The Neonatal Hypoplastic Aortic Arch: Decisions and More Decisions

Langley, Stephen M.; Sunstrom, Rachel E.; Reed, Richard D.; Rekito, Andrew J.; Gerrah, Rabin

doi:10.1053/j.pcsu.2013.01.008

Cited by 38 publications

(31 citation statements)

References 27 publications

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“…Diagnosis of transverse arch hypoplasia was made when the size of the transverse arch in millimeter was less than the patient's body weight in kilogram + 1, or the ratio of the diameter of the transverse arch to the descending aorta was less than 50%. 1) During the same period, there were 11 functional SV and oblique anastomosis ( Fig. 1A-1C).…”

Section: Patientsmentioning

confidence: 85%

“…This success rate is better or comparable to most series of arch reconstruction. 1,2) Another concern is the sacrifice of the subclavian artery which may cause arm ischemia and/or a shorter arm. No such disadvantages, however, have been observed in our longterm experience of subclavian flap aortoplasty.…”

Section: Limitationsmentioning

confidence: 99%

“…Such patients, especially those who also suffering from transverse arch hypoplasia, present a number of challenges to surgeons and there is less certainty and agreement about the best surgical strategy. 1) Although extended aortic arch anastomosis (EAAA) under cardiopulmonary bypass (CPB) has recently demonstrated acceptable early and infants with isthmus hypoplasia who were managed with end-to-end anastomosis, subclavian flap or reversed subclavian flap through a left thoracotomy and these patients were excluded from this study. Five neonates with significant SAS, restricted BVF, aortic valve stenosis, or hypoplasia of the ascending aorta were also excluded since they were candidates for initial Damus-Kaye-Stansel (DKS) procedure on CPB or bilateral PAB.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

Thang

Furugaki

Osaka

et al. 2016

ATCS

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Purpose: There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the midterm outcomes. Methods: In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively. Results: There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan. Conclusion: Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.

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Section: Patientsmentioning

confidence: 85%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

Thang

Furugaki

Osaka

et al. 2016

ATCS

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“…Previous studies reported high coexistence of transverse arch hypoplasia with aortic coarctation. [15] In our study, end-to-end anastomosis and extended end-to-end anastomosis techniques were performed in patients with discrete aortic coarctations. Coarctated segment was removed in these groups totally.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different surgical techniques for repair of aortic coarctation in childhood

Koç¹

2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu retrospektif çalışmada, kliniğimizde aort koarktasyonu nedeniyle uygulanan farklı cerrahi tekniklerin orta dönem sonuçları ve komplikasyonları sunuldu.Ça lış mapla nı:Ocak 2005 -Aralık 2013 tarihleri arasında aort koarktasyonu onarımı yapılan 106 hasta (61 erkek, 45 kız; ort. yaş 2.0±3.7 yıl; dağılım 2 gün-16 yıl) çalışmaya dahil edildi. Hastalar yaş gruplarına göre dörde ayrıldı: yenidoğan (n=36, %34), infant (n=42, %39.6), 1-5 yıl (n=13, %12.2) ve >5 yıl (n=15, %14.2). Hastalara 122 cerrahi işlem uygulandı. Hastalar orta derece vücut soğutulmasını takiben (34-35 °C) sol posterolateral torakotomi yoluyla dördüncü kaburgalar arası aralıktan yapılan kesi ile ameliyat edildi. Bul gu lar:Ortalama takip süresi 34±11 ay (dağılım 1-64 ay) idi. Hastaların %45.9'una uç uca anastomoz, %26.2'sine uzatılmış uç uca anastomoz, %22.1'ine yama ile plasti ve %5.7'sine greft interpozisyonu uygulandı. Takipte 16 hastada (%15.1) rekoarktasyon gelişti. Rekoarktasyon gelişen bütün hastalar altı aydan küçüktü. Rekoarktasyon yenidoğan yaş grubunda istatistiksel olarak anlamlı idi (%27.8'e karşın %7.5, p<0.05). Yenidoğan döneminde gelişen rekoarktasyonlara cerrahi, sonraki dönemde gelişenlere önce balon anjiyoplasti, sonra cerrahi uygulandı. Yirmi hasta (%18.8) erken ameliyat sonrası dönemde kaybedildi.So nuç:Yaş gruplarına göre cerrahi teknikler kıyaslandığında; uzatılmış uç uca anastomozun yenidoğan döneminde; uç uca anastomozun ise diğer yaş gruplarında daha yüksek oranda tercih edildiği görüldü. Rekoarktasyon ve mortalite oranları yenidoğan döneminde cerrahi uygulanan hastalarda daha yüksekti.Anah tar söz cük ler: Aort koarktasyonu; kalp cerrahisi; hipertansiyon; mortalite. ABSTRACTBackground: This retrospective study aims to present the mid-term results and complications of different surgical techniques performed in our clinic due to aortic coarctation.

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“…Другой вариант определения тубулярной гипоплазии опирается на работу A.M. Rudolph et al [5], где на основании исследования 41 новорожденного с обструкцией аорты показано, что восходящая аорта может не соответствовать весу ребенка из-за фетальной гемодинамической «недогруженности». Таким образом, предлагается оценивать гипоплазию дуги аорты, сравнивая ее не с восходящей, а с нисходящей аортой; критерий -менее 50% наружного диаметра нисходящей аорты [6].…”

Section: доступunclassified

Selective cerebral and coronary perfusion in the correction of coarctation of the aorta with tubular aortic arch hypoplasia (literature review)

Bodrov

Kazantsev

Идов

et al. 2020

SMJ

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This literature review presents the analysis of different techniques for approaches and cerebral and cardiac protection in surgical correction of coarctation of the aorta (CoA) with tubular aortic arch hypoplasia. Various definitions of tubular hypoplasia are reviewed. The attempt is made to bring together theoretical basis and data concerning the results of particular methods. The authors investigate up-to-date literature data based on results using thoracotomy and sternotomy approaches in CoA correction with tubular aortic arch hypoplasia. Literature results of operations using these approaches and authors' rival opinions for different methods are presented. The impact of hypothermia and its physiological effects on the brain and the late neurological outcomes of deep hypothermic circulatory arrest are discussed. Advantages and disadvantages of deep hypothermic circulatory arrest and selective cerebral perfusion and authors' opposite opinions on these techniques are presented. The methods of selective cerebral perfusion control and strategies to assess its adequacy are briefly described. Coronary perfusion peculiarities, hypothermic cardioplegia effects on the myocardium, and disadvantages of hyperkalemic cardioplegia are summarized. Based on literature data, the authors justify the implementation of selective coronary perfusion for the correction of CoA with tubular aortic arch hypoplasia.

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The Neonatal Hypoplastic Aortic Arch: Decisions and More Decisions

Cited by 38 publications

References 27 publications

Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

Comparison of different surgical techniques for repair of aortic coarctation in childhood

Selective cerebral and coronary perfusion in the correction of coarctation of the aorta with tubular aortic arch hypoplasia (literature review)

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