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J Skovranek - One of the best experts on this subject based on the ideXlab platform.
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repair of persistent truncus arteriosus with Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 2005Co-Authors: Tomas Tlaskal, B Hucin, Vladimir Kucera, Pavel Vojtovic, Roman Gebauer, V Chaloupecky, J SkovranekAbstract: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.
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results of primary and two stage repair of Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 1998Co-Authors: Tomas Tlaskal, B Hucin, V Chaloupecky, Jaroslav Hruda, Jan Marek, M Kostelka, Jan Janousek, J SkovranekAbstract:Objective: Early results of primary and two-stage repair of Interrupted Aortic Arch have improved. Experience with different surgical approaches should be analysed and compared. Methods: Forty neonates and infants with Interrupted Aortic Arch underwent primary repair (19 patients) or palliative operation (21 patients). Twenty (50%) patients were followed-up for 5.1 ∠ 4.3 years. All patients were regularly examined with the aim of determining clinical development, presence of residual lesions or complications and need for re-intervention. Aortic Arch and the left ventricular outflow tract growth were assessed by echocardiographic examination. Data from hospital and outpatient department records were analysed. Results: The early mortality was 61.9% after palliative operations and 36.8% after the primary repair. Presence of complications (P , 0.001), earlier year of surgery (P , 0.01), bad clinical condition and acidosis ( P , 0.05) represented statistically significant risk factors for death in the whole series. In seven (87.5%) out of eight early survivors, after the initial palliative operation, closure of ventricular septal defect and debanding were done, and in three (37.5%) patients, re-operation for Aortic Arch obstruction was also required. Out of 12 patients, after the primary repair, one required early re-operation for persistent left ventricular outflow tract obstruction and two needed late re-intervention for left bronchus obstruction. In three (25%) patients, after the primary repair, left ventricular outflow tract obstruction with a maximal systolic pressure gradient higher than 30 mmHg developed. At present, all 20 early survivors are alive. Five patients, after palliative operation, are in NYHA class I, but in three patients, who are in class III or IV, the outcome is influenced by severe complications. All patients after the primary repair are in class I or II. Conclusions: Our experience confirmed better results after the primary repair of Interrupted Aortic Arch, which was associated with lower mortality, prevalence of severe complications and need for re-intervention. Higher prevalence of subAortic stenosis after primary repair could be explained by patient selection early in our experience. We recommend the primary repair of Interrupted Aortic Arch and associated heart lesions in neonates, however, in unfavourable conditions an individualised surgical approach with initial palliative surgery should be considered. © 1998 Elsevier Science B.V. All rights reserved
Tomas Tlaskal - One of the best experts on this subject based on the ideXlab platform.
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repair of persistent truncus arteriosus with Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 2005Co-Authors: Tomas Tlaskal, B Hucin, Vladimir Kucera, Pavel Vojtovic, Roman Gebauer, V Chaloupecky, J SkovranekAbstract: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.
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results of primary and two stage repair of Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 1998Co-Authors: Tomas Tlaskal, B Hucin, V Chaloupecky, Jaroslav Hruda, Jan Marek, M Kostelka, Jan Janousek, J SkovranekAbstract:Objective: Early results of primary and two-stage repair of Interrupted Aortic Arch have improved. Experience with different surgical approaches should be analysed and compared. Methods: Forty neonates and infants with Interrupted Aortic Arch underwent primary repair (19 patients) or palliative operation (21 patients). Twenty (50%) patients were followed-up for 5.1 ∠ 4.3 years. All patients were regularly examined with the aim of determining clinical development, presence of residual lesions or complications and need for re-intervention. Aortic Arch and the left ventricular outflow tract growth were assessed by echocardiographic examination. Data from hospital and outpatient department records were analysed. Results: The early mortality was 61.9% after palliative operations and 36.8% after the primary repair. Presence of complications (P , 0.001), earlier year of surgery (P , 0.01), bad clinical condition and acidosis ( P , 0.05) represented statistically significant risk factors for death in the whole series. In seven (87.5%) out of eight early survivors, after the initial palliative operation, closure of ventricular septal defect and debanding were done, and in three (37.5%) patients, re-operation for Aortic Arch obstruction was also required. Out of 12 patients, after the primary repair, one required early re-operation for persistent left ventricular outflow tract obstruction and two needed late re-intervention for left bronchus obstruction. In three (25%) patients, after the primary repair, left ventricular outflow tract obstruction with a maximal systolic pressure gradient higher than 30 mmHg developed. At present, all 20 early survivors are alive. Five patients, after palliative operation, are in NYHA class I, but in three patients, who are in class III or IV, the outcome is influenced by severe complications. All patients after the primary repair are in class I or II. Conclusions: Our experience confirmed better results after the primary repair of Interrupted Aortic Arch, which was associated with lower mortality, prevalence of severe complications and need for re-intervention. Higher prevalence of subAortic stenosis after primary repair could be explained by patient selection early in our experience. We recommend the primary repair of Interrupted Aortic Arch and associated heart lesions in neonates, however, in unfavourable conditions an individualised surgical approach with initial palliative surgery should be considered. © 1998 Elsevier Science B.V. All rights reserved
Yoshiyuki Maekawa - One of the best experts on this subject based on the ideXlab platform.
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Aortic Arch reconstruction for Interrupted Aortic Arch using an aberrant right subclavian artery
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Yoshiyuki Maekawa, Takahiko Sakamoto, Kentaroh Umezu, N Ohashi, Yorikazu HaradaAbstract:An aberrant right subclavian artery can be used in a variety of ways in complex Aortic Arch reconstructions, including reconstruction of an Interrupted Aortic Arch. Here, we described the case of a 4-month-old female infant with a type B Interrupted Aortic Arch, who underwent Arch reconstruction using an aberrant right subclavian artery.
Richard A. Jonas - One of the best experts on this subject based on the ideXlab platform.
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management of Interrupted Aortic Arch
Seminars in Thoracic and Cardiovascular Surgery, 2015Co-Authors: Richard A. JonasAbstract:The introduction of prostaglandin E1 in the late 1970s revolutionized the management of Interrupted Aortic Arch. Complete resuscitation should proceed over several days if necessary before surgery is undertaken. One-stage primary neonatal repair with direct Arch anastomosis and ventricular septal defect closure is the preferred surgical approach. Selective cerebral perfusion with near–infrared monitoring is being used with increasing frequency. Although repair of Interrupted Arch is physiologically corrective, it should not be viewed as fully corrective because of the high incidence of important late left ventricular outflow tract obstruction. This may respond to a simple surgical reintervention such as subAortic resection, but in some cases, an extensive procedure to enlarge the left ventricular outflow tract is necessary. However, procedures directed against subAortic stenosis should rarely be used as part of the initial surgical management during the neonatal period. Careful developmental follow-up is needed for all patients because of the high incidence of DiGeorge syndrome, which frequently manifests as moderately severe developmental delay.
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echocardiographic predictors of left ventricular outflow tract obstruction after repair of Interrupted Aortic Arch
Journal of the American College of Cardiology, 1993Co-Authors: Tal Geva, Richard A. Jonas, Lisa K Hornberger, Stephen P Sanders, Steven D ColanAbstract:Abstract Objectives . This study was designed to identify preoperative echocardiographic predictors of left ventricular outflow tract obstruction after repair of Interrupted Aortic Arch and ventricular septal defect closure. Background . Left ventricular outflow tract obstruction becomes apparent in nearly 50% of patients after repair of Interrupted Aortic Arch and ventricular septal defect closure but is seldom recognized preoperatively. Methods . We analyzed the preoperative echocardiograms of all patients with Interrupted Aortic Arch who had postoperative echocardiographic or catheterization data available. Thirty-seven infants (aged 1 day to 10 months, median 5 days) were included. Off-line measurements were performed on hard copies of selected images. The cross-sectional area (indexed to body surface area) and diameters (indexed to the square root of body surface area) of the left ventricular outflow tract; ascending and descending aorta; ventricular septal defect; and mitral, Aortic and pulmonary valves were compared with outcome by using analysis of variance. Outcome was classified according to development of postoperative left ventricular outflow tract Doppler gradient (Group 1 ≤ 20 mm Hg, Group 2 > 20 mm Hg). Results . The cross-sectional area of the left ventricular outflow tract was significantly smaller in patients who did than in those who did not develop subAortic obstruction ([mean ± SD] 0.64 ±0.25 vs. 1.7 ± 1.01 cm 2 /m 2 , p Conclusions . The preoperatively measured cross-sectional area of the left ventricular outflow tract is significantly smaller in patients with Interrupted Aortic Arch who develop subAortic obstruction postoperatively, with a left ventricular outflow tract area ≤ 0.7 cm 2 /m 2 being a sensitive predictor. Aortic Arch anatomy (i.e., type of Interrupted Aortic Arch and presence of aberrant right subclavian artery) is also predictive of postoperative left ventricular outflow tract obstruction, possibly by influencing the volume of blood flow across the left ventricular outflow tract. These data should enable preoperative identification of infants who may require surgical relief of subAortic stenosis.
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One-stage repair of absence of the aortopulmonary septum and Interrupted Aortic Arch
The Annals of Thoracic Surgery, 1990Co-Authors: Wen-xiang Ding, Zhao-kang Su, Richard A. JonasAbstract:Abstract Absence of the aortopulmonary septum, Interrupted Aortic Arch, Aortic origin of the right pulmonary artery, intact ventricular septum, and patent ductus arteriosus is a rarely reported association. A 3-year-old boy underwent successful one-stage repair of this constellation of anomalies. A Dacron baffle was used both to close the huge aortopulmonary window and to direct blood to the right pulmonary artery. Type A Interrupted Aortic Arch was repaired by direct anastomosis. Postoperatively, pulmonary artery pressure was less than half systemic pressure.
V Chaloupecky - One of the best experts on this subject based on the ideXlab platform.
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repair of persistent truncus arteriosus with Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 2005Co-Authors: Tomas Tlaskal, B Hucin, Vladimir Kucera, Pavel Vojtovic, Roman Gebauer, V Chaloupecky, J SkovranekAbstract: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.
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results of primary and two stage repair of Interrupted Aortic Arch
European Journal of Cardio-Thoracic Surgery, 1998Co-Authors: Tomas Tlaskal, B Hucin, V Chaloupecky, Jaroslav Hruda, Jan Marek, M Kostelka, Jan Janousek, J SkovranekAbstract:Objective: Early results of primary and two-stage repair of Interrupted Aortic Arch have improved. Experience with different surgical approaches should be analysed and compared. Methods: Forty neonates and infants with Interrupted Aortic Arch underwent primary repair (19 patients) or palliative operation (21 patients). Twenty (50%) patients were followed-up for 5.1 ∠ 4.3 years. All patients were regularly examined with the aim of determining clinical development, presence of residual lesions or complications and need for re-intervention. Aortic Arch and the left ventricular outflow tract growth were assessed by echocardiographic examination. Data from hospital and outpatient department records were analysed. Results: The early mortality was 61.9% after palliative operations and 36.8% after the primary repair. Presence of complications (P , 0.001), earlier year of surgery (P , 0.01), bad clinical condition and acidosis ( P , 0.05) represented statistically significant risk factors for death in the whole series. In seven (87.5%) out of eight early survivors, after the initial palliative operation, closure of ventricular septal defect and debanding were done, and in three (37.5%) patients, re-operation for Aortic Arch obstruction was also required. Out of 12 patients, after the primary repair, one required early re-operation for persistent left ventricular outflow tract obstruction and two needed late re-intervention for left bronchus obstruction. In three (25%) patients, after the primary repair, left ventricular outflow tract obstruction with a maximal systolic pressure gradient higher than 30 mmHg developed. At present, all 20 early survivors are alive. Five patients, after palliative operation, are in NYHA class I, but in three patients, who are in class III or IV, the outcome is influenced by severe complications. All patients after the primary repair are in class I or II. Conclusions: Our experience confirmed better results after the primary repair of Interrupted Aortic Arch, which was associated with lower mortality, prevalence of severe complications and need for re-intervention. Higher prevalence of subAortic stenosis after primary repair could be explained by patient selection early in our experience. We recommend the primary repair of Interrupted Aortic Arch and associated heart lesions in neonates, however, in unfavourable conditions an individualised surgical approach with initial palliative surgery should be considered. © 1998 Elsevier Science B.V. All rights reserved
