Anatomic reconstruction for recurrent aortic obstruction in infants and children
| Autor: | Jeffrey S. Heinle, Emmett D. McKenzie, Glenn T. Leonard, Grace C. Kung, Charles D. Fraser, Daniel J. DiBardino, Jason T. Su |
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| Rok vydání: | 2004 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine Aortic arch Thorax medicine.medical_specialty Adolescent medicine.medical_treatment Anastomosis Aortic Coarctation law.invention Recurrence law medicine.artery medicine Cardiopulmonary bypass Humans Thoracotomy Child Retrospective Studies Aorta Aortic Arch Syndromes business.industry Infant Ultrasonography Doppler Magnetic Resonance Imaging Surgery Treatment Outcome Echocardiography Median sternotomy Child Preschool Deep hypothermic circulatory arrest Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 78:926-932 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2004.02.126 |
| Popis: | Background Patients undergoing operative repair of aortic obstruction are at a lifelong risk of recurrent obstruction, and there is controversy regarding the optimal surgical technique. We have used an alternative strategy for recurrent aortic obstruction, typically involving anatomic reconstruction by means of a median sternotomy, and describe our techniques and results. Methods Twenty-one patients presented with recurrent aortic arch obstruction. Mean age and weight were 7.8 ± 5.4 years (range, 0.21 to 15.2 years) and 30.6 ± 21.8 kg (range, 3.6 to 90 kg), respectively. Recurrence involved the aortic arch to some degree in each case, as the mean preoperative transverse aortic arch z score was −2.9 ± 1.6 (range, −7.0 to 0.1). Thoracotomy was possible in 2 patients, using re-resection with end-to-end anastomosis (n = 1) and patch aortoplasty (n = 1). The remaining 19 patients required median sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest for complete relief of obstruction by aortic arch advancement (n = 10), patch aortoplasty (n = 8), or interposition grafting (n = 1). Results There was 1 hospital death. Invasive blood pressure monitoring revealed no residual arm-to-leg gradient in 19 patients and a 20-mm Hg gradient in 2 patients. There have been no late deaths. No patients have undergone subsequent aortic intervention, and all are asymptomatic up to 85 months postoperatively. Two patients are currently followed with a 10-mm Hg arm-to-leg blood pressure gradient. Conclusions Anatomic reconstruction for recurrent aortic obstruction can be safely accomplished in the majority of patients. We favor median sternotomy because of the ability of establishing cardiopulmonary bypass, the facility of anatomic reconstruction techniques, and the ability to repair concomitant cardiovascular lesions. |
| Databáze: | OpenAIRE |
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