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Coarctation and hypoplasia of the aortic arch: will the arch grow?
R D Siewers1, J Ettedgui, E Pahl
1Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Hypoplastic transverse aortic arch in infants with coarctation of the aorta shows excellent growth after surgical repair. Extended arch repair is recommended only for severe cases with low arch indices.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiovascular Surgery
Background:
- Hypoplasia of the transverse aortic arch is frequently observed in infants with coarctation of the aorta.
- This condition is more prevalent when coarctation is associated with intracardiac lesions affecting ascending aorta flow.
- Prostaglandin E1 stabilization has increased surgical interventions for complex coarctation, raising questions about aortic arch growth post-repair.
Purpose of the Study:
- To evaluate the growth potential of hypoplastic transverse aortic arches after conventional surgical repair in infants.
- To determine criteria for selecting patients who may benefit from extended arch repair.
Main Methods:
- Retrospective review of 102 infants undergoing coarctation repair.
- Surgical techniques included subclavian flap aortoplasty and resection with end-to-end anastomosis.
- Follow-up assessed linear growth of the transverse aortic arch.
Main Results:
- Transverse aortic arch hypoplasia was present in 33 (32%) of the infants studied.
- Excellent growth of the transverse aortic arch was observed in all patients available for follow-up after repair.
- An arch index (transverse aortic arch to ascending aorta diameter ratio) less than 0.25 identified infants with severe hypoplasia.
Conclusions:
- Conventional surgical repair of coarctation allows for excellent growth of a hypoplastic transverse aortic arch.
- Extended arch repair is a specialized procedure indicated for a small subset of infants with severe arch hypoplasia (arch index < 0.25).
Abstract:
Hypoplasia of the transverse aortic arch of various degrees of severity is commonly seen in infants who have coarctation of the aorta. It is more often present when the coarctation is associated with intracardiac lesions that diminish or limit forward flow in the ascending aorta and promote right to left flow through an arterial duct. The increased frequency of surgical treatment of infants with complex coarctation, which is in part related to the ability to stabilize their condition with prostaglandin E1, has posed the question of the potential for growth and development of the originally hypoplastic aortic arch after conventional repair of aortic coarctation. Review of our experience with transverse aortic arch hypoplasia, found in 33 (32%) of 102 infants undergoing coarctation repair by subclavian flap aortoplasty or classic resection and end-to-end anastomosis, revealed excellent growth of the transverse arch after repair in all patients available for linear follow-up. The currently proposed extended arch repair should be reserved for the small group of infants with transverse aortic arch to ascending aorta diameter ratios (arch indices) of less than 0.25.