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Related Experiment Videos

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
PubMed
Summary
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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.

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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.