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Transverse aortic arch obstruction: when to go from the front

John W Brown1, Mark D Rodefeld, Mark Ruzmetov

  • 1Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. jobrown@iupui.edu

Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
|April 8, 2009
PubMed

Insights

Transverse aortic arch hypoplasia, often with heart defects, requires surgical repair. Distal arch issues use extended coarctation repair, while proximal arch problems need sternotomy and bypass.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Thoracic Surgery

Background:

  • Transverse aortic arch hypoplasia can occur with various intra-cardiac anomalies.
  • Surgical approaches for aortic arch hypoplasia depend on the location and severity of the obstruction.

Purpose of the Study:

  • To outline surgical management strategies for transverse aortic arch hypoplasia.
  • To differentiate treatment for distal versus proximal aortic arch obstructions.

Main Methods:

  • Review of surgical techniques for aortic arch hypoplasia.
  • Comparison of left thoracotomy for distal repairs versus sternotomy with cardiopulmonary bypass for proximal repairs.

Main Results:

  • Extended end-to-end coarctation repair via left thoracotomy is effective for distal transverse aortic arch and isthmus hypoplasia.
  • Proximal aortic arch obstruction management remains controversial, typically requiring sternotomy and cardiopulmonary bypass.

Conclusions:

  • Surgical repair of transverse aortic arch hypoplasia is feasible and tailored to obstruction location.
  • Distal arch repairs utilize less invasive approaches, while proximal repairs require more complex surgical strategies.

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