[Surgical treatment of interrupted aortic arch with aorticopulmonary window]

From January, 1988, through September, 1993, 3 neonates underwent one-stage repair for interrupted aortic arch (IAA) with aorticopulmonary window (APW). Their mean weight was 3.0 kg (2.7-3.3 kg). IAA was Celloria-Patton classification type B in two patients and type A in the other. In all cases, APW was Mori's classification type II. Two patients took a sudden turn for worse during the stay of our hospital and underwent emergency operation. Surgical procedures were as follows; In the first patient, aortic arch reconstruction was performed with phi 8 mm Golaski graft, under extracorporeal circulation for only upper body under moderate hypothermia. After distal anastomosis, perfusion for lower body was restarted through the graft branch, then proximal anastomosis was done. In the other two patients, arch reconstruction was performed by end to side direct anastomosis under total circulatory arrest and deep hypothermia, and APW was divided during recirculation, rewarming period. In the first patient, graft was anastomosed to the defect of the ascending aorta. In the other two patients the defect of the aorta was directly closed. The defect of the pulmonary artery was closed directly in two patients and with autopericardium in the other. There was no operative deaths. Two cases who underwent emergency operation due to sudden turn for worse didn't become well soon. Thus, we concluded that surgical intervention should be done as soon as possible before patient became critically ill and one-stage repair should be recommended because of the difficulty of palliation such as PA banding in this disease.