Single-stage repair of coarctation of aorta or interrupted arch and associated intracardiac defects through median sternotomy / 中华胸心血管外科杂志

ABSTRACT

Objedtve To summarize the experience of single-stage repair of coarctation of aorta(CoA) or interrupted aortic arch (IAA)and associated intracardiac defects through median stemotomy.Methods From Jan 2007 to Jul 2008,a total of 24 pa-tients with CoA or IAA and associated intracardisc defects were surgically repaired in single-stage through median stermotomy,inchud-ing 9 coanctation of aorta,12 coarctation with aortic arch hypoplasia,and 3 interrupted aorlic arch,.The associated intracardiac de-fects were Taussing-Bing anomaly 4,non-restricted VSD 22,subaortic stenosis 1 and pulmonary vein stenosis 1.The age ranged form 1 to 99 months (average 16 months) and the body weight ranged from 4 to 19 kg(average 9.3 kg).Aortic arch reconstruction was performed by hypothermic continuous low flow bypass using regional perfusion for all patients.Three patients with LAA and 9 patients with CoA underwent end-to-end ansetomosis.Of the 12 patients with coarctation and aortic arch hyipoplasia,8 patiellts underwent ex-tended end-to-end anastomosis,2 patients underwent end-to-side anastomosis and 2 patients underwent aortoplasfy.Results 2 cases were dead. One infant with Taussig-Bing type heart was dead of severe infection after 47 days postoperative,the other one who associ-ated with LAA and VSD dead of pulmonary hypertension crisis due to pneumonia after 15 days postoperative.No patient presented neu-rdogieal complication and renal insufficiency during the perioperation.2 cases presented recurrent respiratory problem.During the 18months follow-up,no patient presented with recoarctation except one with pressure gradient more than 20 mm Hg.Conclusion Pa-tients with coarctation of aorta or interrupted aortic arch and associsted intracardisc defects should be surgically treated as early as pos-sible when diagnosis was mode.Single-stage sortic arch reconstruction through median stemotomy using continuous regional perfusion is an effective and safe procedurd.Sufficient resection of ductus,extensive dissection of thoracic vessels and optimal tissus-tissue anas-tomosis techmique are very important for successful repair and avoiding recoarctation.