ABC | Volume 113, Nº1, July 2019

Clinicoradiological Correlation Arq Bras Cardiol. 2019; 113(1):103-105 Atik et al Pulmonary atresia in a long natural evolution 1. Presnell LB, Blankenship A, Cheatham SL, Owens GE, Staveski SL. An overviewof pulmonary atresia andmajor aortopulmonary collateral arteries. World J Pediatr Congenit Heart Surg. 2015; 6(4):630-9. 2. Liava’aM, BrizardCP, Konstantinov IE, Robertson T, CheungMM,Weintraub R, d’Udekem Y. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg. 2012;93(1):185-91. References This is an open-access article distributed under the terms of the Creative Commons Attribution License flow to improve quality of life with better physical tolerance is presumed. The consideration of the expectant conduct would not be totally ruled out considering the patient's age, with other development risks. Comments: The natural evolution of this patient until the adult age highlights unfavorable elements, considering that the previous palliative surgery, the Blalock-Taussig anastomosis, occluded spontaneously. Hence, it certainly did not influence this temporal evolution. They are represented in this case by the enlargement of the heart cavities, the right ventricular hypertrophy with RV dysfunction and the pronounced increase in the concentration of red blood cells, which repeatedly required hemapheresis. The doubt persists regarding the performance of another systemic-pulmonary anastomosis to further prolong life and improve quality of life. On the other hand, the expectant conduct should also be considered in this case, given the high and considerable surgical risk in this age group. 1 The question is, in similar cases in childhood, whether it would be more convenient to attempt an earlier correction. Undoubtedly, it should always be considered at different times to create an anatomic shape that is adequate and favorable to blood dynamics. 2 105