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Aortic Arch Interruption

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Emin Tireli – 1st expert 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 – 2nd expert 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 – 3rd expert 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)