Long-term evolution of aortic arch interruption repair with pulmonary artery autograft

Abstract

Surgical correction of the aortic arch interruption (IAA) is regularly complicated by anastomosis stenosis or the long-term occurrence of arterial hypertension. In order to prevent these complications, a new surgical technique has been developed in our center consisting of the interposition of a segment of the main pulmonary artery to enlarge the aortic anastomosis. The purpose of this study was to assess the 10 years outcome of this intervention. Four children undergoing this surgery with a follow-up over 10 years were retrospectively included. Data collected focused on the last measure of blood pressure (BP), the last echocardiographic evaluation, and the aortic arch dimension on the last CT. The whole patients had IAA type B and 22q11 microdeletion. The median follow-up duration was 13.9 years (range: 9.3 to 15.3). None of them had a new surgery of the aortic arch, but one need enlargement of ascending aorta. Only one patient developed a mild restenosis at the isthmic insertion of the pulmonary autograft [Z score −2.7 at CT ( Fig. 1 C)], responsible of mild arterial hypertension (systolic BP 75th percentile, diastolic BP 98th percentile), and a left ventricle hypertrophy (Z score IVSd 2.5, Z Score LVPWd 2.1). The three others patients displayed normal BP, no left ventricular hypertrophy, no significant aortic arch obstruction on Doppler evaluation and minimum Z score of aortic arch at CT from −1.8 to −0.4 ( Fig. 1 A, B, D). None of them did experience a main pulmonary artery stenosis. Reconstruction of the aortic arch with a pulmonary artery autograft for the correction of IAA provides a good long-term result.