Comparison of Doty and McGoon techniques for surgical reconstruction of congenital supravalvular aortic stenosis

Abstract Background: We aimed to compare the results of two surgical methods for the treatment of congenital supravalvular aortic stenosis. Methods: From May 2004 to January 2020, 29 patients underwent surgical repair for supravalvular aportic stenosis in a single centre. The perioperative evaluation of the patients was retrospectively reviewed. Results: Fifteen (51.7%) and 14 (48.2%) patients were treated with the Doty and the McGoon methods, respectively. The median age of our cohort was 4.5 (3.0–9.9) years. Ten (34.5%) patients had Williams–Beuren syndrome, and pulmonary stenosis was observed in 12 (41.3%) patients. The median follow-up time was 2.5 (0.7–7.3) years. On follow-up, five patients had residual stenosis with the McGoon technique and one with the Doty technique (p = 0.05). One patient died early in the post-operative period in the Doty group, and three patients were re-operated on due to restenosis in the McGoon group. Freedom from re-operation in the Doty group at 1, 3, 5, and 10 years was 100%. In the McGoon group, freedom from re-operation rates at the 1-, 3-, and 7-year follow-up were 100, 88.9, and 44.4%, respectively (p = 0.08). Conclusion: Our results with both surgical techniques suggest that supravalvular aortic stenosis can be treated with good results. The Doty method provided better relief for the supravalvular aortic segment, considering the residual stenosis and the re-operation rates.

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Surgical Repair for Supravalvular Aortic Stenosis: Intermediate to Long-term Follow-up

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.1997.tb00158.x ◽

1997 ◽

Vol 12 (6) ◽

pp. 398-402 ◽

Cited By ~ 6

Author(s):

Kenji Minakata ◽

Kazunobu Nishimura ◽

Shin-ichi Nomoto ◽

Katsuhiko Matsuda ◽

Toshihiko Ban

Keyword(s):

Aortic Stenosis ◽

Surgical Repair ◽

Supravalvular Aortic Stenosis ◽

Long Term Follow Up

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Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Neurosurgical FOCUS ◽

10.3171/2011.6.focus1193 ◽

2011 ◽

Vol 31 (2) ◽

pp. E4 ◽

Cited By ~ 27

Author(s):

John M. Mesa ◽

Frank Fang ◽

Karin M. Muraszko ◽

Steven R. Buchman

Keyword(s):

Surgical Technique ◽

Surgical Repair ◽

Surgical Techniques ◽

Senior Author ◽

Surgical Correction ◽

Surgical Reconstruction ◽

Calvarial Bone ◽

The Mean ◽

The Aesthetic

Object Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly. Methods The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction. Results The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case). Conclusions Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

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An infant with suspected missed diagnosis of Williams syndrome failed weaning off CPB after surgical correction of pulmonary stenosis: a case report and literature review

Perfusion ◽

10.1177/02676591211046876 ◽

2021 ◽

pp. 026765912110468

Author(s):

Yuan Yuan ◽

Ronghua Zhou

Keyword(s):

Aortic Stenosis ◽

Williams Syndrome ◽

Myocardial Protection ◽

Developmental Disorder ◽

Pulmonary Stenosis ◽

Surgical Correction ◽

Supravalvular Aortic Stenosis ◽

Cardiac Insufficiency ◽

Valvular Stenosis ◽

Missed Diagnosis

Williams syndrome (WS) is a rare congenital developmental disorder caused by the deletion of between 26 and 28 genes on chromosome 7q11.23. For patients with WS, in view of the particularity of the supravalvular aortic stenosis, choosing appropriate arterial cannula, maintaining higher perfusion pressure as well as strengthening myocardial protection during cardiopulmonary bypass (CPB) is essential to the clinical outcome. Here, we report a child with pulmonary artery valvular stenosis who failed to wean off CPB because of malignant arrhythmias and cardiac insufficiency after surgical correction of pulmonary valvular stenosis. With the assistance of extracorporeal membrane oxygenation (ECMO), emergency cardiac catheterization revealed supravalvular aortic stenosis (SVAS), which suggests a suspected missed diagnosis of WS. Finally, under the support of ECMO, the cardiac function gradually returned to normal, and the child was discharged 23 days after surgery.

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Follow-up study of morphology and cardiac function in rats undergoing induction of supravalvular aortic stenosis

Arquivos Brasileiros de Cardiologia ◽

10.1590/s0066-782x2003001400003 ◽

2003 ◽

Vol 81 (6) ◽

pp. 569-575 ◽

Cited By ~ 4

Author(s):

Henrique Barbosa Ribeiro ◽

Katashi Okoshi ◽

Antonio Carlos Cicogna ◽

Edson Antonio Bregagnollo ◽

Maria Aparecida Marchesan Rodrigues ◽

...

Keyword(s):

Aortic Stenosis ◽

Cardiac Function ◽

Supravalvular Aortic Stenosis ◽

Follow Up Study

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Surgical repair of aortic coarctation in adults: half a century of a single centre clinical experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz259 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1178-1185 ◽

Cited By ~ 4

Author(s):

Djamila Abjigitova ◽

Mostafa M Mokhles ◽

Maarten Witsenburg ◽

Pieter C van de Woestijne ◽

Jos A Bekkers ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Repair ◽

Coarctation Of The Aorta ◽

Surgical Reconstruction ◽

Refractory Hypertension ◽

Tertiary Referral Centre ◽

Related Quality ◽

Hospital Morbidity

Abstract OBJECTIVES Coarctation of the aorta (CoA) is rarely diagnosed and treated in adults and nowadays mostly treated with percutaneous techniques. The objective of this study is to report the long-term outcomes and health-related quality of life in a unique cohort of patients treated with an open surgical repair for their primary adult CoA. METHODS Ninety adult patients underwent primary surgical repair of CoA at our tertiary referral centre between 1961 and 2008 when the treatment strategy for adult CoA was exclusively surgical. RESULTS The median age at surgery was 24 years (interquartile range 20–36 years), and 39 patients (43%) were asymptomatic at presentation. CoA was located paraductally in most patients (64%), and bicuspid aortic valve was present in 39 (43%) patients. Surgical reconstruction of CoA with an end-to-end anastomosis was performed in majority of the patients (57%). Overall, in-hospital mortality occurred in 1 patient (1%). There was no in-hospital stroke, spinal cord ischaemia, renal replacement therapy or respiratory failure. The cumulative survival was 97.7%, 89.5%, 82.6%, 70.9% and 61.4% at 10, 20, 30, 40 and 50 years, respectively. Thirty-one patients (34%) required an additional cardiac surgery during follow-up. The majority of patients (77%) suffered from refractory hypertension even after decades of surgery. Compared with the matched Dutch population, patients reported a lower social functioning, mental health, vitality and general health with a higher body pain. CONCLUSIONS Patients with native adult CoA have low in-hospital morbidity and mortality when treated with an open surgical reconstruction. However, refractory hypertension and impaired quality of life remain important challenges during follow-up.

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GP37 Echocardiographic follow-up of children with supravalvular aortic stenosis

10.1136/archdischild-2019-epa.103 ◽

2019 ◽

Author(s):

Betül Çınar ◽

Sezen Ugan Atik ◽

Ayşe Güler Eroğlu ◽

Levent Saltık

Keyword(s):

Aortic Stenosis ◽

Supravalvular Aortic Stenosis

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Avoidance of malignant arrhythmia caused by displacement of the right coronary artery ostium in surgical correction of supravalvular aortic stenosis

Journal of International Medical Research ◽

10.1177/0300060518818021 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5702-5710

Author(s):

Bo Peng ◽

Qiang Wang

Keyword(s):

Coronary Artery ◽

Aortic Stenosis ◽

Right Coronary Artery ◽

Coronary Sinus ◽

Surgical Techniques ◽

Ecmo Support ◽

Supravalvular Aortic Stenosis ◽

Surgical Approaches ◽

Malignant Arrhythmia ◽

The Right

Objective This study was performed to identify the effects of different surgical approaches on the right coronary artery ostium in patients with congenital supravalvular aortic stenosis (SVAS) and to determine how to avoid surgically induced right coronary artery occlusion. Methods The surgical techniques and outcomes of 91 patients who underwent surgical treatment of SVAS from 2008 to 2015 in our institution were retrospectively reviewed to identify the causes of early death, reoperation, and extracorporeal membrane oxygenation (ECMO) support. Results Four perioperative deaths (Doty’s technique, n = 4), six cases of ECMO support (Doty’s technique, n = 4; Brom’s technique, n = 1; McGoon’s technique, n = 1), and eight reoperations (Doty’s technique, n = 5; Brom’s technique, n = 2; McGoon’s technique, n = 1) occurred. In cases of reoperation, adjustment of the shape and position of the right coronary sinus patch relieved the malignant arrhythmia. Conclusion Different surgical techniques have different effects on the right coronary artery. The shape of the patch inserted into the right coronary sinus should be carefully clipped to avoid distortion and ischemia of the right coronary artery.

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