Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion.

Détails

ID Serval
serval:BIB_03F60776091F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion.
Périodique
European Journal of Cardio-thoracic Surgery
Auteur(s)
Dave H., Rosser B., Reineke K., Nguyen-Minh S., Knirsch W., Prêtre R.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
41
Numéro
4
Pages
906-912
Langue
anglais
Résumé
OBJECTIVE: To analyse the technique of neonatal aortic arch enlargement without cardiopulmonary bypass through a left posterior thoracotomy, as an adjunct to extended resection for Coarctation and severe arch hypoplasia.
METHODS: Ten neonates with coarctation, severe arch hypoplasia and a persistent ductus arteriosus (PDA) were subjected to arch repair through a left posterior thoracotomy. Nine of these patients had associated significant intracardiac anomalies; three of them received pulmonary artery (PA) banding. After exclusion from circulation, the roof of the intervening arch between left carotid and left subclavian was enlarged using a patch. After adequate reperfusion, a classic resection and extended end-to-end anastomosis was performed. Median age and weight were 5.5 (1-10) days and 3.3 (2.2-4.1) kg respectively. The median preoperative arch diameter was 1.07 (0.75-1.32) mm/kg body weight.
RESULTS: All patients could be successfully operated with this approach. The non-ischaemic and ischaemic aortic clamp times were 40 (15-68) and 23 (18-32) min, respectively. The median postoperative arch diameter achieved was 1.43 (1.06-1.46) mm/kg body weight. None of the patients had significant gradient early postoperatively. Two patients with recurrent stenosis were successfully treated with balloon dilatation (1) or surgery with cardiopulmonary bypass (CPB) (1). One patient has a corrected gradient of 16 mmHg in the proximal arch which is being observed. The remaining patients are free from stenosis at a median follow-up of 30.1 (13.2-57.8) months.
CONCLUSIONS: Use of PDA for lower body perfusion allows complex reconstruction of the arch without incurring lower body ischaemia. The extended resection could then be performed without excessive stretch. This modification saves these patients from undergoing a complex arch reconstruction with CPB in the early neonatal period.
Pubmed
Web of science
Création de la notice
16/12/2014 18:35
Dernière modification de la notice
03/03/2018 13:21
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