All-autologous Repair Of Late-presenting Aortic Arch Interruption
Sujata Subramanian, MD, Ziyad Binsalamah, Erin Gottlieb, Carlos Mery.
Dell Children's Medical Center, Austin, TX, USA.
Objective: We describe the use of all-autologous sliding arch aortoplasty for repair of a late-presenting child with a long-segment aortic arch interruption.Methods: A 6-year-old girl was found to be hypertensive with a 30-mmHg blood pressure gradient. Echocardiogram and CT angiogram revealed a diffusely hypoplastic aortic arch with a long-segment of interruption at the level of the isthmus and very large and extensive collaterals. (Figure 1) Results:After complete mobilization of the ascending aorta, arch, brachiocephalic vessels and proximal descending aorta, cardiopulmonary bypass was established through innominate arterial graft and bicaval cannulation. Extensive collaterals were ligated and divided. After cooling to 18 degrees, and cardioplegic arrest, selective antegrade cerebral perfusion was instituted. The 1.5 cm atretic segment of isthmus was excised and a sliding arch aortoplasty repair was performed. (Figure 2) At the end of the procedure, there was no gradient between the upper and lower extremities. Post-operative CT angiography showed a widely open reconstructed arch. Conclusions: All-autologous sliding arch aortoplasty can be used even in cases of long-segment aortic coarctation with a good result. This technique allows for continued growth and may minimize the need for future re-intervention.
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