[Reoperation for coarctation of the aorta and interrupted aortic arch]
1Department of Pediatric Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Insights
Restenosis after aortic arch repair, including coarctation of the aorta (CoA) and interrupted aortic arch (IAA), can necessitate reoperation years later. This case series highlights surgical interventions for complex congenital heart defects and subsequent restenosis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) and interrupted aortic arch (IAA) are complex congenital heart defects.
- Surgical repair in infancy and childhood can lead to long-term complications such as restenosis.
Observation:
- Four patients with a history of CoA or IAA repair experienced significant pressure gradients, indicating restenosis.
- Reoperations were performed between 1 and 17 years after initial repairs.
- Various initial repair techniques were used, including expanded polytetrafluoroethylene (ePTFE) grafts and patch angioplasty.
Findings:
- Reoperation was required due to high pressure gradients (20-64 mmHg) between the ascending and descending aorta or upper and lower limbs.
- Reoperation methods included bypass grafting from the left subclavian artery to the descending aorta in three cases.
Implications:
- Long-term surveillance is crucial for patients undergoing repair of CoA and IAA to detect restenosis.
- Reconstructive surgery, including bypass grafting, can be effective for managing restenosis in these complex cases.
- Understanding the long-term outcomes of different surgical techniques is vital for improving patient management.
Abstract:
This report presented four patients who underwent surgery for restenosis after repair of coarctation of the aorta (CoA) or interrupted aortic arch (IAA) at our institution between January 1980 and October 1994. Case #1 underwent primary repair for IAA, VSD, and PDA consisting of aortic arch reconstruction using a EPTFE (expanded polytetrafluoroethylene) graft of 10 mm in diameter at the age of four years. After 17 years, pressure gradient of 58 mmHg between the ascending aorta and the descending aorta prompted the reoperation. Case #2 underwent primary repair for CoA, VSD, and PDA consisting of a bypass between the ascending aorta and the descending aorta with an EPTFE graft of 11 mm in diameter at the age of three years. After 13 years, he had reoperation because of pressure gradient of 64 mmHg. Case #3 had pressure gradient of 20 mmHg between the upper and lower limb at the hospital discharge following patch angioplasty for CoA at five years of age. He underwent unsuccessful percutaneous transluminal balloon angioplasty at age 12 and had reoperation at age 15. Case #4 underwent subclavian flap angioplasty as the first stage operation for CoA, VSD, and PDA at 1 month after birth. About 9 months after the initial operation, the pressure gradient between the upper and lower limb had reached 40 to 50 mmHg, and the patient had reoperation at the age of 1 year. The reoperation method for cases #1, #2 and #3 consisted of bypass grafting from the left subclavian artery to the descending aorta under a simple cross clamping of the thoracic aorta.(ABSTRACT TRUNCATED AT 250 WORDS)
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