Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T09:55:34.228Z Has data issue: false hasContentIssue false

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Irwin, ED, Braunlin, EA, Foker, JE.Staged repair of interrupted aortic arch and ventricular septal defect in infancy. Ann Thorac Surg 1991; 52: 632639.CrossRefGoogle ScholarPubMed
Trinquer, F, Vouché, PR, Vernant, F, Touati, G, Roux, P, Pome, G, Leca, F, Neveux, J.. Coarctation of the aorta in infants: Which operation? Ann Thorac Surg 1988; 45: 186191.CrossRefGoogle Scholar
Oelert, H, Stegmann, TH, Luhmer, I, Borst, HG.. Partial repair followed by total correction in congenital heart anomalies. J Cardiovasc Surg 1979; 20: 467470.Google ScholarPubMed
Harlan, JL, Doty, DB, Brandt, B III, Ehrenhaft, JL.. Coarctation of the aorta in infants. J Thorac Cardiovasc Surg 1984; 88: 10121019.CrossRefGoogle ScholarPubMed
Tiraboschi, R, Alfieri, O, Carpentier, A, Parenzan, L.. One-stage correction of coarctation of the aorta associated with intracardiac defects in infancy. J Cardiovasc Surg 1978; 19: 1116.Google ScholarPubMed
Moulton, AL, Bowman, FO. Primary definitive repair of type B interrupted aortic arch, ventricular septal defect, and patent ductus arteriosus. J Thorac Cardiovasc Surg 1981; 82: 501510.CrossRefGoogle Scholar
Turley, K, Yee, ES, Ebert, PA. The total repair of interrupted arch complex in infants: the anterior approach. Circulation 1984; 70(suppl Iyes): I 16–I 20.Google ScholarPubMed
Schumacher, G, Schreiber, R, Meisner, H, Lorenz, HP, Sebening, F, Bühlmeyer, K.Interrupted aortic arch: Natural history and operative results. Pediatr Cardiol 1986; 7: 8993.CrossRefGoogle ScholarPubMed
Yasui, H, Kado, H, Nakano, E, Yonenaga, K, Mitani, A, Tomita, Y, Iwao, H, Yoshii, K, Mizoguchi, Y, Sunagawa, H.. Primary repair of interrupted aortic arch and severe aortic stenosis in neonates. J Thorac Cardiovasc Surg 1987; 93: 539545.CrossRefGoogle ScholarPubMed
Hazekamp, MG, Quaegebeur, JM, Singh, S, Hardjowijono, R, Bogers, AJJC, Ottenkamp Rohmer, J, Witsenburg, M, Hess, J, Bos, E, Huysmans, HA. One stage repair of aortic arch anomalies and intracardiac defects. Eur J Cardio-thorac Surg 1991; 5: 283287.CrossRefGoogle ScholarPubMed
Ungerleider, RM, Ebert, PA. Indications and techniques for midline approach to aortic coarctation in infants and children. Ann Thorac Surg 1987; 44: 517522.CrossRefGoogle ScholarPubMed
Monro, JL, Bunton, RW, Sutherland, GR, Keeton, BR. Correction of interrupted aortic arch. J Thorac Cardiovasc Surg 1989; 98: 421427.CrossRefGoogle ScholarPubMed
Heinemann, M, Ziemer, G, Luhmer, I, Haverich, A, Kallfelz, HC, Borst, HG.Coarctation of the aorta in complex congenital heart disease: simultaneous repair via sternotomy. Eur J Cardio-thorac Surg 1990; 4: 482486.CrossRefGoogle ScholarPubMed
Hammon, JW, Merrill, WH, Prager, RL, Graham, TP, Bender, HW Jr. Repair of interrupted aortic arch and associated malformations in infancy: Indications for complete or partial repair. Ann Thorac Surg 1986; 42: 1721.CrossRefGoogle ScholarPubMed
Norwood, WI, Lang, P, Castañeda, AR, Hougen, TJ.Reparative operations for interrupted aortic arch with ventricular septal defect. J Thorac Cardiovasc Surg 1983; 86: 832837.CrossRefGoogle ScholarPubMed
Celoria, GC, Patton, RB.. Congenital absence of the aortic arch. Am Heart J 1959; 58: 407413.CrossRefGoogle ScholarPubMed
Kawashima, Y, Fujita, T, Miyamoto, T, Manabe, H.. Intraventricular rerouting of blood for the correction of Taussig-Bing malformation. J Thorac Cardiovasc Surg 1971; 62: 825829.CrossRefGoogle ScholarPubMed
Goldman, S, Hernández, J, Pappas, G. Results of surgical treatment of coarctation of the aorta in the critically ill neonate. J Thorac Cardiovasc Surg 1986; 91: 732737.CrossRefGoogle ScholarPubMed
Barratt-Boyes, BG, Nicholls, TT, Brandt, PWT, Neutze, JM.Aortic arch interruption associated with patent ductus arteriosus ventricular septal defect, and total anomalous pulmonary venous connection. Total correction in an 8-day-old infant by means of profound hypothermia and limited cardiopulmonar bypass. J Thorac Cardiovasc Surg 1972: 367373.CrossRefGoogle Scholar
Sano, S, Brawn, WJ, Mee, RBB.Repair of truncus arteriosus and interrupted aortic arch. J Cardiac Surgery 1990; 5: 157162.CrossRefGoogle ScholarPubMed
Scott, WA, Rocchini, AP, Bove, EL, Behrendt, DM, Beekman, RH, Dick, M II, Serwer, G, Snider, R, Rosenthal, A. Repair of interrupted aortic arch in infancy. J Thorac Cardiovasc Surg 1988; 96: 564568.CrossRefGoogle ScholarPubMed
Damus, P.Letter to the editor. Ann Thorac Surg 1975; 20: 724725.CrossRefGoogle Scholar
Kaye, MP.. Anatomic correction of transposition of great arteries. Mayo Clin Proc 1975; 50: 638640.Google ScholarPubMed
Stansel, HC Jr. A new operation for a d-loop transposition of the great vessels. Ann Thorac Surg 1975; 19: 565567.CrossRefGoogle ScholarPubMed
Norwood, WI, Stellin, GJ.Aortic atresia with interrupted aortic arch: reparative operation. J Thorac Cardiovasc Surg 1981; 81: 239244.CrossRefGoogle ScholarPubMed
Sell, JE, Jonas, RA, Mayer, JE, Blackstone, EH, Kirklin, JW, Castañeda, AR.J Thorac Cardiovasc Surg 1988; 96: 864877.CrossRefGoogle Scholar
Sawin, RS, Hall, DG, Mansfield, PB, Rittenhouse, EA.. Staged repair of interrupted aortic arch with ventricular septal defect compared with primary repair in infancy. Am J Surgery 1989; 157: 487489.CrossRefGoogle ScholarPubMed