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Objective:To investigate the efficacy of descending aortic translocation in relieving the compression of trachea or bronchus caused by aortic deformity.Methods:From January 2017 to July 2019, a total of 11 patients with distal trachea or proximal bronchial stenosis caused by aortic deformity were treated with descending aortic translocation. Cardiac CT and fiberoptic bronchoscopy were performed before surgery. The median age was 55(23-540) days, and the body weight was 4(2.1-9.0)kg. Five patients had a special type of vascular ring(left aortic arch with right descending aorta, small aortic window with funnel chest; left aortic arch with right descending aorta and right artery ligament, vagus right subclavian artery, combined with trachea, carina and left and right bronchial stenosis in 1 case; Right aortic arch with left descending aorta, combined with tracheomalacia stenosis in 1 case; Right aortic arch with left descending aorta combined with broad tracheal stenosis and left pulmonary dysplasia in 1 case) compressed tracheal or bronchial tube in 5 cases. Three patients with left main bronchus constriction after traditional arch disconnection surgery. 3 patients with left main bronchus stenosis before coarctation or interrupted aortic arch.Surgical methods: Descending aortic translocation was performed through a midline sternotomy with cardiopulmonary bypass and deep hypothermia.The proximal descending aorta was transected distal to the left subclavian artery, proximal sutures were performed, and the distal brought up though the transverse sinus caudad to the right pulmonary artery and tracheal carina, and anastomosed in end-to-end fashion to the ascending aorta, and simultaneous correction was performed with intracardiac malformations, such as airway plasty was performed at the same time without improvement after compression of tracheal stenosis.Results:There was no death in the whole group. Median cardiopulmonary bypass was 180(136-337)min with an median aortic cross-clamp time of 51(30-84)min; Median absence of perfusion to the descending thoracic aorta 34(21-50)min .Tracheal compression was effectively relieved in 5 patients, and airway plasty was performed simultaneously in 6 patients due to persistent tracheal softening and stenosis. All patients had resolution of symptoms.There was only one case anastomotic stenosis after descending aortic translocation.The mean follow-up was(18.0±9.4)months.Conclusion:Descending aortic translocation can effectively relieve this kind of pressure due to aortic deformity.
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Objective:This study defined mid-term results of a policy of single-stage repair of interrupted aortic arch associated cardiac anomalies.Methods:Between October 2012 and June 2019, 38 patients with interrupted aortic arch were evaluated for short- and mid-term results after surgical treatment, the average age of patients was(12±7) days and the mean body weight was(3.3±0.5)kg.29 patients belonged to IAA type A, and 7 patients to type B, and 2 patients belonged to IAA type C, 30 patients were complicated with ventricular septal defect, atrial septal defect, and patent ductus arteriosus, two complicated with bicuspid aortic valve, four complicated with Taussig-Bing malformation and two with double outlet right ventricle, one with truncus arteriosus(A4), one with aortopulmonary window, one with left ventricle outflow tract obstruction. Single-stage repair was performed in all patients with cardiac anomalies.Results:Early mortality was 5.2%(2 cases), one was die for low cardiac output syndrome, the other die of septic shock. Median CPB time was 138 min(90-305 min), and median aortic cross clamping time was 68 min(47-163 min). Hospital day was 25d( 13-52 days).32 patients were followed-up, median time 34 months(9-85months). 2 patients(6.0%) were mild pulmonary stenosis pressure(20-25 mmHg), 3 patients(9.3%) suffer aortic anastomosis mild stnosis(21-44)mmHg.1 patient(3.1%) LVOTO was repaired ten months after the repair of interrupted aortic arch. The left broncus of of one patient was mild stenosis but without dyspnea.Conclusion:Single-stage end -to-side anastomosis repair of interrupted aortic arches in neonatal and repair of associated cardiac anomalies is safe and have low effective with low motality.
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Objective To summarize the clinical characteristics and therapeutic effect of congenital vascular rings in in-fants. Methods The clinical data of 54 children with vascular rings were retrospectively analyzed from August 2011 to June 2017 at our center for surgical treatment. Age 2 days to 11 months,the median age was 1 months;weight 1. 4 - 9. 4 kg,the average weight of(4. 52 ± 1. 89)kg. The type of vascular ring includes 21 cases of double aortic arch,right aortic arch with left aortic duct / ligament with or without vagal left subclavian artery in 14 cases,9 cases of pulmonary artery suture,left aortic arch with right aortic duct / ligament with or without 5 cases of oblique right subclavian artery,3 cases of nameless arterial com-pression syndrome,2 cases of other vascular rings. All cases underwent echocardiography,chest radiography,and CT scan of the heart,and 42 cases were examined before operation or intraoperative bronchoscopy. 39 cases(72％)had tracheal stenosis. Results Twenty-six patients underwent extracorporeal circulation underwent vascular anteroposterior surgery with an average extracorporeal circulation time of( 160 ± 61)min and 28 patients underwent extracorporeal circulation. Postoperative mechani-cal ventilation 1 to 22 days,the median number of days 2 days;hospitalization time 7 to 62 days,the median of 19 days,hos-pital death in 2 cases(3. 7％). Discharge patients were followed up for 2 to 74 months,respiratory symptoms to varying degrees to ease or disappear,discharged in 3 cases. Conclusion Airway stenosis is a serious complication of the vascular ring. CT is the best way to determine the vascular ring. To avoid serious airway complications,the vascular ring should be operated as soon as possible,and the airway stenosis and intracardiac malformation Children suggested concurrent treatment,this can improve the survival rate of surgery and improve the prognosis of children.