Early and Late Results After Repair of Aortopulmonary Septal Defect and Associated Anomalies in Infants < 6 Months of Age (original) (raw)
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Staged repair of interrupted aortic arch and ventricular septal defect in infancy☆
The Annals of Thoracic Surgery, 1991
Staged repair of interrupted aortic arch and ventricular septal defect was carried out in 20 infants from 1979 through 1990. Among the important associated cardiac defects were transposition of the great arteries, truncus arteriosus, and anomalous origin of the right pulmonary artery. The first stage, usually consisting of the placement of an 8-or 10-mm polytetrafluoroethylene graft, pulmonary artery banding, and ligation of the patent ductus arteriosus, resulted in 20 survivors (100%) There were two interim deaths (10%) before the second stage of ventricular septal defect closure and pulmonary artery band removal, which had 15 survivors (83%, 15/18). Because the major morbidity and mortality early in this experience could be traced to leaving the pulmonary artery band on too long, early removal (within 2 to 3 months) was begun. Since 1985, 8 (100%) of 8 infants he outlook has greatly improved for infants born with T interrupted aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA), which, until relatively recently, was usually lethal [l]. Several series [2-9; Bowman FO Jr, unpublished results] have reported survival of more than 50% of infants after operation either by a staged approach or by primary repair, and the trend is to further improvement. Complete repair in which the PDA is excised, a primary aortic anastomosis is carried out, and the VSD is closed has considerable appeal, and successful series have been reported from several institutions [ 5 7 , Bowman FO Jr, unpublished results]. On the other hand, excellent results have been reported using a staged procedure in which the arch is repaired first, usually with a conduit, and the pulmonary artery (PA) banded. Later, the VSD is closed and the PA band removed [ 2 4 , 81. Infants with an IAA may have a constellation of problems, and longer follow-up and evaluation will be necessary to accurately determine the advantages and disadvantages of each approach. Despite the attraction and apparent increasing success rate of primary repair, there may be a subset of infants for whom the staged approach would be the best choice. Moreover, our midterm results continue to suggest there may be advantages to this approach for the entire group. The purpose of this report Presented in part at the Current Controversies and Techniques in Congenital Heart Surgery Meeting, Baltimore, MD, Sep &9, 1989. Address reprint requests to Dr Foker, Box 495 UMHC, 420 Delaware St SE, Minneapolis, MN 55455.
Operative Techniques in Thoracic and Cardiovascular Surgery, 2007
P ulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCAs) is a complex and rare lesion in which considerable morphologic variability exists regarding the sources of pulmonary blood flow. The true central pulmonary arteries range from a size approaching normal to complete absence. Major aortopulmonary collaterals, probably derived embryologically from the splanchnic vascular plexis, 1 are also highly variable in their size, number, course, origin, arborization, and histopathologic makeup. 2-5 A segment of lung may be supplied solely from the true pulmonary arteries, solely from the aortopulmonary collaterals, or from both with connections between the two sources occurring at central or peripheral points and at single or multiple sights. 4 By contrast, the intracardiac component of this defect is usually relatively straightforward, with a large anteriorly malaligned ventricular septal defect, well-developed right and left ventricles with appropriate atrioventricular valves, and concordant atrioventricular and ventriculoarterial connections. More complex intracardiac arrangements may occur but are rare with MAPCAs. More complex intracardiac arrangements occur more frequently with ductal-dependent forms of pulmonary atresia.
The Annals of Thoracic Surgery, 1994
BURKE AND ROSENFELD AP WINDOW AND IAA 543 Aortopulmonary septal defect, interruption of the aortic arch, and anomalous origin of the right pulmonary artery from the aorta comprised a challenging constellation of defects in a 13-day-old neonate, who underwent complete repair without homograft tissue or synthetic graft. After the aorta was separated from the pulmonary artery, the descending aorta was anastomosed to the septal defect in the ascending aorta. The right pulmonary artery was anastomosed to the septal defect in the main pulmonary artery, anterior to the aorta. The postoperative course was uncomplicated, and the potential for growth of both great vessels was optimized.
Interrupted aortic arch in infancy: A 10-year experience
Pediatric Cardiology, 1992
Fifty infants with interrupted aortic arch (IAA), admitted between 1979 and 1988, were reviewed. They usually presented early in severe cardiac failure or shock. In the initial 5-year period, 17 of the 21 infants underwent diagnostic or confirmatory cardiac catheterization, in contrast with the latter 5 years when only eight of the subsequent 29 patients underwent catheterization. Since 1987, all patients underwent surgery after cross-sectional echocardiography. Fifteen infants had a type A IAA and 35 had type B. All had associated cardiac anomalies. Four infants were not operated on.
International Journal of Cardiology, 2000
Respiratory symptoms are often present in infants with congenital cardiac anomalies, but the intrinsic pathology of the airway itself or external compression by abnormal vessels is frequently undetected before cardiac repair. We collected 12 patients with airway pathology from July 1996 to October 1998; all had definite diagnosis of lesions of the airway and its adjacent vessels by preoperative ultrafast computed tomography. Four had intrinsic pathology (one retrotracheal diverticulum, three tracheal stenosis) as well as external compression. Among them, six had complete vascular ring, four partial rings and three had bronchial compression by aneurysmal dilatation of branch pulmonary arteries. Simultaneous airway repair (one diverticulectomy, three patch tracheoplasty) and external decompression were performed in ten cases under cardiopulmonary bypass, nine of ten had simultaneous cardiac repair; the other two were done before cardiac repair. All survived except three. We concluded that ultrafast computed tomography is indispensable for definite diagnosis of airway and adjacent cardiovascular pathology. Mere repair of congenital cardiac defects without rectification of the airway and its adjacent structures is incompatible with survival.
The repair of atrioventricular septal defects in infancy
International Journal of Cardiology, 1986
Kirklin JW, Blackstone EH, Bargeron LM, Jr, Pacific0 AD, Kirklin JK. The repair of atrioventricular septal defects in infancy. Int J Cardiol 1986;13:333-351. Two (3%) of 72 patients undergoing repair of atrioventricufar septal defects, 19&l-September 1985, died in hospital, and among the 58 patients with isolated atrioventricular septal defect, one (2Yo) died in hospital. One (3%) of the 30 patients with isolated atrioventricufar septal defects undergoing repair in the first year of life died. The absence of an incremental risk of young age is a continuation of the trend demonstrated in a parametric analysis of the earlier 1%7-1982 experience (n = 310).