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[Extended aortic arch anastomosis for aortic coarctation in neonate and early infancy--experience in 5 patients]
Insights
Extended aortic arch anastomosis effectively repaired aortic coarctation in infants, even with hypoplastic arches. This surgical technique shows promise for complex congenital heart disease in neonates and infants.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Context:
- Aortic coarctation (CoA) is a critical congenital heart defect requiring timely surgical intervention.
- Infants, especially neonates, present unique surgical challenges due to their small size and associated cardiac anomalies.
- Hypoplastic aortic arch (AA) can complicate standard CoA repair, necessitating tailored surgical approaches.
Purpose:
- To evaluate the efficacy and safety of extended aortic arch (AA) anastomosis for repairing aortic coarctation (CoA) in neonates and infants.
- To assess the feasibility of this technique in patients with hypoplastic aortic arches and associated cardiac lesions.
- To determine the early postoperative outcomes and pressure gradients following this surgical repair.
Summary:
- Five neonates and infants underwent CoA repair using extended AA anastomosis.
- Associated lesions included ventricular septal defect, atrial septal defect, and complete atrioventricular canal.
- The procedure was successful in all patients, including those with hypoplastic aortic arches, with low average aortic clamp time and minimal intraoperative gradients.
- Postoperative evaluations showed no significant pressure gradients between upper and lower extremities, indicating successful repair.
Impact:
- This surgical technique provides a viable option for complex aortic coarctation repair in early infancy.
- It demonstrates successful outcomes even in cases with hypoplastic aortic arches, potentially improving long-term results.
- The study highlights the safety and effectiveness of extended AA anastomosis, offering a valuable approach for pediatric cardiac surgeons.
Abstract:
The aortic coarctation (CoA) was repaired with extended aortic arch (AA) anastomosis in 5 consecutive patients, 2 in neonate and 3 in infancy, ranging in age from 3 to 106 days. The associated lesions were ventricular septal defect in 2, atrial septal defect in 2 and complete atrioventricular canal in 1. Patent ductus was found in 4 and prostaglandin E1 was required in 2 with response in 1 patient. The AA was hypoplastic in 2 patients with arch to descending aorta diameter ratio below 0.5. The CoA repair was performed as the first procedure in all. The primary anastomosis was possible in all between AA and the descending aorta without undue tension after removal of the all ductus tissue and extensive mobilization of the aorta. Aortic clamp time was 28 minutes in average. The intraoperative pressure gradient after repair across AA was 0 to 10 mmHg (average 4.6 mmHg). All except 1 with preceding hepatic dysfunction tolerated the procedure without complication or operative death. Postoperative evaluation at 1 to 11 months showed no significant pressure gradient between upper and lower extremities. This method appears to be useful for CoA in early infancy particularly when AA is hypoplastic.