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Morphologic study of the ascending aorta and aortic arch in hypoplastic left hearts: surgical implications
André M Ilbawi1, Diane E Spicer, Saroja Bharati
1University of Pennsylvania, School of Medicine, Philadelphia, PA, USA. ailbawi@mail.med.upenn.edu
Insights
Hypoplastic left heart syndrome often involves aortic arch narrowing and infolding, causing obstruction. Surgical reconstruction should include the ascending aorta for better outcomes in these patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Hypoplastic left heart is characterized by diminished blood flow, leading to a smaller ascending aorta and aortic arch.
- Obstructions within the aorta can further compromise blood flow in affected infants.
Purpose of the Study:
- To quantify the presence and degree of aortic obstruction in hypoplastic left heart syndrome.
- To discuss the surgical significance of these findings in aortic reconstruction.
Main Methods:
- Ninety-six hypoplastic left heart specimens were analyzed.
- Measurements were taken to evaluate aortic narrowing and tissue infolding.
- Quantitative assessments of infolding and its impact on flow obstruction were performed.
Main Results:
- Aortic arch narrowing was observed in 62.5% of specimens.
- Tissue infolding at the brachiocephalic artery junction occurred in 58.3%, correlating with smaller aortas.
- Ductal coarctation was present in 81.1% and correlated with smaller ascending aorta diameter.
Conclusions:
- Significant obstructions exist within the ascending aorta in hypoplastic left heart syndrome.
- The pathogenesis of these obstructions is discussed.
- Ascending aorta inclusion in surgical reconstruction is crucial for initial palliation.
Objectives:
The ascending aorta and aortic arch in patients with hypoplasia of the left heart are hypoplastic as a result of diminished blood flow. In this study, the presence and degree of obstruction owing to areas of narrowing or infolding within the diminutive aorta are quantified, and their surgical significance is discussed.
Methods:
Ninety-six specimens with hypoplasia of the left heart were studied and measurements were taken at specified sites to evaluate areas of narrowing. Quantitative assessments of infoldings and their contribution to obstruction of flow are made.
Results:
Narrowing of the distal ascending aorta was found in 60 (62.5%) specimens, with a decrease in circumference of the distal ascending aorta (0.72 +/- 1.06 mm) present when compared with its midpoint (P < .05). Tissue infolding at the orifice of the brachiocephalic artery and its junction with the distal ascending aorta was observed in 56 (58.3%) hearts, with major infolding in 29 (30.2%) and minor infolding in 27 (28.5%). Tissue infolding at this site correlated with a smaller ascending aorta (P < .001) but not with narrowing in the distal ascending aorta (P = .53). Ductal coarctations were detected in 77 (81.1%) specimens. Their presence correlated with a smaller diameter of the ascending aorta (P < .05), and their severity correlated with the presence of aortic and mitral valvular atresia (P < .05).
Conclusions:
Important areas of obstruction in the ascending aorta in patients with hypoplasia of the left heart were found, and their pathogenesis is discussed. The findings highlight the importance of incorporating the ascending aorta into the aortic reconstruction at the time of initial palliation for patients with hypoplasia of the left heart.
