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Transverse aortic arch aneurysms--a challenge ahead
H D Waikar1, K P Gopakumar, K Mohandas
1Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum.
Indian Heart Journal
|May 1, 1993
Summary
Deep hypothermia and circulatory arrest (DHCA) is a critical procedure for complex pediatric heart conditions. This study highlights outcomes in transverse aortic arch aneurysm repair, noting neurological deficits and mortality risks.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hypothermic Circulatory Arrest
Background:
- Deep hypothermia and circulatory arrest (DHCA) is a standard technique for complex congenital heart repairs in children.
- Transverse aortic arch aneurysms present significant surgical challenges requiring specialized approaches.
Purpose of the Study:
- To report the clinical experience and outcomes of using DHCA in pediatric patients undergoing transverse aortic arch aneurysm repair.
Main Methods:
- Seven pediatric patients with transverse aortic arch aneurysms underwent surgical repair using DHCA.
- Core cooling on cardiopulmonary bypass was employed, reaching rectal temperatures of approximately 19°C for total circulatory arrest (TCA).
- Anesthesia included nitrous oxide, oxygen, morphine, halothane, and pancuronium, with thiopentone and hydrocortisone administered before arrest.
Main Results:
- Mean cardiopulmonary bypass time was 151.4 ± 8.7 minutes, with a mean circulatory arrest duration of 38.6 ± 6.9 minutes.
- Two patients (28.6%) experienced permanent neurological deficits, one requiring tracheostomy for prolonged ventilation.
- Two patients (28.6%) died due to complications including persistent bleeding, low cardiac output, and hypoxia.
Conclusions:
- DHCA can be utilized for transverse aortic arch aneurysm repair in children, but carries significant risks.
- Neurological complications and mortality are notable concerns, necessitating careful patient selection and meticulous surgical technique.