Surgical Treatment Of Aortic Coarctation Research Articles

Surgical treatment of aortic coarctation under normothermia without cardiopulmonary bypass: a report of 15 cases

To evaluate the early and mid-term outcome of surgical repair for post-ductal coarctation of the aorta (CoA) under normothermia without cardiopulmonary bypass. Clinical data from 15 patients (11 males, 4 females, mean age 18 +/- 10 years) undergoing surgical repair for post-ductal CoA under normothermia without cardiopulmonary bypass between January 1999 and December 2004 were analyzed retrospectively. There were 7 isolated cases, 7 cases associated with patent ductus arterious (PDA), 1 case with PDA and ventricular septal defects. Operation was performed under normothermia with partial cross-clamping of descending aorta in 8 cases, compete cross-clamping in 6 cases and temporary shunt in 1 case. Operative techniques adopted prosthetic bypass graft in 9 cases, Gore-Tex patch graft aortoplasty in 4 cases and stenosis resection with end-to-end anastomosis in 2 cases. PDA was ligated at single-stage in 8 cases. Ventricular septal defect was repaired at second stage in 1 case. No early and late death. Hypertension occurred in 9 cases during early postoperative period but was normalized gradually in 5 cases without medication during follow-up period, from 6 months to 5 years. The arterial blood pressure of lower extremities increased significantly and no hoarseness, paraplegia occurred after operation. No recoarctation and aneurysm formation were found during follow-up. Surgical repair of post-ductal CoA under normothermia without cardiopulmonary bypass is safe and effective, which is a procedure of choice for patients with isolated CoA, CoA associated with PDA, or with other intracardiac anomalies that are ready to be repaired at second-stage.

Ascending Aorta-to-Descending Aorta Bypass via Right Thoracotomy for the Re-Coarctation of the Aorta: An Alternative Surgical Approach for Re-Coarctation

Surgical treatment of aortic coarctation is performed with low postoperative complication rates. However, some patients may require additional surgical interventions due to stenosis or re-coarctation of the aorta, and ascending-to-descending aortic bypass via right thoracotomy is a valid alternative approach in the adult population group. Risk of massive intraoperative bleeding due to adhesions at the previous left thoracotomy site and the risk of spinal cord ischemia due to aortic cross-clamping or injury to the recurrent laryngeal nerve may be avoided with right thoracotomy in such cases. In this report, we present an adult patient with re-coarctation of the aorta who was successfully treated by extra-anatomic ascending-to-descending aortic bypass via right thoracotomy without cardiopulmonary bypass.

A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band

OBJECTIVESWe propose a new strategy using coarctation repair together with a polidioxanone absorbable pulmonary artery banding to limit operative risk and to spare infants with aortic coarctation subsequent operations.BACKGROUNDThe alternative for the surgical management of aortic coarctation associated with ventricular septal defect (VSD) is single-stage repair versus coarctation repair with or without banding of the pulmonary artery.METHODSEleven infants (mean weight 2,560 ± 1,750 g, range 1,320 to 3,800 g) underwent a coarctation repair with a polydioxanone banding. Seven had a trabecular and four a perimembranous VSD. The mean size of the VSD was 5 ± 0.7mm (range 4 to 7 mm). The systolic pulmonary pressure was >80% of the aortic pressure in all. The pulmonary band was tightened until the systolic pulmonary pressure fell below 50% of the aortic pressure.RESULTSThere were no hospital deaths. The reabsorption of the banding was complete after 5.7 months in all patients (3 to 6.5 months). The VSD closed completely in four infants and partially in six, in whom the pulmonary artery pressure was normal without evidence for significant left-to-right shunt. One patient with a large trabecular VSD underwent surgical closure of his defect after four months. Finally, a subsequent open-heart surgery could be avoided in 91% (10/11) of patients.CONCLUSIONSProvided the VSD belongs to types prone to close spontaneously, this policy may reduce the number of surgical procedures per infant as well as in-hospital mortality and morbidity rates. It should be proposed as an alternative to more complex procedures.

A New Strategy for the Surgical Treatment of Aortic Coarctation Associated With Ventricular Septal Defect in Infants Using an Absorbable Pulmonary Artery Band

A New Strategy for the Surgical Treatment of Aortic Coarctation Associated With Ventricular Septal Defect in Infants Using an Absorbable Pulmonary Artery Band

A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band

A new strategy for the surgical treatment of aortic coarctation associated with ventricular septal defect in infants using an absorbable pulmonary artery band

Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990: Success of extended end-to-end arch aortoplasty

There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end-to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25% and 33% of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57% (confidence limits 28% to 78%) after subclavian flap angioplasty, 77% (confidence limits 60% to 87%) after end-to-end anastomosis, 83% (confidence limits 66% to 92%) after extended end-to-end anastomosis and 96% (confidence limits 77% to 100%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies. (J THORAC CARDIOVASC SURG 1994;107:74-86)

Atypical aortic coarctation (author's transl)

Special problems in the surgical treatment of aortic coarctation may be caused by unusual morphological findings as a long hypoplastic segment, the combination with pre- or poststenotic aneurysms or by atypical localisation of the stenosis in the aortic arch, the decreasing or abdominal aorta. A bypass procedure is considered as the method of choice for the repair of coarctation in the aortic arch or the "critical zone" of the abdominal aorta (renal- and suprarenal segment). The bypass-principle allows many variations of branching and avoids cross-clamping of the aorta. The involvement of important branches as is the left common carotid, the superior mesenteric or the renal artery, necessitates a vascular reconstruction in the same session. Probably the first report about a very rare combined lesions is presented: the combination of an aortic arch coarctation in association with a complete situs inversus (right descending aorta), a common carotid trunc, an aneurysm of the left subclavian artery (first branch of the arch) and congenital cysts of the right upper lobe of the lung (Case No. 1). Usually concomitant aneurysms are found in the pre- or poststenotic aortic segment. Some of the infrarenal fusiform aneurysms (Case No. 4 and 5) are occasionally of poststenotic origin, secondary to a longstanding infrarenal coarctation. In these cases the procedure of choice is the total exstirpation and the interposition of a Dacrongraft. Important branches (as the subclavian or renal artery) can be some times inserted directly in the vascular protheses. Using the bypass technic or the patch graftplastic of Vosschulte the risk of late operation (beyond the age of 30 years) may be remarkably reduced.