Transverse aortic arch aneurysms--a challenge ahead

Deep Hypothermia and Circulatory Arrest (DHCA) is widely used to repair complex congenital heart lesions in children. We report our experience of DHCA in seven patients of transverse aortic arch aneurysm repair. Anaesthesia consisted of Nitrous Oxide, Oxygen, morphine 1 to 1.5 mg kg-1, halothane and pancuronium. Core cooling on cardiopulmonary bypass was used. At 19 +/- 0.64 degrees C (rectal) temperature, Total Circulatory Arrest (TCA) was established. Thiopentone 30 mg.kg-1 and hydrocortisone hemisuccinate 400 mg was administered before arrest. Head was packed with ice during cooling and patients were placed in steep Trendelenberg's position before opening the aneurysm sac. Mean cardiopulmonary bypass time was 151.4 +/- 8.7 minutes. Mean duration of circulatory arrest was 38.6 +/- 6.9 minutes (range, 15 to 77 minutes). Permanent neurological deficit was found in two patients. Tracheostomy was performed in one of these patients for prolonged ventilation. Two patients died of persistent bleeding, low cardiac output and hypoxia due to right lung collapse.