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Ann Thorac Surg 1988;45:174-180
© 1988 The Society of Thoracic Surgeons

Articles

Surgical Management of Patients with Interrupted Aortic Arch and Severe Subaortic Stenosis

Michel N. Ilbawi, M.D.*, Farouk S. Idriss, M.D., Serafin Y. DeLeon, M.D., Alexander J. Muster, M.D., D. Woodrow Benson, Jr., M.D., Milton H. Paul, M.D.

From the Divisions of Cardiovascular-Thoracic Surgery and Cardiology, The Children's Memorial Hospital, and the Departments of Surgery and Pediatrics, Northwestern University Medical School, Chicago, IL

Accepted for publication September 10, 1987.

* Address reprint requests to Dr. Ilbawi, Division of Cardiovascular-Thoracic Surgery, The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614

Ten patients underwent palliative surgery for interrupted aortic arch and severe subaortic obstruction due to posterior displacement of the conal septum. Their ages ranged between 4 and 28 days (mean, 11.0 ± 7.7 days) and their weights, between 2.1 and 4.2 kg (mean, 2.85 ± 0.6 kg). Preoperative echocardiography and cardiac catheterization were performed on all patients. The ratios of the left ventricular outflow tract diameters and the ascending aortic diameters to the descending aortic diameters were 0.56 ± 0.03 and 0.56 ± 0.06, respectively, compared with 0.81 ± 0.12 and 0.95 ± 0.17, respectively, in 20 patients with interrupted aortic arch but without obstruction (p < 0.001). Four of the 10 patients underwent pulmonary artery banding and insertion of a bypass graft between the ascending and the descending aorta. All 4 died of low cardiac output soon after operation (100% operative mortality). The remaining 6 patients underwent banding and insertion of a graft between the main pulmonary artery proximal to the band, and the descending aorta. All of these patients survived, and all except 1 are doing well 3 months to 4 years postoperatively.

The use of a pulmonary artery-descending aorta conduit and of distal pulmonary artery banding provides good palliation for patients with interrupted aortic arch and major subaortic stenosis.




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