Reverse Subclavian Flap Repair and Maintenance of Antegrade Blood Flow within the Left Subclavian Artery in Neonates with Aortic Coarctation and Distal Arch Hypoplasia

2013 ◽  
Vol 16 (1) ◽  
pp. 52 ◽  
Author(s):  
Yuri S. Sinelnikov ◽  
A. V. Gorbatyh ◽  
S. M. Ivantsov ◽  
M. S. Strelnikova ◽  
I. A. Kornilov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Left Subclavian Artery ◽  
Surgical Palliation ◽  
Flap Repair ◽  
Neonates And Infants ◽  
Aortic Arch Hypoplasia

Surgical palliation for aortic coarctation with aortic arch hypoplasia in neonates and infants has been used in the clinic as the most beneficial treatment for this disorder. This technique allows the correction of aortic coarctation by the use of "extended" anastomosis without cardiopulmonary bypass, which expands the hypoplastic distal aortic arch via the use of a reverse subclavian flap repair. This technique maintains antegrade blood flow within the left subclavian artery.

Interrupted fourth aortic arch with persistent fifth aortic arch and aortic coarctation—treatment with balloon angioplasty combined with surgery

1994 ◽  
Vol 4 (3) ◽  
pp. 304-306 ◽  
Author(s):  
Raul Jurí ◽  
Luis Eduardo Alday ◽  
Roberto De Rossi
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Balloon Angioplasty ◽  
Aortic Coarctation ◽  
Left Subclavian Artery ◽  
Balloon Dilation ◽  
Descending Aorta ◽  
Persistent Fifth Aortic Arch

AbstractA symptomatic neonate was referred for aortic coarctation and, at cineangiography, was shown to have an interruption of the aortic arch at the isthmus together with coarctation related to a persistent fifth aortic arch. Balloon dilation of the coarctation was performed, but the coarctation was still evident after six months. A graft was then interposed between the left subclavian artery and the descending aorta. Balloon dilation was repeated five years later leaving a residual gradient of 11 mm Hg.

Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre

2021 ◽  
pp. 1-6
Author(s):  
Amr Ashry ◽  
Amer Harky ◽  
Abdulla Tarmahomed ◽  
Christopher Ugwu ◽  
Heba M. Mohammed ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Recurrent Laryngeal Nerve Injury ◽  
Coarctation Repair ◽  
Aortic Arch Reconstruction ◽  
Retrospective Data Collection ◽  
Laryngeal Nerve Injury ◽  
Neonates And Infants ◽  
Arch Reconstruction ◽  
Aortic Arch Hypoplasia

Abstract Objectives: There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants. Methods: We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR). Results: The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9–43.25 days). Median weight was 3.5 kg (IQR 3.10–4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9–46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7). Conclusion: Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation

2013 ◽  
Vol 24 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Stany Sandrio ◽  
Matthias Karck ◽  
Matthias Gorenflo ◽  
Tsvetomir Loukanov
Keyword(s):  
Spinal Cord ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Aortic Coarctation ◽  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Main Pulmonary Artery ◽  
Neurologic Complication ◽  
Spinal Cord Protection ◽  
Age Range

AbstractBackgroundThe aim of this study was to evaluate the surgical treatment of complex aortic coarctation using partial cardiopulmonary bypass to increase the spinal cord protection.MethodsA total of 15 patients (age range from 7 to 48 years) underwent coarctation repair through a left posterolateral thoracotomy with cardiopulmonary bypass. Cannulation was performed via the descending aorta and the main pulmonary artery. In all, six surgeries were performed under hypothermic circulatory arrest and nine repairs were performed under mild hypothermia. The clinical outcome regarding the development of restenosis, as well as major neurologic complication, was studied.ResultsThere was no mortality. None of the patients developed paraplegia. Of the 15 patients, two developed a recurrent stenosis at the proximal anastomosis between the aortic arch and the aortic prothesis at a mean follow-up of 5.5 years. In the remaining 13 patients, echocardiography and magnetic resonance imaging showed no evidence of a significant gradient.ConclusionComplex aortic coarctation without hypoplasia of the proximal aortic arch and intra-cardiac anomalies can be repaired with low mortality and neurologic morbidity via a left thoracotomy using cardiopulmonary bypass. The use of cardiopulmonary bypass goes along with a low risk of spinal cord and lower body ischaemia and provides a sufficient amount of time for the anastomoses.

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