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Interruption of the aortic arch. Surgical considerations
Insights
Surgical outcomes for interruption of the aortic arch (IAA) showed a 60% mortality rate. Successful two-stage repair was achieved in one infant, while another survivor underwent total correction, highlighting improved survival with associated lesion repair.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Interruption of the aortic arch (IAA) is a critical congenital heart defect.
- Surgical management of IAA presents significant challenges.
- Associated cardiac anomalies are common in IAA patients.
Purpose of the Study:
- To review surgical outcomes for interruption of the aortic arch (IAA).
- To evaluate different surgical strategies for IAA repair.
- To identify factors influencing survival rates in IAA patients.
Main Methods:
- Retrospective analysis of 5 patients with IAA operated between 1965 and 1975.
- Description of surgical techniques including two-stage repair and total correction.
- Comparison of outcomes with palliative versus corrective procedures.
Main Results:
- Overall mortality rate was 60% (3 out of 5 patients).
- Two patients survived: one infant with Type A IAA underwent successful two-stage repair, and a 3-year-old with Type B IAA had total correction.
- Improved survival was noted when associated lesions (VSD, PDA) were addressed concurrently.
Conclusions:
- Surgical repair of IAA has a high mortality rate.
- Staged or palliative procedures can be effective, particularly in infants.
- Total correction, when feasible, combined with management of associated defects, improves survival outcomes for interruption of the aortic arch.
Abstract:
During a 10 year period, January, 1965, through January, 1975, 5 patients with interruption of the aortic arch (IAA) underwent operation at the Texas Heart Institute. The mortality rate was 60 per cent; 2 patients survived the operation. One 11-day-old infant with IAA, type A, a ventricular septal defect (VSD), and a patent ductus arteriosus (PDA) underwent successful two-stage treatment. A left subclavian-ductus anastomosis, closure of the PDA, and banding of the pulmonary artery were done initially. The VSD was closed later. The second survivor, a 3-year-old girl, had IAA, type B, with a PDA and VSD. Total correction was done with the aid of cardiopulmonary bypass and hypothermia. Considerations include palliative and staged procedures versus total correction with either conventional cardiopulmonary bypass or deep hypothermia and circulatory arrest. Survival rate is improved if associated lesions are totally repaired or palliated at the time of reconstruction of IAA.