Pulmonary Artery-to-Left Atrium Communication

The above letter was referred to Dr. Alexi-Meskishvilli, who replies in this manner:

We appreciate the comments of Drs. Krisnamoorthy and Rao on our paper “Right Pulmonary Artery-to-Left Atrium Communication.” ¹ Although the authors were able to make their diagnosis with transesophageal echocardiography and successfully operate on their patient without using cardiopulmonary bypass, we still believe, as we noted in our case report, that “surgery for this anomaly carries considerable risk and should be approached with caution.” A review of the published data shows an overall mortality rate of 22%, ² mostly because of bleeding; further, cardiopulmonary bypass is the method of choice in anatomically difficult cases. Our patient had a very short, fistula-like communication between the right pulmonary artery and the left atrium. ¹ We believe that cardiopulmonary bypass is the method of choice in such a case as ours.