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Ann Thorac Surg 2001;71:1530-1536
© 2001 The Society of Thoracic Surgeons
a Division of Cardio-Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
b The Sibley Heart Center Children’s Healthcare of Atlanta at Egleston, Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
Address reprint requests to Dr Kanter, Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd, Atlanta, GA 30322
e-mail: kkanter{at}emory.org
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. Management of hypoplastic aortic arch associated with coarctation in infancy can be challenging. Reverse subclavian flap aortoplasty plus coarctation resection offers simplicity without needing foreign material or cardiopulmonary bypass.
Methods. Since 1988, 46 of 162 infants less than 3 months undergoing coarctation repair had hypoplastic arch enlargement with reverse subclavian flap aortoplasty. Median age was 11 days; mean weight was 3.2 kg. Thirty-seven patients (80%) had associated cardiac defects including single or multiple ventricular septal defects (14 infants), transposition of the great arteries (7), aortic or mitral stenosis (5), and complete atrioventricular septal defect (5 infants). Twenty-eight patients had pulmonary artery banding; 2 had an arterial switch operation through a separate median sternotomy.
Results. There were two hospital deaths: one 4 months postoperatively in a patient requiring a Norwood procedure the next day for underestimated left ventricular hypoplasia; the other of sepsis more than 1 month postoperatively. On follow-up from 1 to 129 months (mean, 38 months), there were five recurrent obstructions: three at the coarctation site treated with balloon dilatation and two at the arch site. Twenty-six children had their heart defects corrected with 29 subsequent operations including an arterial switch operation for transposition of the great arteries/ventricular septal defect (3 infants), relief of aortic or mitral stenosis ± ventricular septal defect closure (5), multiple ventricular septal defect closure (3), a bidirectional Glenn (2), complete atrioventricular septal defect (2), and anomalous left coronary with ventricular septal defect repair (1 infant). Four children await debanding and ventricular septal defect closure or Glenn anastomosis. There have been two late deaths (overall survival, 91%).
Conclusions. Reverse subclavian flap aortoplasty is excellent for relief of arch hypoplasia and coarctation in infants with low recurrence rates and acceptable operative and intermediate survival.
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  G. Gargiulo, C. P. Napoleone, E. Angeli, and G. Oppido Neonatal coarctation repair using extended end-to-end anastomosis MMCTS, May 23, 2008; 2008(0523): 2691. [Abstract] [Full Text] [PDF]
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 K. R. Kanter, W. T. Mahle, B. E. Kogon, and P. M. Kirshbom What is the Optimal Management of Infants With Coarctation and Ventricular Septal Defect? Ann. Thorac. Surg., August 1, 2007; 84(2): 612 - 618. [Abstract] [Full Text] [PDF]
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 A. F. Corno, U. Botta, M. Hurni, M. Payot, N. Sekarski, P. Tozzi, and L. K. von Segesser Surgery for aortic coarctation: a 30 years experience Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1202 - 1206. [Abstract] [Full Text] [PDF]
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