Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion

Autor: Kim Reineke, Hitendu Dave, Barbara Rosser, René Prêtre, Walter Knirsch, Sylvie Nguyen-Minh
Přispěvatelé: University of Zurich, Dave, H
Rok vydání: 2011
Předmět:
Heart Defects
Congenital
Pulmonary and Respiratory Medicine
Aortic arch
medicine.medical_specialty
Aorta
Thoracic
610 Medicine & health
Anastomosis
Aortic Coarctation
2705 Cardiology and Cardiovascular Medicine
law.invention
Postoperative Complications
law
Ductus arteriosus
medicine.artery
Internal medicine
Cardiopulmonary bypass
medicine
Humans
10220 Clinic for Surgery
Ductus Arteriosus
Patent
Ultrasonography
Aorta
Cardiopulmonary Bypass
Spinal Cord Ischemia
business.industry
Infant
Newborn
General Medicine
medicine.disease
Magnetic Resonance Imaging
10020 Clinic for Cardiac Surgery
2746 Surgery
Surgery
Stenosis
medicine.anatomical_structure
Thoracotomy
Regional Blood Flow
10036 Medical Clinic
2740 Pulmonary and Respiratory Medicine
Cardiothoracic surgery
Pulmonary artery
Cardiology
Cardiology and Cardiovascular Medicine
business
Pericardium
Zdroj: European Journal of Cardio-Thoracic Surgery. 41:906-912
ISSN: 1873-734X
1010-7940
DOI: 10.1093/ejcts/ezr110
Popis: OBJECTIVE To analyse the technique of neonatal aortic arch enlargement without cardiopulmonary bypass through a left posterior thoracotomy, as an adjunct to extended resection for Coarctation and severe arch hypoplasia. METHODS Ten neonates with coarctation, severe arch hypoplasia and a persistent ductus arteriosus (PDA) were subjected to arch repair through a left posterior thoracotomy. Nine of these patients had associated significant intracardiac anomalies; three of them received pulmonary artery (PA) banding. After exclusion from circulation, the roof of the intervening arch between left carotid and left subclavian was enlarged using a patch. After adequate reperfusion, a classic resection and extended end-to-end anastomosis was performed. Median age and weight were 5.5 (1-10) days and 3.3 (2.2-4.1)kg respectively. The median preoperative arch diameter was 1.07 (0.75-1.32)mm/kg body weight. RESULTS All patients could be successfully operated with this approach. The non-ischaemic and ischaemic aortic clamp times were 40 (15-68) and 23 (18-32)min, respectively. The median postoperative arch diameter achieved was 1.43 (1.06-1.46)mm/kg body weight. None of the patients had significant gradient early postoperatively. Two patients with recurrent stenosis were successfully treated with balloon dilatation (1) or surgery with cardiopulmonary bypass (CPB) (1). One patient has a corrected gradient of 16mmHg in the proximal arch which is being observed. The remaining patients are free from stenosis at a median follow-up of 30.1 (13.2-57.8) months. CONCLUSIONS Use of PDA for lower body perfusion allows complex reconstruction of the arch without incurring lower body ischaemia. The extended resection could then be performed without excessive stretch. This modification saves these patients from undergoing a complex arch reconstruction with CPB in the early neonatal period
Databáze: OpenAIRE
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