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. 1997;24(4):317–321.

One-stage neonatal repair of complex aortic arch obstruction or interruption. Recent experience at Texas Children's Hospital.

K Hirooka 1, C D Fraser Jr 1
PMCID: PMC325474  PMID: 9456485

Abstract

The optimal surgical approach for complex aortic coarctation or an interrupted aortic arch with associated intracardiac defects is not universally agreed upon. We reviewed our experience with 18 consecutive patients (10 with coarctation, 8 with interrupted aortic arch) undergoing a 1-stage repair through median sternotomy between September of 1995 and February of 1997. Age at operation ranged from 3 days to 3 months (mean 23 days) and weight ranged from 1,700 g to 5,100 g (mean 3,350 g). Under hypothermic circulatory arrest, the aortic arch was reconstructed using native tissue-tissue anastomoses, and coexisting intracardiac anomalies were repaired by standard techniques. All patients survived the procedure and were ultimately discharged from the hospital. There were 2 late deaths in the interrupted aortic arch group, 1 during reoperation for subaortic stenosis and the other from noncardiac causes 5 months after discharge. Another interrupted aortic arch patient required a Ross-Konno procedure 8 months later. There has been no recoarctation among the 16 survivors. Thus a 1-stage repair for complex aortic arch obstruction in neonates can be accomplished with low operative risk, although long-term outcome is strongly influenced by the presence of subaortic obstruction.

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Selected References

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  1. Bove E. L., Minich L. L., Pridjian A. K., Lupinetti F. M., Snider A. R., Dick M., 2nd, Beekman R. H., 3rd The management of severe subaortic stenosis, ventricular septal defect, and aortic arch obstruction in the neonate. J Thorac Cardiovasc Surg. 1993 Feb;105(2):289–296. [PubMed] [Google Scholar]
  2. CELORIA G. C., PATTON R. B. Congenital absence of the aortic arch. Am Heart J. 1959 Sep;58:407–413. doi: 10.1016/0002-8703(59)90157-7. [DOI] [PubMed] [Google Scholar]
  3. Dietl C. A., Torres A. R. Repair of interrupted aortic arch with an augmented aortic anastomosis. Ann Thorac Surg. 1993 Jul;56(1):142–148. doi: 10.1016/0003-4975(93)90419-i. [DOI] [PubMed] [Google Scholar]
  4. Hammon J. W., Jr, Merrill W. H., Prager R. L., Graham T. P., Jr, Bender H. W., Jr Repair of interrupted aortic arch and associated malformations in infancy: indications for complete or partial repair. Ann Thorac Surg. 1986 Jul;42(1):17–21. doi: 10.1016/s0003-4975(10)61827-9. [DOI] [PubMed] [Google Scholar]
  5. Hirooka K., Fraser C. D., Jr Ross-Konno procedure with interrupted aortic arch repair in a premature neonate. Ann Thorac Surg. 1997 Jul;64(1):249–251. doi: 10.1016/s0003-4975(97)00457-8. [DOI] [PubMed] [Google Scholar]
  6. Irwin E. D., Braunlin E. A., Foker J. E. Staged repair of interrupted aortic arch and ventricular septal defect in infancy. Ann Thorac Surg. 1991 Sep;52(3):632–639. doi: 10.1016/0003-4975(91)90963-q. [DOI] [PubMed] [Google Scholar]
  7. Karl T. R., Sano S., Brawn W., Mee R. B. Repair of hypoplastic or interrupted aortic arch via sternotomy. J Thorac Cardiovasc Surg. 1992 Sep;104(3):688–695. [PubMed] [Google Scholar]
  8. Konno S., Imai Y., Iida Y., Nakajima M., Tatsuno K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg. 1975 Nov;70(5):909–917. [PubMed] [Google Scholar]
  9. Messmer B. J., Minale C., Mühler E., von Bernuth G. Surgical correction of coarctation in early infancy: does surgical technique influence the result? Ann Thorac Surg. 1991 Sep;52(3):594–603. doi: 10.1016/0003-4975(91)90954-o. [DOI] [PubMed] [Google Scholar]
  10. Monro J. L., Bunton R. W., Sutherland G. R., Keeton B. R. Correction of interrupted aortic arch. J Thorac Cardiovasc Surg. 1989 Sep;98(3):421–427. [PubMed] [Google Scholar]
  11. Norwood W. I., Lang P., Castaneda A. R., Hougen T. J. Reparative operations for interrupted aortic arch with ventricular septal defect. J Thorac Cardiovasc Surg. 1983 Dec;86(6):832–837. [PubMed] [Google Scholar]
  12. Ross D., Jackson M., Davies J. Pulmonary autograft aortic valve replacement: long-term results. J Card Surg. 1991 Dec;6(4 Suppl):529–533. doi: 10.1111/jocs.1991.6.4s.529. [DOI] [PubMed] [Google Scholar]
  13. Sandhu S. K., Beekman R. H., Mosca R. S., Bove E. L. Single-stage repair of aortic arch obstruction and associated intracardiac defects in the neonate. Am J Cardiol. 1995 Feb 15;75(5):370–373. doi: 10.1016/s0002-9149(99)80556-6. [DOI] [PubMed] [Google Scholar]
  14. Schumacher G., Schreiber R., Meisner H., Lorenz H. P., Sebening F., Bühlmeyer K. Interrupted aortic arch: natural history and operative results. Pediatr Cardiol. 1986;7(2):89–93. doi: 10.1007/BF02328957. [DOI] [PubMed] [Google Scholar]
  15. Scott W. A., Rocchini A. P., Bove E. L., Behrendt D. M., Beekman R. H., Dick M., 2nd, Serwer G., Snider R., Rosenthal A. Repair of interrupted aortic arch in infancy. J Thorac Cardiovasc Surg. 1988 Oct;96(4):564–568. [PubMed] [Google Scholar]
  16. Sell J. E., Jonas R. A., Mayer J. E., Blackstone E. H., Kirklin J. W., Castaneda A. R. The results of a surgical program for interrupted aortic arch. J Thorac Cardiovasc Surg. 1988 Dec;96(6):864–877. [PubMed] [Google Scholar]
  17. Siewers R. D., Ettedgui J., Pahl E., Tallman T., del Nido P. J. Coarctation and hypoplasia of the aortic arch: will the arch grow? Ann Thorac Surg. 1991 Sep;52(3):608–614. doi: 10.1016/0003-4975(91)90958-s. [DOI] [PubMed] [Google Scholar]
  18. Vouhé P. R., Trinquet F., Lecompte Y., Vernant F., Roux P. M., Touati G., Pome G., Leca F., Neveux J. Y. Aortic coarctation with hypoplastic aortic arch. Results of extended end-to-end aortic arch anastomosis. J Thorac Cardiovasc Surg. 1988 Oct;96(4):557–563. [PubMed] [Google Scholar]
  19. Zannini L., Gargiulo G., Albanese S. B., Santorelli M. C., Frascaroli G., Picchio F. M., Pierangeli A. Aortic coarctation with hypoplastic arch in neonates: a spectrum of anatomic lesions requiring different surgical options. Ann Thorac Surg. 1993 Aug;56(2):288–294. doi: 10.1016/0003-4975(93)91162-g. [DOI] [PubMed] [Google Scholar]
  20. van Heurn L. W., Wong C. M., Spiegelhalter D. J., Sorensen K., de Leval M. R., Stark J., Elliott M. J. Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990. Success of extended end-to-end arch aortoplasty. J Thorac Cardiovasc Surg. 1994 Jan;107(1):74–86. [PubMed] [Google Scholar]

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