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One-stage repair for intracardiac malformations associated with interrupted aortic arch or aortic coarctation in the first year of life

Published online by Cambridge University Press:  19 August 2008

Osamu Matsuki*
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Toshikatsu Yagihara
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Fumio Yamamoto
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Kyoichi Nishigaki
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Hideki Uemura
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Koji Kagisaki
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Osahiro Takahashi
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Tetsuro Kamiya
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
Yasunaru Kawashima
Affiliation:
From the Department of Cardiovascular Surgery and the Department of Pediatrics, National Cardiovascular Center, Suita
*
Dr. Osamu Matsuki, Department of Cardiovascular Surgery National Cardiovascular Center, 5-7- Fujishirodai Suita-City, Osaka 565 Japan. Tel. 06-833-5012; Fax. 06-833-9865.

Abstract

A one-stage repair was performed for correction of the intracardiac malformations associated with coarctation of aorta in five pateints or interrupted aortic arch in eight patients. The ages ranged from four to 294 (median 35) days. The anomalies within the heart were a ventricular septal defect with or without subaortic stenosis (n=7), an aortopulmonary window (n=2), common arterial trunk (n=2), aortic valvar stenosis (n=1) and the TaussigBing anomaly (n=1). Surgery was performed through a median sternotomy employing cardiopulmonary bypass with moderate to deep hypothermia. In terms of the aortic reconstruction, an extended direct anastomosis was performed in 10 patients, while a vascular graft was interposed in three. So long as the aortic cannula did not interfere with the proximal anastomotic site on the aorta, circulatory arrest was avoided. As for surgery within the heart, the ventricular septal defects were closed via the right atrium with myotomy and myectomy if a morphological substrate for subaortic stenosis was confirmed (n=4). There were two hospital deaths (15.4%) due to low cardiac output. In patients who underwent myotomy and myectomy for subaortic stenosis, the postoperative pressure gradient across the aortic valve was negligible. We conclude that surgical results of one-stage repair for the intracardiac malformations associated with interrupted aortic arch or aortic coarctation are reasonable. We suggest that the early relief of obstruction within the left ventricular outflow tract may have played some role in the favorable outcome.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1995

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