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The Annals of Thoracic Surgery, Vol 52, 608-613, Copyright © 1991 by The Society of Thoracic Surgeons
RD Siewers, J Ettedgui, E Pahl, T Tallman and PJ del Nido
Hypoplasia of the transverse aortic arch of various degrees of severity is
commonly seen in infants who have coarctation of the aorta. It is more
often present when the coarctation is associated with intracardiac lesions
that diminish or limit forward flow in the ascending aorta and promote
right to left flow through an arterial duct. The increased frequency of
surgical treatment of infants with complex coarctation, which is in part
related to the ability to stabilize their condition with prostaglandin E1,
has posed the question of the potential for growth and development of the
originally hypoplastic aortic arch after conventional repair of aortic
coarctation. Review of our experience with transverse aortic arch
hypoplasia, found in 33 (32%) of 102 infants undergoing coarctation repair
by subclavian flap aortoplasty or classic resection and end-to-end
anastomosis, revealed excellent growth of the transverse arch after repair
in all patients available for linear follow-up. The currently proposed
extended arch repair should be reserved for the small group of infants with
transverse aortic arch to ascending aorta diameter ratios (arch indices) of
less than 0.25.
ARTICLES
Coarctation and hypoplasia of the aortic arch: will the arch grow?
Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
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