Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management (original) (raw)
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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.
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 Several series [2-9; Bowman FO Jr, unpublished results] have reported survival of more than 50% of infants after operation either by a staged approach or by primary repair, and the trend is to further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.
Multimedia Manual of Cardio-Thoracic Surgery, 2007
Surgical repair of the aortic arch is entailed in the neonatal period of patients with: hypoplastic left heart syndrome, interrupted aortic arch, hypoplastic aortic arch and complex aortic coarctation. Aortic arch surgery requires a period of circulatory arrest and deep hypothermia. Cerebral selective perfusion has recently been introduced as an alternative to circulatory arrest with the aim of reducing mortality and neurological complications. Moreover, the arch reconstruction phase can be safely performed under moderate hypothermia and with cerebral and myocardial perfusion (on beating heart), thus, completely avoiding cerebral ischemia and completely avoiding or drastically reducing myocardial ischemia.
The Journal of Thoracic and Cardiovascular Surgery, 2006
The objective was to determine outcomes and risk factors of surgical management of patients with aortopulmonary window associated with interrupted aortic arch. From 1987From to 1997 neonates with interrupted aortic arch were enrolled prospectively from 33 institutions. Associated aortopulmonary window was present in 20 patients. Competing risk methodology determined the prevalence of reintervention for postrepair pulmonary artery and aortic arch obstruction.
Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach
The Journal of Thoracic and Cardiovascular Surgery, 2016
Objectives: Coarctation with hypoplastic aortic arch can be treated with resection and extended end-to-end anastomosis (REEEA) as well as end-to-side anastomosis (ESA). The aim of the study was to review our experience with these techniques in newborns and infants and to assess mid-term outcome with regards to morbidity, mortality, and reintervention rate in relation to operative access and technique. Patients and Methods: Retrospective review of hospital charts and surgical reports from 183 consecutive newborns and infants with coarctation and hypoplastic aortic arch with or without ventricular septal defect between 1996 and 2013. Median age at surgery was 15 days (0-345). Lateral thoracotomy was used as operative access in 111 patients; 72 patients had a median sternotomy, 71 of them with cardiopulmonary bypass (ESA n ¼ 30, REEEA n ¼ 41). Fifty-two patients (28.4%) had an additional ventricular septal defect closure. Follow-up data were available for 75.96% with a median follow-up of 6.3 years (0.2-18.16 years). Results: Thirty-day mortality was 0.54% with no late mortality occurring during follow-up. There was 1 severe complication: paraplegia and cerebral hypoxemia after REEEA. Freedom from mortality and reintervention at 10 years was 99.27% and 90.12%, respectively. Lateral thoracotomy as operative access was a risk factor for recurrent obstruction (P ¼ .03). Conclusions: REEEA and ESA were safe and effective treatments in newborns and infants. In borderline cases, aortic arch reconstruction should be performed through a median sternotomy on bypass.
The Journal of Thoracic and Cardiovascular Surgery, 2005
We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. Methods: From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33 institutions. Competing risks methodology was used to determine simultaneous risk and associated incremental risk factors for death, initial and subsequent left ventricular outflow tract procedures, and arch reinterventions. Results: Overall survival was 59% at 16 years after study entry but improved with successive birth cohort. In general, risk factors for death in each of the competing risks analyses included lower birth weight, younger age at study entry, type B interrupted aortic arch, and major associated cardiac anomalies. Of 453 patients who had interrupted aortic arch repair, after 16 years 33% had died and 28% had undergone an arch reintervention. Reintervention was more likely for those who had truncus arteriosus repair, interrupted aortic arch repair by a method other than direct anastomosis with patch augmentation, and the use of polytetrafluoroethylene as either an interposition graft or a patch. From study entry, competing risks after 16 years showed that 28% had died and 34% had undergone an initial left ventricular outflow tract procedure. Initial left ventricular outflow tract procedure was more likely for those with single ventricle, type B interrupted aortic arch, bicuspid aortic valve, or anomalous right subclavian artery. Among those who had undergone an initial left ventricular outflow tract procedure, after 16 years 37% had died and 28% had undergone a second procedure. Conclusion: Anatomic features affect mortality and initial left ventricular outflow tract procedures, whereas characteristics of the arch repair affect arch reintervention. I nterrupted aortic arch (IAA) occurs infrequently, and although most patients have only an isolated ventricular septal defect (VSD), more complex associated cardiovascular anomalies may occur. In addition, a spectrum of left ventricular outflow tract (LVOT) obstructive lesions, particularly subaortic stenosis, may further complicate management. Although recent reports have reflected improvements in operative survival, further interventions are often required to address residual or recurrent left heart outflow or arch repair obstructions. A previous Congenital Heart Surgeons Society (CHSS) study reported outcomes for 183 neonates entered from 1987 to 1992.
Pediatric Cardiology, 2009
The success rate of right-heart bypass surgery in patients with a functionally single ventricle (f-SV) and systemic obstruction is low. In patients with a high risk of subaortic stenosis, we performed an initial step of pulmonary artery banding (PAB) and arch reconstruction before placing a bidirectional cavopulmonary shunt (BCPS) in infants with or without Damus-Kaye-Stansel (DKS) anastomosis. We assessed the success of right-heart bypass surgery. Between October 2003 and August 2008, we performed surgery in 19 neonates (median age 5 days) with f-SV and arch obstruction. Extended aortic arch anastomosis, with or without distal arch augmentation, was performed in 10 patients, and subclavian flap aortoplasty was performed in 9 patients. The circumference of the PAB was determined as the individual patient's body weight in kilograms plus 16.2 ± 3.7 mm. Eighteen of 19 infants (95%) underwent successful BCPS placement at a median age of 7.8 months. DKS anastomosis was performed concomitantly during BCPS placement in 11 infants in whom subaortic stenosis was morphologically suspected but not demonstrated physiologically. As our first-stage operation, arch reconstruction plus PAB provided high success rates for right-heart bypass operations. This strategy is not leading, but it is a reliable approach for progression along a Fontan pathway.
Determinants of survival following repair of interrupted aortic arch in infancy
International Journal of Cardiology, 1990
Between January 1971 and March 1987, surgery was performed in 26 infants with interrupted aortic arch. At operation the 14 boys and 12 girls weighed between 1.71 and 4.23 kg (mean rfr SD = 3.1 + 0.63 kg) and ranged in age from 2 to 90 days (13 +_ 18 days). The interruption was distal to the left subclavian artery in 4 (15%), between the left carotid and subclavian arteries in 20 (77%) and between the brachiocephalic (innominate) and left carotid arteries in 2 (8%). Associated complex cardiac lesions in 8 patients included complete transposition (2), common arterial trunk (2), aortopulmonary window (2), double inlet left ventricle (1) and tricuspid atresia (1). The remaining patients had an isolated ventricular septal defect. The arch was reconstructed with a prosthetic conduit in 14 patients; by a direct anastomosis in 6; using the subclavian artery in 3; and with the pulmonary trunk and the arterial duct in 2. Twenty patients (77%) underwent palliative surgery as the first stage of management, and banding of the pulmonary trunk was also performed in 16 of these. Five patients (19%) underwent primary complete repair of the interruption and intracardiac anomalies. One patient (4%) died soon after thoracotomy for palliative surgery. Of the 15 (57%, 70% confidence limits CL = 46-69%) early deaths, 7 occurred in patients with complex associated defects and 4 occurred when single stage repair was attempted. Survival following first-stage palliative surgery for arch interruption with isolated ventricular septal defect was 64% (9/14) 170% CL = 47-79%]. All of these patients subsequently underwent complete repair. Chi-squared and t-tests showed the year of operation and the type of operation (two-stage repair) to be associated with improved survival. It is concluded that a two-stage repair of interrupted aortic arch offers a reasonable alternative to primary complete correction and will lead to satisfactory subsequent repair in most cases.