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Emin Tireli - One of the best experts on this subject based on the ideXlab platform.

  • Case report - Congenital The use of pulmonary autograft patch for type A Aortic Interruption and Swiss-cheese ventricular septal defect (VSD)
    2020
    Co-Authors: Emin Tireli
    Abstract:

    The surgical management of the Aortic Arch pathologies is controversial. Primary anastomosis and patch aortoplasties combined with endto-end anastomosis have some complications like recurrence and aneurysm formation. Surgical repair of apical muscular (Swiss-cheese) defects is also still under debate. A 6-year-old patient with diagnosis of type A Aortic Arch Interruption and Swiss-cheese ventricular septal defect (VSD) underwent successful intracardiac repair and Aortic Arch reconstruction. Aortic Arch reconstruction was done by end-to-side anastomosis of distal Aortic Archus and thoracic aorta without cardiopulmonary bypass. The anterior side of the anastomosis was augmented by using pulmonary autograft patch and this patch was extended to the inferior surface of the Archus aorta. Swiss-cheese VSD was repaired with a single patch using septal obliteration technique via transatrial approach. Pulmonary autograft patch aortoplasty and end-to-side anastomosis may be an alternative surgical management for surgical repair and it may be done without the need for cardiopulmonary bypass. In these patients associated multiple apical muscular VSDs can be repaired with a single patch, septal obliteration technique. q 2003 Elsevier B.V. All rights reserved.

  • Repair of multiple muscular ventricular septal defects: septal obliteration technique.
    Journal of Cardiac Surgery, 2005
    Co-Authors: Gürkan Çetin, Ahmet Özkara, Atif Akcevin, Ali Kubilay Korkut, Ilksen Soyler, Ozge Koner, Emin Tireli
    Abstract:

    Abstract Background: The management of the apical multiple muscular ventricular septal defects (VSDs) remains still controversial. There are various surgical techniques and approaches for closure of “Swiss-cheese” VSDs. In this study, we report the outcome of multiple muscular VSDs repair, using the septal obliteration technique. Methods: We used the septal obliteration technique in five “Swiss-cheese” ventricular septal defects cases through right atriotomy. Four of the cases had isolated multiple VSDs. One case also had an Aortic Arch Interruption type A, which was repaired prior to cardiopulmonary bypass. Their ages varied between 43 days and 6 years. Results: We did not experience any mortality or serious morbidity. Tracheostomy was required in one patient. There was no important residual shunt in postoperative period, except a minimal shunt in one case. Conclusion: The closure technique of “Swiss-cheese” trabecular multiple VSDs using a large single patch was not troubling. Transatrial approach prevented postoperative problems of ventricular incision. Using a large needle with a large pledgett is the key, which provides deep tissue penetration to avoid residual shunt.

  • The use of pulmonary autograft patch for type A Aortic Interruption and Swiss-cheese ventricular septal defect (VSD).
    Interactive Cardiovascular and Thoracic Surgery, 2004
    Co-Authors: Gürkan Çetin, Emin Tireli, Ahmet Özkara, Funda Öztunç
    Abstract:

    : The surgical management of the Aortic Arch pathologies is controversial. Primary anastomosis and patch aortoplasties combined with end-to-end anastomosis have some complications like recurrence and aneurysm formation. Surgical repair of apical muscular (Swiss-cheese) defects is also still under debate. A 6-year-old patient with diagnosis of type A Aortic Arch Interruption and Swiss-cheese ventricular septal defect (VSD) underwent successful intracardiac repair and Aortic Arch reconstruction. Aortic Arch reconstruction was done by end-to-side anastomosis of distal Aortic Archus and thoracic aorta without cardiopulmonary bypass. The anterior side of the anastomosis was augmented by using pulmonary autograft patch and this patch was extended to the inferior surface of the Archus aorta. Swiss-cheese VSD was repaired with a single patch using septal obliteration technique via transatrial approach. Pulmonary autograft patch aortoplasty and end-to-side anastomosis may be an alternative surgical management for surgical repair and it may be done without the need for cardiopulmonary bypass. In these patients associated multiple apical muscular VSDs can be repaired with a single patch, septal obliteration technique.

Hiroshi Kamma - One of the best experts on this subject based on the ideXlab platform.

  • Persistent fifth Aortic Arch associated with type a Aortic Arch Interruption
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2001
    Co-Authors: Naotaka Atsumi, Naoya Moriki, Yuzuru Sakakibara, Toshio Mitsui, Hitoshi Horigome, Hiroshi Kamma
    Abstract:

    A male infant, having a persistent fifth Aortic Arch and Interruption of the aorta distal to the left subclavian artery, underwent successful surgical treatment. A histological study of the excised segment of the aorta showed that the ductal tissue extended to the junction between the fifth Arch and the descending aorta with consequent narrowing in the corresponding region. The ductal tissue, however, did not contribute to occlusion in the fourth Aortic Arch. The morphogenesis of this combination of Aortic Arch anomalies was also discussed.

  • persistent fifth Aortic Arch associated with type a Aortic Arch Interruption histological study and morphogenesis
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2001
    Co-Authors: Naotaka Atsumi, Naoya Moriki, Yuzuru Sakakibara, Toshio Mitsui, Hitoshi Horigome, Hiroshi Kamma
    Abstract:

    A male infant, having a persistent fifth Aortic Arch and Interruption of the aorta distal to the left subclavian artery, underwent successful surgical treatment. A histological study of the excised segment of the aorta showed that the ductal tissue extended to the junction between the fifth Arch and the descending aorta with consequent narrowing in the corresponding region. The ductal tissue, however, did not contribute to occlusion in the fourth Aortic Arch. The morphogenesis of this combination of Aortic Arch anomalies was also discussed.

Vaughn A Starnes - One of the best experts on this subject based on the ideXlab platform.

  • one stage repair of interrupted Aortic Arch ventricular septal defect and subAortic obstruction in the neonate a novel approach
    The Journal of Thoracic and Cardiovascular Surgery, 1996
    Co-Authors: Giovanni Battista Luciani, Ruben J Ackerman, Anthony C Chang, Winfield J Wells, Vaughn A Starnes
    Abstract:

    Abstract Background: One-stage repair of interrupted Aortic Arch, ventricular septal defect, and severe subAortic stenosis represents a surgical challenge. Techniques that use extracardiac conduits to bypass the subAortic area or involve transAortic or transatrial resection of the conal septum have shown limitations and have failed to reduce the high mortality rate associated with subAortic obstruction. Methods and results: A new operative approach was used in nine neonates (2.1 to 3.9 kg) who underwent one-stage repair of interrupted Aortic Arch (type B, eight patients; type C, one patient), ventricular septal defect, and severe subAortic stenosis. All patients had severe subAortic stenosis according to preoperative echocardiography (mean ratio of subAortic to descending Aortic diameter, 0.63 ± 0.08). With a transpulmonary (seven patients) or transatrial (two patients) approach and without resection of the conal septum, the ventricular septal patch was placed on the left side of the septum to deflect the conal septum anteriorly and away from the subAortic area. There were no early or late deaths. Median intensive care unit and hospital stays were 17 days (6 to 47 days) and 21 days (10 to 55 days), respectively. On follow-up echocardiography (1 to 29 months, median 12 months), no patients had significant residual subAortic obstruction and one patient had mild residual Arch obstruction (20 mm Hg). Growth of the subAortic region was demonstrated in all patients (mean ratio of subAortic to descending Aortic diameter, 1.20 ± 0.10; Conclusions: Relief of severe subAortic stenosis during one-stage neonatal repair of Aortic Arch Interruption and ventricular septal defect can be accomplished successfully without resection of the conal septum. (J Thorac Cardiovasc Surg 1996;111:348-58)

Takashi Miyamoto - One of the best experts on this subject based on the ideXlab platform.

  • staged repair of truncus arteriosus with interrupted Aortic Arch adjustable pulmonary artery banding
    The Annals of Thoracic Surgery, 2010
    Co-Authors: Tohru Kobayashi, Takashi Miyamoto, Tomio Kobayashi, Kentaro Ikeda, Kyoko Koizuka, Hirotsugu Okamoto, Kagami Miyaji
    Abstract:

    We report a successful two-stage treatment for an infant with truncus arteriosus with Aortic Arch Interruption. The treatment consisted of flow-adjustable bilateral pulmonary artery banding using clipping and postoperative balloon dilation, followed by staged repair. The merits of this strategy are as follows: (1) bilateral pulmonary artery banding is less invasive than neonatal one-stage repair; (2) use of cardiopulmonary bypass can be avoided in the newborn period; and (3) control of pulmonary blood flow adjusted for body size is possible. Although further studies are needed, our therapeutic strategy might provide a clinically important option for managing severe congenital heart disease.

  • repair of truncus arteriosus and Aortic Arch Interruption outcome analysis
    The Annals of Thoracic Surgery, 2005
    Co-Authors: Takashi Miyamoto, Nicodeme Sinzobahamvya, Daiva Kumpikaite, Boulos Asfour, Joachim Photiadis, Anne Marie Brecher, A E Urban
    Abstract:

    Background The excellent results for repair of truncus arteriosus reported in some centers have not applied to patients with associated interrupted Aortic Arch. This work aims at understanding the discrepancy of results in our own experience. Patients and Methods Ten patients among 83 consecutive children with truncus arteriosus repaired from 1987 to September 2004 who had Aortic Arch Interruption were analyzed, with particular emphasis on clinical presentation and outcome. The comprehensive Aristotle complexity score was calculated for each patient. The Kaplan-Meier method was used to estimate survivals. Results Preoperative mechanical ventilation was necessary in 5 of the 10 patients; 2 of them were moribund. Associated major lesions were as follows: severe (n = 2) and moderate (n = 4) truncal valve regurgitation, coronary artery anomalies (n = 3) and Di-George's syndrome (n = 4). The comprehensive Aristotle score was at least 20 in 6 patients. There were 5 operative deaths (5 of 10); early mortality was 50% (95% confidence limits: 19% to 81%). These deaths occurred in patients with Aristotle score of 20 or greater (5 of 6=83%). All 4 patients who had no moderate or severe truncal valve regurgitation survived the intervention. Survival was a low 37.5% ± 16.1% from 1 year on compared with a high 95.5% ± 2.5% for the 73 patients without Aortic Arch Interruption. Conclusions This study confirms the predictive value of the Aristotle score, hospital mortality being significantly correlated with the highest Aristotle score ( p = 0.024). To improve outcome in these high-risk patients, preoperative management should be optimized, repair should not be delayed, and regurgitant truncal valve should be repaired or replaced.

J Skovranek - One of the best experts on this subject based on the ideXlab platform.

  • repair of persistent truncus arteriosus with interrupted Aortic Arch
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Tomas Tlaskal, B Hucin, Vladimir Kucera, Pavel Vojtovic, Roman Gebauer, V Chaloupecky, J Skovranek
    Abstract:

    Objective: The aim of our study was to analyse experience with repair of truncus arteriosus with interrupted Aortic Arch. Methods: Between 1993 and 2004, eight consecutive patients underwent repair of truncus arteriosus with interrupted Aortic Arch. The median age was 6.5 days (range 1—85 days) and median weight was 3.2 kg (range 2.6—4.8 kg). Five patients had type A and 3 patients had type B Aortic Arch Interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in Aortic Arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit. Results: One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0—11.7 years (median2.6years).Nopatientdiedafterthedischargefromhospital.In4patients1—3reinterventionswererequired0.6—10.0yearsafterrepair. Reoperations wereperformedfor conduitobstructionin2 patients, Aorticregurgitationin2 patients, rightpulmonaryartery stenosisin 2 patients andairwayobstructionin1 patient.In2 patientsconcommitantAorticvalveand conduitreplacementwasrequired.Balloonangioplastyfor Aortic Arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II. Conclusions: Primary repair of persistent truncus arteriosus with interrupted Aortic Arch can be done with low mortality and good mid-term results. Aortic Arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and Aortic insufficiency. # 2005 Elsevier B.V. All rights reserved.

  • Tactics and technique of primary correction of Aortic Arch Interruption using a median sternotomy
    Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 1995
    Co-Authors: Tláskal T, Jan Janoušek, Jan Marek, Kostelka M, Chaloupecký, Kucera, P, J Skovranek
    Abstract:

    : Primary correction of an interrupted Aortic Arch was performed in seven neonates aged 2 to 26 days. The operation was performed from median sternotomy with extracorporeal circulation using hypothermic arrest of the circulation for reconstruction of the Aortic Arch. In all neonates it proved possible to make a direct anastomosis of the ascendent and descendent aorta. At the same time in six children a defect of the ventricular septum was closed, in two the common arterial trunk was corrected, in one resection of subAortic stenosis was performed and in another child correction of the aortopulmonary window. After the operation three neonates died from sepsis and multiorgan failure. At present four patients are alive who, 10 to 20 months after operation, are in a good condition. All have a non-restrictive anastomosis of the aorta. Primary correction of an interrupted Aortic Arch and associated defects is preferred by the authors to two-stage surgery.