RF22 EXTRA-ANATOMIC BYPASS IN AN INFANT WITH SEVERE AORTIC ARCH AND THORACIC DESCENDING AORTA THROMBOSIS

Abstract

Background: Aortic arch thrombosis in neonates and infants is a rare and potentially life threatening condition. The initial management usually entails anticoagulation or thrombolysis, but in some cases surgery is needed. Objective: The aim of this report is to describe a rare case of an infant with aortic arch and thoracic descending aortic thrombosis. Clinical Presentation: A 2 month-old and 4.1 kg infant was admitted to our department with clinical signs of heart failure and feeble femoral pulse. Echo examination showed severe ventricular dysfunction and signs of aortic arch thrombosis. Due to hemodynamic instability, the patient was intubated and inotropes were started. A CT-Scan was performed, which confirmed the diagnosis. Management: Medical therapy failed to resolve the problem. Therefore, rescue surgical operation was indicated. The infant underwent extra-anatomic bypass via a postero-lateral thoracotomy with a 4 mm Goretex graft placed between the left caroted artery and the descending aorta. The post-operative course was uneventful and the infant was discharged after 2 months with appropriate anticoagulation therapy. At 14 months after surgery, the patient had severe hypertension (165 mmHg). A CT-Scan was performed and showed patency of the by-pass. Cardiac Cath study demonstated a DP of 50 mmHg. Echo showed a good cardiac function with persistent hypertrophy. The patent was scheduled for surgery and underwent total aortic arch replacement with aortic arch homograft. Conclusions: The present anecdotal experience suggests that various types of extra-anatomic bypass may be used as rescue and potentially definitive therapy to manage aortic arch thrombosis in infancy.