Surgical repair of isolated right pulmonary artery using pulmonary artery flap and preserved PDA stent

Isolated right pulmonary artery (RPA) from the ductus arteriosus is rare and often managed in stages to promote vessel growth. We present a 12-year-old girl with ductal-origin RPA who had undergone patent ductus arteriosus (PDA) stenting at age three and serial balloon dilations. Through median sternotomy, a posterior wall flap was created from the main pulmonary artery (MPA) and rotated toward the RPA, incorporating the preserved stented PDA segment as the posterior wall. The anterior wall was reconstructed with a decellularized pulmonary homograft patch, creating a 9 mm lumen. The patient recovered uneventfully, and postoperative imaging confirmed a widely patent RPA without a gradient. Preserving the PDA stent and combining it with an MPA flap and homograft augmentation offered a durable repair for long-gap ductal-origin RPA, avoiding synthetic conduit use and minimizing dissection.