Surgical correction of aortic arch hypoplasia associated with crestlike protrusion of the superior arch wall and isthmic coarctation.

Abstract

Aortic arch hypoplasia with varying degrees of severity is frequently seen in infants who have isthmic coarctation. In some cases of severe aortic arch hypoplasia, the superior aortic wall between the origins of the arch vessels becomes invaginated into the lumen like a crest. Extended end-to-end anastomosis can produce only limited relief of the arch hypoplasia. Although optimal surgical management of infants with aortic coarctation and concomitant hypoplastic arch remains controversial, we recognize, on the basis of our experience, that any persistent aortic arch stenosis after surgery can increase the prevalence of chronic systemic arterial hypertension in these patients. For this reason, we strongly believe that aggressive surgical enlargement of the hypoplastic arch segment at the time of infant coarctation repair to restore a homogeneous aortic arch like a “romanesque arch” is mandatory. We describe herein a modification of the technique previously reported by Amato, Rheinlander, and Cleveland,1 which provides an excellent option to the surgeon for the management of arch hypoplasia associated with crestlike protrusion of superior aortic arch wall. Patients. From January 1997 to December 1999, 80 patients underwent surgical repair of aortic coarctation and associated aortic arch hypoplasia. In 36 of these patients, the diameter of the distal aortic arch was less than 30% of that of the descending aorta, and preoperative echocardiographic SURGICAL CORRECTION OF AORTIC ARCH HYPOPLASIA ASSOCIATED WITH CRESTLIKE PROTRUSION OF THE SUPERIOR ARCH WALL AND ISTHMIC COARCTATION