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Ann Thorac Surg 2007;84:715
© 2007 The Society of Thoracic Surgeons

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Correspondence

Partial Cardiopulmonary Bypass in Infants With Coarctation and Anomalous Right Subclavian Arteries

Cardiac Surgery Unit, Royal Children’s Hospital, Parkville, Melbourne, 3052 Australia

(Email: yves.dudekem{at}rch.org.au).

To the Editor:

We read with interest the contribution by Backer and colleagues [1] on the use of cardiopulmonary bypass (CPB) in children with coarctation of the aorta and inadequate collateral flow. The subset of patients with anomalous right subclavian artery is a small but important minority. As noted in their article, paraplegia is a rare but devastating complication from coarctation repair.

From an informal correspondence with colleagues from other institutions, we are aware of four postoperative paraplegias, all in infants with anomalous right subclavian arteries. Lerberg and colleagues [2] have noted that this anatomical substrate may increase the risk as their series showed that 1 in 8 patients with anomalous right subclavian artery had paraplegia develop.

We performed two operations in infants with an anomalous right subclavian artery arising from the pre-ductal aorta. Both were 7 weeks old with weights of 3.9 and 5 kg. They were noted to have anomalous right subclavian arteries intraoperatively.

Because of the important collaterals that come off both subclavians, we believe it is imperative to account for the lack of spinal collateral blood flow by instituting partial CPB. In our opinion, cannulation of the left atrial appendage, especially in infants, is cumbersome. We prefer to perform partial CPB between the main pulmonary artery and descending aorta gaining access to the main pulmonary artery by minimal dissection of the pleura anterior to the phrenic nerve. Partial CPB, entailing half of full flow, allows the heart to keep ejecting to the cerebral circulation.

Anomalous right subclavian artery should not be discounted when performing this operation. Even in small infants, the use of partial CPB is technically feasible. This approach cannot be substantiated but we believe it is justified.

	References

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1. Backer CL, Stewart RD, Kelle AM, Mavroudis C. Use of partial cardiopulmonary bypass for coarctation repair through a left thoracotomy in children without collaterals Ann Thorac Surg 2006;82:964-972.[Abstract/Free Full Text]
2. Lerberg DB, Hardesty RL, Siewers RD, Zuberbuhler JR, Bahnson HT. Coarctation of the aorta in infants and children: 25 years of experience Ann Thorac Surg 1982;33:159-170.[Abstract]

This article has been cited by other articles:

				C. L. Backer Reply Ann. Thorac. Surg., August 1, 2007; 84(2): 715 - 716. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Shaun P. Setty Christian P. Brizard Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Setty, S. P. Articles by d’Udekem, Y. Search for Related Content PubMed PubMed Citation Articles by Setty, S. P. Articles by d’Udekem, Y. Related Collections Congenital - acyanotic Related Article