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[A new method for the plastic repair of the aorta in coarctation]
Insights
This study details a surgical technique for coarctation of the aorta, achieving successful outcomes in pediatric and adult patients. The described method facilitates direct anastomosis, improving long-term results and accommodating growth in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Context:
- Coarctation of the aorta is a congenital heart defect requiring surgical intervention.
- Previous surgical methods had limitations, especially in pediatric patients.
- The Samara Cardiosurgical Centre performed 36 operations between 1987-1991.
Purpose:
- To evaluate a specific surgical technique for aortic coarctation repair.
- To assess the safety and efficacy of a direct anastomosis method.
- To determine long-term outcomes in patients undergoing this procedure.
Summary:
- A lateral thoracotomy approach was used to resect the constricted aortic segment and ductus arteriosus orifice.
- A triangular flap anastomosis technique was employed, with an average aortic cross-clamp time of 27 minutes.
- No fatal outcomes were reported; complications included bleeding and wound suppuration in a small number of patients.
Impact:
- The described technique allows for direct anastomosis, reducing the need for prostheses.
- This method supports the growth of the aortic lumen in pediatric patients, preventing recoarctation.
- Long-term follow-up showed 25 out of 29 patients remained asymptomatic with normal blood pressure.
Abstract:
Thirty-six patients underwent operation in the Samara Cardiosurgical Centre in the period from 1987 to 1991. Their ages ranged from 18 months to 28 years, 32 of them were under 16 years of age. The operation was carried out through a lateral approach in third or fourth intercostal space. After mobilization of the aorta the constricted part was resected together with the orifice of the ductus arteriosus at a distance of 2-3 mm from the constricting membrane without removal of areas of conic constrictions of the remaining ends of the vessels. Longitudinal incisions were made in the aortic walls perpendicular to one another and the edges of the flaps were shaped to form triangles. An anastomosis was then formed with continuous sutures. The average time of compression of the aorta was 27 +/- 2.5 min. There were no fatal outcomes. Among the complications were bleeding which called for rethoracotomy in 2 patients, and suppuration of the wound in 3 patients. Thirty-two persons were discharged from the clinic with normal arterial pressure, in 4 patients the pressure reduced as compared to the preoperative level. The long-term results were studied in 29 patients in follow-up periods of 6 months to 4 years. Twenty-five of them had no complaints, residual hypertension was encountered in 4 patients but without signs of recoarctation. Thus, with the use of the described method the possibility for forming a direct anastomosis in cases in which a prosthesis had to be formed applied is greater, and in operations on children it became possible to increase the lumen of the anastomosis with growth of a child.