Anatomic reconstruction for recurrent aortic obstruction in infants and children

The Annals of Thoracic Surgery
Daniel J DiBardinoCharles D Fraser

Abstract

Patients undergoing operative repair of aortic obstruction are at a lifelong risk of recurrent obstruction, and there is controversy regarding the optimal surgical technique. We have used an alternative strategy for recurrent aortic obstruction, typically involving anatomic reconstruction by means of a median sternotomy, and describe our techniques and results. Twenty-one patients presented with recurrent aortic arch obstruction. Mean age and weight were 7.8 +/- 5.4 years (range, 0.21 to 15.2 years) and 30.6 +/- 21.8 kg (range, 3.6 to 90 kg), respectively. Recurrence involved the aortic arch to some degree in each case, as the mean preoperative transverse aortic arch z score was -2.9 +/- 1.6 (range, -7.0 to 0.1). Thoracotomy was possible in 2 patients, using re-resection with end-to-end anastomosis (n = 1) and patch aortoplasty (n = 1). The remaining 19 patients required median sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest for complete relief of obstruction by aortic arch advancement (n = 10), patch aortoplasty (n = 8), or interposition grafting (n = 1). There was 1 hospital death. Invasive blood pressure monitoring revealed no residual arm-to-leg gradient in 19 patients and a 20-mm Hg gradient in ...Continue Reading

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Citations

Aug 13, 2013·Case Reports in Vascular Medicine·Alban MalajGiuseppe Mazzesi
Apr 23, 2014·The Annals of Thoracic Surgery·Carlos M MeryCharles D Fraser
Aug 30, 2011·The Annals of Thoracic Surgery·Takashi OgasawaraIkuo Fukuda
Apr 8, 2009·Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual·John W BrownMark Ruzmetov
Jul 13, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Thomas KrasemannShakeel A Qureshi
Apr 28, 2005·The Annals of Thoracic Surgery·Assaf K FessehaAntonio R Mott
Jan 30, 2007·The Annals of Thoracic Surgery·Joseph W RossanoAntonio R Mott
Jun 3, 2008·Asian Cardiovascular & Thoracic Annals·Madan M MaddaliSunny Zacharias
May 18, 2007·Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi·Takashi SasakiNaoki Wada
Aug 11, 2006·The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi·Masahito YamashiroToshio Kikuchi
Jun 3, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jeremy S Y WongYves d'Udekem

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