Alternative techniques for surgical management of recoarctation
| Autor: | Bar-El Y, Joseph Caspi, David A. Roberson, Otto G. Thilenius, Michel N. Ilbawi, Milo S, Rene A. Arcilla |
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| Rok vydání: | 1997 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Adolescent medicine.medical_treatment Subclavian Artery Anastomosis Aortic Coarctation law.invention Recurrence law Internal medicine medicine.artery Ascending aorta medicine Cardiopulmonary bypass Humans Thoracotomy Child Aorta Subclavian artery Retrospective Studies business.industry Vascular disease Anastomosis Surgical Infant General Medicine medicine.disease Surgery Child Preschool Descending aorta cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 12:116-119 |
| ISSN: | 1010-7940 |
| Popis: | OBJECTIVE To evaluate the different surgical options in patients with recoarctation and minimal collaterals. METHODS Thirty-three cases operated on between January 1980 and January 1995 were reviewed. Initial repair was end-to-end anastomosis in 16 patients, subclavian artery aortoplasty in 10, synthetic patch aortoplasty in 4 and bypass conduit in 3 patients. Age at reoperation was 7.5 +/- 5.2 years (1-17 years). Pressure gradient was 20-48 Torr (33 +/- 9). Upper extremity resting or exercise systemic hypertension was present in all. In 18 patients recoarctation was repaired using subclavian artery aortoplasty (n = 15) or synthetic patch aortoplasty (n = 3); alone in 9, with temporary heparinized bypass in 2, or in addition to placement of ascending aorta to descending aorta conduit as a permanent bypass through a left thoracotomy in 9. In 13 patients a conduit was interposed between ascending aorta and descending aorta through a right thoracotomy. In one patient recoarctation segment was patched on cardiopulmonary bypass through a midsternotomy. RESULTS There was no mortality or complications. All patients had no echocardiographic pressure gradients across recoarctation on 5 +/- 3.4 years follow-up. Persistent systemic hypertension following recoarctation repair was present in 3/8 patients (37%) operated on at age greater than 10 years, but has been resolved in all 25 patients less than 10 years of age (P = 0.02). CONCLUSIONS Use of ascending aorta to descending aorta conduit, either alone through a right thoracotomy, or as permanent bypass in combination with patching the recoarctation through a left thoracotomy provides safe and excellent relief of obstruction. |
| Databáze: | OpenAIRE |
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