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[Surgical treatment of coarctation of the aorta and interrupted aortic arch]
Insights
Staged surgical repair with pulmonary artery banding is effective for infants with coarctation of the aorta or interrupted aortic arch and complex heart defects. This approach minimizes early mortality and allows for later total correction of associated lesions.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Arch Anomalies
Context:
- Infants with coarctation of the aorta and interrupted aortic arch often present with complex cardiac lesions.
- Staged surgical repair is a strategy to manage these complex conditions.
Purpose:
- To evaluate the outcomes of staged surgical repair, including pulmonary artery banding, for infants with coarctation of the aorta or interrupted aortic arch and associated cardiac anomalies.
Summary:
- Ten infants with coarctation of the aorta and six with interrupted aortic arch underwent staged repair between 1984 and 1987.
- Pulmonary artery banding was used in conjunction with initial repairs for complex lesions, including ventricular septal defects (VSD).
- The study reported no operative deaths in the initial stage, with two late deaths. Eight survivors underwent successful total correction of associated lesions later. Specific complex procedures like the Damus-Kaye-Stansel and Jatene operations were also successful.
Impact:
- Staged repair with pulmonary artery banding demonstrates a favorable early outcome for complex aortic arch anomalies in infants.
- This approach facilitates subsequent complete correction of associated intracardiac defects.
- The findings support the preference for staged repair in managing these challenging pediatric cardiac conditions.
Abstract:
From December, 1984, through April, 1987, ten infants with coarctation of the aorta and six with interrupted aortic arch underwent staged repair of aorta and other cardiac lesions. Simultaneous pulmonary artery banding was performed in six of 8 patients with ventricular septal defect (VSD) and in all of seven patients with complex cardiac lesions. With first operation, there were no operative deaths and two late deaths. Eight of 14 survivors underwent total correction of associated lesions at three to 17 months after initial operation. VSD was closed in five patients with one operative death. One patient required pulmonary artery debanding alone because of decrease of VSD size. The Damus-Kaye-Stansel operation was performed successfully in one patient with Taussig-Bing anomaly and the Jatene operation was done in one with transposition of the great arteries. Based on these results, we prefer staged repair with pulmonary artery banding for coarctation or interruption of the aorta associated with complex cardiac lesions.