oak tree. The main trunk of the tree is the pulmonary artery (the main artery from the heart to the lungs). From the trunk, two to three large branches (arteries) form and expand outward, and from each of those, more branches are created. This happens over and over until eventually there are several small branches and millions of little twigs that reach to every section of the lungs. That’s what the vessels inside normal lungs look like.

When your/your child’s pulmonary arteries do not grow correctly in utero or are damaged after birth, you will not have a full tree. With unifocalization, our talented heart surgeons re-create the pulmonary system to bring your/your child’s heart-lung circulation as close to normal as possible.

About major aortopulmonary collateral arteries

When pulmonary arteries do not grow while a baby develops in the womb, their body reacts to the fact that blood is not flowing in the normal direction and that there is no blood flow to the lungs. The lungs need blood, so the body develops MAPCAs—collateral arteries from all different areas of the body. MAPCAs create a different path to carry blood to the lungs. In unifocalization, we use MAPCAs to rebuild your/your child’s “tree”/pulmonary artery structure and help improve circulation in the heart and lungs.

Using MAPCAs to rebuild the lungs

Think of MAPCAs as two or three main branches that were cut off of the trunk of a tree that have been scattered in a field (in the chest/abdominal cavity). In unifocalization, our PAR surgeons go and find these scattered branches and use them to build the main “trunk” (artery) and “branches” (vessels) of your pulmonary tree. 

Over time, smaller branches and twigs grow to create healthy lungs. Together with a repaired heart, the reconstructed lungs deliver oxygen-rich blood to every cell in your/your child’s body, helping you/your child feel better and engage in life.

Highlights of our unifocalization care:

• We achieve near-normal heart-lung circulation with our highly technical surgical procedure to help you/your child experience a longer and better quality of life.
• We have an entire team of heart surgeons who are able to perform unifocalization, which is unique to Stanford Medicine Children’s Health.
• We use EchoPixel, an advanced cardiac imaging technology, to create a 3-D road map of your/your child’s lungs to guide unifocalization before the procedure day for better planning and outcomes.

View how we treat complex conditions with PAR.