Subscribe to RSS
DOI: 10.1055/s-0031-1298065
Modified Repair of Interrupted Aortic Arch Utilizing Retroesophageal Right Subclavian Artery Based on a Neonatal Hybrid Approach in Hypoplastic Left Heart Complex
Publication History
21 July 2011
05 September 2011
Publication Date:
05 January 2012 (online)
Abstract
Objective Interrupted aortic arch (IAA) combined with an aberrant right subclavian artery (ARSA) is frequently associated with a hypoplastic ascending aorta. Neonatal surgical therapy carries a high risk particularly for aortic arch obstructions during the further follow-up.
Methods We performed a modified reconstruction of the aortic arch utilizing the ARSA as a natural substitute in a staged surgical approach. In a novel approach, the distal part of the ARSA is reimplanted into the brachiocephalic trunk.
Results In three patients, a novel arch reconstruction was successfully performed during complete biventricular repair. In a follow-up of 60 to 87 months, the reconstructed aortic arch has grown without any signs of obstruction in all three patients.
Conclusion Utilizing the ARSA for surgical aortic arch repair is a satisfactory solution, when postnatal borderline left heart obstruction associated with IAA and ARSA is postponed by an initial hybrid approach.
-
References
- 1 Ramaswamy P, Lytrivi ID, Thanjan MT , et al. Frequency of aberrant subclavian artery, arch laterality, and associated intracardiac anomalies detected by echocardiography. Am J Cardiol 2008; 101 (5) 677-682
- 2 Fulton JO, Mas C, Brizard CPR, Cochrane AD, Karl TR. Does left ventricular outflow tract obstruction influence outcome of interrupted aortic arch repair?. Ann Thorac Surg 1999; 67 (1) 177-181
- 3 Schreiber C, Eicken A, Vogt M , et al. Repair of interrupted aortic arch: results after more than 20 years. Ann Thorac Surg 2000; 70 (6) 1896-1899, discussion 1899–1900
- 4 Serraf A, Lacour-Gayet F, Robotin M , et al. Repair of interrupted aortic arch: a ten-year experience. J Thorac Cardiovasc Surg 1996; 112 (5) 1150-1160
- 5 Brown JW, Ruzmetov M, Okada Y, Vijay P, Rodefeld MD, Turrentine MW. Outcomes in patients with interrupted aortic arch and associated anomalies: a 20-year experience. Eur J Cardiothorac Surg 2006; 29 (5) 666-673, discussion 673–674
- 6 Chen Q, Modi P, Caputo M, Pawade A. Truncus arteriosus with interrupted aortic arch: successful repair using modified cardiopulmonary bypass and surgical techniques. Ann Thorac Surg 2006; 82 (5) 1884-1886
- 7 Akintuerk H, Michel-Behnke I, Valeske K , et al. Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 2002; 105 (9) 1099-1103
- 8 Akintürk H, Michel-Behnke I, Valeske K , et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol 2007; 28 (2) 79-87
- 9 Celoria GC, Patton RB. Congenital absence of the aortic arch. Am Heart J 1959; 58: 407-413
- 10 Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. Pediatr Cardiol 2005; 26 (4) 356-360
- 11 Michel-Behnke I, Akintuerk H, Marquardt I , et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart 2003; 89 (6) 645-650
- 12 Nathan M, Rimmer D, del Nido PJ , et al. Aortic atresia or severe left ventricular outflow tract obstruction with ventricular septal defect: results of primary biventricular repair in neonates. Ann Thorac Surg 2006; 82 (6) 2227-2232
- 13 Bacha EA, Sawaqed R. Use of the aberrant right subclavian artery in complex aortic arch reconstruction. Ann Thorac Surg 2007; 83 (4) 1566-1568
- 14 Sakai T, Miki S, Ueda Y , et al. Left main bronchus compression after aortic reconstruction for interruption of aortic arch. Eur J Cardiothorac Surg 1995; 9 (11) 667-669
- 15 Galantowicz M, Cheatham JP, Phillips A , et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 2008; 85 (6) 2063-2070, discussion 2070–2071