Ann Thorac Surg 1997;63:980
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Pascal R. Vouhé, MD
Service de Chirurgie Cardiaque, Hôpital Laënnec, 42 rue de Sèvres, 75340 Paris Cedex 07, France
See also page 975.
This article raises and at the same time answers two important questions regarding the surgical management of aortic coarctation with associated hypoplasia of the aortic arch.
First, the hypoplastic aortic arch does not always grow after coarctation repair; this is particularly true for infants operated on beyond the neonatal period. This may lead to residual arch obstruction. Several reports have shown that extended end-to-end anastomosis provides adequate repair of both aortic coarctation and hypoplasia of the transverse arch. This procedure can be performed through a left thoracotomy in infants with isolated coarctation or through a median sternotomy in patients requiring the concomitant treatment of intracardiac anomalies. Extended end-to-end anastomosis entails a very low risk of recurrent arch obstruction and is therefore the procedure of choice in patients with aortic coarctation with a hypoplastic aortic arch.
Second, this report shows that anatomic repair accomplished by arch enlargement can be safely performed in patients with residual arch obstruction requiring surgical treatment. I agree that there is therefore no longer a place for extraanatomic bypass grafts with their potential to cause late complications in growing patients.
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