scholarly journals Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect

2020 ◽  
Vol 87 (7-8) ◽  
pp. 29-32
Author(s):  
Ya. P. Тruba ◽  
А. А. Dovhaliuk ◽  
І. V. Dzyurii ◽  
P. А. Danchenko ◽  
О. S. Golovenko ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Late Results ◽  
Neurological Complications ◽  
Aortic Arch Reconstruction ◽  
Complete Form ◽  
Staged Approach ◽  
Arch Reconstruction

Objective. Tactics of treatment and results of the hypoplasia of the aortic arch correction in newborn babies with complete form of atrio-ventricular septal defect were studied. Маterials and methods. During period from 2011 tо 2019 yrs in 21 patients correction of hypoplasia of aortic arch and atrio-ventricular septal defect were performed. The investigated group consisted of patients with a two-ventricular physiology. The patients, suffering imbalanced form of atrio-ventricular septal defect and with variants of hypoplasia in left parts of the heart, were excluded from the investigation. There were 9 (42.9%) boys and 12 (57.1%) girls. Average age of the patients have constituted (2.3 ± 1.1) mo (from 0.06 до 7.7 mo). Average body mass of the patients have constituted (3.8 ± 1.0) kg (from 2.0 до 5.9 kg). The aortic arch segment was considered a hypoplastic one if a Z-score (Standard Score - standard estimation) shift have constituted lesser than 2.0. Results. Hospital lethality have constituted 14.2%. Three newborn babies died: 2 - after first stage of correction, and 1 - after second stage of correction. All the patients, to whom a one-staged correction was done, have survived. The causes of lethality were not connected with method of the aortic arch reconstruction. While performance of echocardiography before discharge from the hospital the pressure gradient on place of the aortic arch plasty have constituted (13.6 ± 6.8) mm Hg at average. Average follow-up period have constituted (2.6 ± 2.1) yrs (from 2 mo tо 8.1 yr). In late follow-up period lethality was absent. In 2 (9.5%) patients in postoperative period reoperations on aortic arch and mitral valve were performed. Tracheal compression as well as the main bronchi compression, neurological complications in late follow-up period were absent. Conclusion. For the patients, suffering complete form of atrio-ventricular septal defect in conjunction with hypoplasia of aortic arch the staged correction constitutes a more favorable option, owing good immediate and late results. A staged approach in the treatment is indicated for newborn babies, suffering hypoplasia of distal aortic arch and competent atrio-venticular valves or with small regurgitation. Оne-stage correction is indicated in hypoplasia of aortic arch, pronounced regurgitation on common atrio-ventricular valve and pronounced heart failure.

Double aortic arch: an elusive diagnosis in a child with CHD

2021 ◽  
pp. 1-3
Author(s):  
Mariana Lemos ◽  
Miguel Fogaça da Mata ◽  
Ana Coutinho Santos
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Ct Angiography ◽  
Septal Defect ◽  
Vascular Ring ◽  
Pulmonary Atresia ◽  
Double Aortic Arch ◽  
Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

Surgical repair of interrupted aortic arch with ventricular septal defect

1998 ◽  
Vol 8 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Lindsey D Allan ◽  
Howard D Apfel ◽  
Yosef Levenbrown ◽  
Jan M Quaegebeur
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Ventricular Outflow Tract ◽  
Interrupted Aortic Arch ◽  
Left Ventricular ◽  
Subaortic Stenosis ◽  
Current Debate ◽  
Aortic Orifice

AbstractBackgroundInterrupted aortic arch is often associated with subaortic narrowing and hypoplasia of the aortic orifice. The best surgical strategy for the management of these additional lesions is a matter of current debate.Methods and ResultsBetween 1986 and 1996, 19 patients underwent repair of interrupted aortic arch with closure of ventricular septal defect in a single stage, with no attempt at subaortic resection, irrespective of the dimensions of the left ventricular outflow tract. There was no perioperative hospital mortality, and all patients were alive at 1 year. Follow-up ranges from 0.75 −10 years, with a mean 4.2 ± 3.0 years. Seven patients (37%) have required reintervention for relief of subaortic stenosis, 2 of whom have died.ConclusionsOur results suggest that primary one-stage biventricular repair can be accomplished with low perioperative mortality without addressing the subaortic region. Further long-term follow-up will determine whether this is accomplished at the expense of later morbidity and mortality.

scholarly journals The analyze of neurological complications after aortic arch reconstruction in patients with proximal aortic dissection

2015 ◽  
Vol 17 (2) ◽  
pp. 35
Author(s):  
A. M. Chernyavskiy ◽  
S. A. Alsov ◽  
M. M. Lyashenko ◽  
D. A. Sirota ◽  
D. S. Khvan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Neurological Complications ◽  
Pathological Process ◽  
Arterial Lesions ◽  
Aortic Arch Reconstruction ◽  
Almost All ◽  
Arch Reconstruction ◽  
The Brain

The article analyzes the neurological complications after interventions on the ascending aorta and the aortic arch in dissection I type by De Bakey. Group of authors investigated over a decade of experience in surgery of aortic dissection in both acute and chronic. Authors estimated the incidence of neurological complications after surgical intervention in 124 patients in the early post-operative and long term period. It were studied both qualitative measures (methods of reconstruction of the aortic arch, type of cerebral perfusion, the etiology of the pathological process, comorbidities) and quantitative (the duration of the different stages of surgery, age, height, weight). The analysis revealed that almost all cases of strokes were observed in the older age group and were associated with concomitant occlusive-stenotic arterial lesions caused by Takayasu's syndrome and atherosclerosis, as well as a set of related diseases. Increase in the number of strokes contribute to more complex, and therefore more time-consuming intervention types of reconstruction of the aortic arch. Antegrade perfusion of the brain, to our knowledge, did not have statistically significant advantages over retrograde perfusion or hypothermic circulatory arrest of the brain.

scholarly journals Staged Correction of Pulmonary Atresia, Ventricular Septal Defect and Collateral Arteries

2021 ◽  
Author(s):  
Pieter van de Woestijne ◽  
M. Mokhles ◽  
Ingrid van Beynum ◽  
Peter de Jong ◽  
Jeroen Wilschut ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Pulmonary Vasculature ◽  
Collateral Arteries ◽  
Staged Approach ◽  
The Right ◽  
Rv Function

Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA’s) has a variable anatomy with regard to the pulmonary vasculature, asking for an individualized surgical treatment. A protocol was applied consisting of staged unifocalization and correction. Methods Since 1989 39 consecutive patients were included (median age at first operation 13 months). In selected cases a central aorto-pulmonary shunt was performed as first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Postoperatively and at follow up echocardiographic data were obtained. Results In 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, four of them died. One patient is awaiting further correction. Correction was done successfully in 28 patients. Operative mortality was 3% and late mortality 11%. Median follow-up after correction was 19 years. Eleven patients needed homograft replacement. Freedom from conduit replacement was 88%, 73% and 60% at 5, 10 and 15 years respectively. Right ventricular function was reasonable or good in 75 % of the patients. Conclusions After complete unifocalization 30/37 patients (81%) were considered correctable. The main reasons for palliative treatment without correction were pulmonary hypertension and/or inadequate outgrowth of pulmonary arteries. Staged approach of PA, VSD and SPCA’s results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.

scholarly journals Single-stage repair for coarctation with ventricular septal defect: results of 100 cases at a single centre

2020 ◽  
Vol 31 (4) ◽  
pp. 559-564
Author(s):  
Nguyen Ly Thinh Truong ◽  
Nguyen Tuan Mai ◽  
Tran Quang Vinh ◽  
Doan Vuong Anh ◽  
Mai Dinh Duyen
Keyword(s):  
Survival Rate ◽  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Septal Defect ◽  
Median Sternotomy ◽  
Multivariate Logistic Regression Analysis ◽  
Single Stage ◽  
Selective Cerebral Perfusion

Abstract OBJECTIVES The outcomes of the single-stage surgical repair of aortic arch hypoplasia (AAH) and/or coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remain controversial, especially in a lower middle-income country. This study reports the results of a single-stage repair protocol at our institution for AAH/CoA with VSD using selective cerebral perfusion. METHODS This retrospective study included 100 consecutive patients who underwent single-stage repair via median sternotomy using selective cerebral perfusion for AAH/CoA with VSD from July 2010 to March 2017. RESULTS The patients consisted of 65 males and 35 females. The median age of the patients was 67 days (range 4–2266 days); the median weight was 3.8 kg (range 2.1–15 kg). The average cardiopulmonary bypass time was 132 ± 28 min, the aortic cross-clamp time was 92 ± 23 min and the selective cerebral perfusion time was 33 ± 10 min. The survival rate of all patients was 94.7 ± 2.3%, with an in-hospital mortality of 5% and no late mortality at a median follow-up of 37 months (range 4–96 months). Four patients required reoperation due to recoarctation. The overall event-free survival rate following surgery was 87.1%. The median pressure gradient across the anastomosis at the last follow-up was 8.3 ± 2.8 mmHg. Multivariate logistic regression analysis revealed proximal aortic arch obstruction as a predictor of mortality (odds ratio = 3.8). The aortic isthmus diameter was identified as a predictor for reintervention by Cox regression (hazard ratio = 6.7). CONCLUSIONS Single-stage repair for AAH/CoA with VSD is safe and feasible in a developing country.

Biventricular Repair in Interrupted Aortic Arch Type C With Aortic Atresia

2017 ◽  
Vol 10 (2) ◽  
pp. 228-230 ◽  
Author(s):  
Dhananjay P. Malankar ◽  
Andrew C. Glatz ◽  
Paul M. Weinberg ◽  
James W. Gaynor
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Interrupted Aortic Arch ◽  
Single Stage ◽  
Initial Operation ◽  
Biventricular Repair ◽  
Aortic Atresia ◽  
Type C ◽  
Arch Reconstruction

We report a case of interrupted aortic arch type C with aortic atresia and a ventricular septal defect with two well-developed ventricles, who underwent a successful single-stage biventricular repair with the modified Yasui procedure and arch reconstruction. Angiography done during conduit revision showed bilateral brachiocephalic trunks with high branching. The child is doing well six years after the initial operation.

scholarly journals Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

2019 ◽  
Vol 11 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Yuriy Y. Kulyabin ◽  
Yuriy N. Gorbatykh ◽  
Ilya A. Soynov ◽  
Alexey V. Zubritskiy ◽  
Alexey V. Voitov ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Unit Length ◽  
Kidney Injury ◽  
Neurological Complications ◽  
Lower Body ◽  
Aortic Arch Reconstruction ◽  
Arch Reconstruction ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Background: Aortic arch reconstruction is often challenging, especially in infants, owing to its high postoperative complication risks. This study aimed to compare the effectiveness between selective antegrade cerebral perfusion (SACP) alone and SACP in combination with continuous lower body perfusion with descending aortic cannulation (DAC) in preserving renal function, and to determine the influence of perfusion strategy on the postoperative course of infants who underwent aortic arch reconstruction. Material and Methods: A total of 121 infants who underwent aortic arch reconstruction between January 2008 and December 2018 were included in the analysis. Patients (median age: 29 days, range: 3-270 days) were divided into the following groups: those who underwent repair with SACP (SACP group, 79 patients) and those who underwent additional lower body perfusion (DAC group, 42 patients). Results: Three (7.1%) and nine (11.4%) patients died in the DAC and SACP groups, respectively ( P = .54). The SACP group had more patients requiring renal replacement therapy ( P = .002) and higher incidence of second stage acute kidney injury (AKI) development (Kidney disease improving global outcomes (KDIGO) criteria; P = .032). The SACP group had higher frequency of open chest postoperatively than the DAC group ( P = .011). The DAC group had lower vasoactive inotropic score (VIS) at the first postoperative day ( P < .001) and shorter intensive care unit length of stay ( P = .050). There was no difference in neurological complications between the groups ( P = .061). High VIS was associated with early mortality (odds ratio [OR]: 1.79 [1.33-2.41], P < .001) and AKI (OR: 1.60 [1.35-1.91], P < .001). The DAC perfusion strategy with minimal hypothermia was associated with lower risk of AKI (OR: 0.91 [0.84-0.98], P = .016). Conclusion: Antegrade cerebral perfusion with continuous lower body perfusion via DAC could effectively be used for improving early postoperative results among infants undergoing procedures that include aortic arch reconstruction.

Surgical outcome of Yasui procedure for preserving biventricular function: single centre experience

2021 ◽  
pp. 1-5
Author(s):  
Omar Alhadi ◽  
Mohamed S. Kabbani ◽  
Fahad Alhabshan ◽  
Mohammed Alamer ◽  
Ahmed Alomrani ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Retrospective Chart Review ◽  
Outflow Tract ◽  
Coarctation Of Aorta ◽  
Two Stage ◽  
Biventricular Function

Abstract Background: Yasui procedure is surgical repair intended to preserve biventricular function for patients with left ventricle outflow tract obstruction associated with aortic arch lesions and ventricular septal defect. Methods: Retrospective chart review analysis of all patients who had Yasui procedure (2008–2020) comparing midterm outcome of one versus two stage repair. Results: Twenty patients (70% female) underwent Yasui procedure in our center. Eight patients (40%) had left ventricle outflow tract obstruction /interrupted aortic arch, 7 patients (35%) had left ventricle outflow tract obstruction /coarctation of aorta, 3 patients (15%) had double outlet ventricle and ventricular septal defect that were unattainable for tunneling to one of the semilunar valves without creating obstruction, and 2 patients (10%) had aortic atresia with hypoplastic aortic arch. All patients had associated ventricular septal defect. Fifteen patients (75%) had one-stage repair and 5 patients (25%) had two-stage repair. Means age and weight for one and two-stage repair were 1.3 ± 2 months, 13.4 ± 11.5 months and 3.3 ± 0.6 kg, 7.8 ± 3.4 kg, respectively. During follow up, 8 patients (40%) required re- intervention, mainly for right ventricle–pulmonary artery conduit either dilation or replacement. The average duration of follow up was 5 years with nil mortality. Conclusion: Yasui procedure is effective approach for children who have left ventricle outflow tract obstruction associated with aortic arch anomalies and ventricular septal defect. Survival rate with single or staged repair is comparably good. During the first 5 year of follow up, nearly 40% of operated patients required re-intervention.

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