Anatomic correction of interrupted aortic arch complex in neonates

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Neonatal Cardiology

Background:

• Interrupted aortic arch complex is a severe congenital heart defect requiring prompt surgical intervention.
• Previous surgical techniques for interrupted aortic arch complex have varying success rates.
• Early diagnosis and intervention are crucial for improving outcomes in neonates with interrupted aortic arch complex.

Purpose of the Study:

• To evaluate the efficacy of direct aortic anastomosis for the anatomic correction of interrupted aortic arch complex in neonates.
• To assess the short-term and intermediate-term outcomes of this surgical technique.
• To establish corrective surgery as the preferred treatment for newborns with interrupted aortic arch complex.

Main Methods:

• Surgical correction using direct aortic anastomosis in five neonates (2-19 days old) with Type A or Type B interrupted aortic arch.
• Procedures performed via transverse bilateral thoracotomy with hypothermic circulatory arrest.
• Mobilization of the descending thoracic aorta, excision of the ductus arteriosus, end-to-side anastomosis of the descending aorta to the ascending aorta, and patching of ventricular septal defects.

Main Results:

• Three out of five neonates survived the surgery and demonstrated satisfactory clinical progress.
• Post-operative studies revealed excellent anatomic repairs with no residual intracardiac shunts in survivors.
• Aortic anastomosis showed minimal or no systolic gradients in two survivors, with no ascending aortic hypertension in the third survivor.

Conclusions:

• Direct aortic anastomosis is a viable and effective surgical procedure for the anatomic correction of interrupted aortic arch complex in neonates.
• Early surgical intervention prior to metabolic decompensation is recommended for optimal patient outcomes.
• This technique offers excellent results and should be considered the procedure of choice for newborns diagnosed with interrupted aortic arch complex.