One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: A novel approach

Luciani, Giovanni Battista; Ackerman, Ruben J.; Chang, Anthony; Wells, Winfield J.; Starnes, Vaughn A.

doi:10.1016/s0022-5223(96)70444-0

Cited by 81 publications

(79 citation statements)

References 19 publications

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“…IAA with ventricular septal defect (VSD) is an uncommon lesion, accounting for 1.5% of all congenital heart disease [6]. Most reports highlight type B morphology as the most common form (52-90%) [4,5,7,8].…”

Section: Incidencementioning

confidence: 99%

“…A spectrum of left ventricular outflow tract obstructive (LVOTO) lesions, particularly subaortic stenosis (SAS), is also common [1,4,5,7,15]. The malalignment of the conal septum with the resulting SAS is thought to be responsible for the in utero involution of the ascending aorta and aortic arch (fourth aortic arch) and there is reciprocal development of the pulmonary artery and ductus arteriosus (sixth aortic arch) [6]. The degree of SAS therefore is directly proportional to the size of the pulmonary trunk and inversely proportional to the size of the ascending aorta [6,15].…”

Section: Morphologymentioning

confidence: 99%

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Management strategies for interrupted aortic arch with associated anomalies

Mishra

2009

European Journal of Cardio-Thoracic Surgery

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Interrupted aortic arch (IAA) is characterised by a lack of luminal continuity between the ascending and descending thoracic aorta. It represents a critical ductus dependent congenital heart disease, which without surgery is associated with high mortality in the neonatal period. Management remains challenging, although in recent years overall mortality appears to be improving. Long-term morbidity and need for repeated interventions are areas of concern. It is difficult to make generalised recommendations based on this literature review as complex associated anomalies often require individualised management strategy.

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Section: Incidencementioning

confidence: 99%

Section: Morphologymentioning

confidence: 99%

Management strategies for interrupted aortic arch with associated anomalies

Mishra

2009

European Journal of Cardio-Thoracic Surgery

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“…Current treatment of IAA consists of a one-stage primary neonatal repair by means of aortic arch repair and VSD closure, with concomitant management of subaortic obstruction [Bove et al, 1993b;Luciani et al, 1996], if needed. Specific cardiac phenotype of del22q11.2 may suggest specific techniques to be adopted during initial surgical repair.…”

Section: Interrupted Aortic Archmentioning

confidence: 99%

“…The proximity of the septum to the aortic valve makes resection of the infundibular septum intrinsically hazardous to the aortic semilunar valve. In such cases the VSD is best closed via a transpulmonary approach, and the stitches relative to the apical portion of the VSD patch may be positioned on the left side of the infundibular septum to promote anterior deflection of the displaced septum away from the left ventricular outflow tract: in such way relief of subaortic stenosis can be accomplished successfully without resection of the infundibular septum [Luciani et al, 1996]. Concerning aortic arch reconstruction, this is best achieved by direct anastomosis with homograft patch augmentation [McCrindle et al, 2005;Roussin et al, 2002].…”

Section: Interrupted Aortic Archmentioning

confidence: 99%

Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome

Carotti

Digilio

Piacentini

et al. 2008

Dev Disabil Res Revs

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Specific types and subtypes of cardiac defects have been described in children with 22q11.2 deletion syndrome as well as in other genetic syndromes. The conotruncal heart defects occurring in patients with 22q11.2 deletion syndrome include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus, interrupted aortic arch, isolated anomalies of the aortic arch, and ventricular septal defect. These conotruncal heart defects are frequently associated in this syndrome with additional cardiovascular anomalies of the aortic arch, pulmonary arteries, infundibular septum, and semilunar valves complicating cardiac anatomy and surgical treatment. In this review we describe the surgical anatomy, the operative treatment, and the prognostic results of the cardiac defects associated with 22q11.2 deletion syndrome. According to the current literature, in patients with tetralogy of Fallot with/without pulmonary atresia and truncus arteriosus, in spite of the complex cardiac anatomy, the presence of 22q11.2 deletion syndrome does not worsen the surgical prognosis. On the contrary in children with pulmonary atresia with ventricular septal defect and probably in those with interrupted aortic arch the association with 22q11.2 deletion syndrome is probably a risk factor for the operative treatment. The complex cardiovascular anatomy in association with depressed immunological status, pulmonary vascular reactivity, neonatal hypocalcemia, bronchomalacia and broncospasm, laryngeal web, and tendency to airway bleeding must be considered at the time of diagnosis and surgical procedure. Specific diagnostic, surgical, and perioperative protocols should be applied in order to provide appropriate treatment and to reduce surgical mortality and morbidity.

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“…However, we need to be aware that this procedure has considerable drawbacks in the postoperative mortality and morbidity. 2 The Ross or Ross-Konno procedure may be an acceptable procedure of choice for infants and children with the tunnel-like LVOT stenosis. However, the long-term outcome of the pulmonary valve in the systemic circuit as well as of the reconstructed right ventricular outflow tract are matters of the current concern particularly in the small sized infant of less than 3 kg.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of tunnel-like subaortic stenosis via ventricular septal defect in a patient with the interrupted aortic arch

Suzuki

Kuga

Minakawa

et al. 2004

Jpn J Thorac Caridovasc Surg

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A 24-day-old male with interrupted aortic arch (type B), ventricular septal defect, and tunnel-like subaortic stenosis underwent a one-stage surgical treatment. The operative procedure comprised reconstruction of the aortic arch, transatrial excision of the subaortic fibromuscular tissue via the ventricular sepatal defect, and patch closure of the defect. The patient tolerated the procedure well and the postoperative echocardiography demonstrated a residual pressure gradient across the left ventricular outflow tract of 20 mmHg. Our result suggests that the transatrial surgical management of subaortic stenosis via the ventricular sepatal defect produces a safe and promising surgical option.

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One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: A novel approach

Abstract: Relief of severe subaortic stenosis during one-stage neonatal repair of aortic arch interruption and ventricular septal defect can be accomplished successfully without resection of the conal septum.

Cited by 81 publications

References 19 publications

Management strategies for interrupted aortic arch with associated anomalies

Management strategies for interrupted aortic arch with associated anomalies

Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome

Surgical management of tunnel-like subaortic stenosis via ventricular septal defect in a patient with the interrupted aortic arch

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