Arcus Aorta Reconstructions in Neonates and Early Infants

Abstract

Introduction: Various instances of aortic arch hypoplasia (AAH) with a wide spectrum of severity have been observed in the neonatal patients. The purpose of this paper is to discuss the aortic arch reconstruction in the coarctation of the aorta and AAH while focusing on the surgical decisions and patient management for the neonatal and infant patients. Patients and Methods: We performed a retrospective review of 15 patients who underwent aortic arch reconstruction. Importantly, we investigated postoperative outcomes with associated complex congenital heart diseases. Results: The median age and mean weight of the patients were 74 days (range: 4-306 days) and 4192 ± 1253 gram, respectively. The surgical correction of aortic arch congenital abnormalities was performed under selective antegrade cerebral perfusion in all the 15 patients. All the reconstructions were performed with pericardial patch, and the coarcted segment of the aorta was completely resected in seven of the patients. One-stage repair was performed in the seven of the patients. The mean follow-up time was 13.7 ± 9.3 months. In one patient, transcatheter balloon angioplasty was performed for re-coarctation six months after operation. There was one early and one late mortality. Conclusion: Aortic arch reconstruction can be performed with a low mortality and morbidity in the newborn and infants.

Keywords

• Arch of the aorta
• reconstructive surgical procedure
• aortic arch reconstruction
• neonate

Yenidoğan ve Bebeklik Döneminde Arkus Aorta Rekonstrüksiyonları

Abstract

Giriş: Aortik ark hipoplazisinin çeşitliliği yenidoğan hastalarda geniş bir spektrumda görülebilir. Bu yazıda koarktasyon ve hipoplastik aortik ark tanılı hastalarda, aortik ark rekonstrüksiyonu tartışılacak, yenidoğan ve bebek hastalarda cerrahi kararlara ve hasta yönetimine odaklanılacaktır. Hastalar ve Yöntem: Aortik ark rekonstrüksiyonu yapılan 15 hasta retrospektif olarak incelendi. Beraberinde komplike doğumsal kalp hastalıkları bulunan bu hastalarda operasyon sonrası cerrahi sonuçları araştırıldı. Bulgular: Hastaların ortanca yaşı 74 gün (4-306 gün) ve ortalama ağırlığı 4192 ± 1253 gram idi. Aortik ark doğumsal hastalığının cerrahi tedavisi, 15 hastada antegrad serebral perfüzyon ile yapılmıştır. Bütün hastalarda aortik rekonstrüksiyon perikardiyal yama ile yapılmış ve yedi hastada koarkte segment tamamen rezeke edilmiştir. Hastaların yedisinde tek aşamalı onarım gerçekleştirilmiştir. Ortalama takip süresi 13.7 ± 9.3 aydı. Bir hastaya tekrar gelişen aort koarktasyonu nedeniyle ameliyat sonrası altıncı ayda balon anjiyoplasti uygulanmıştır. Takip sırasında bir erken ve bir geç mortalite saptanmıştır. Sonuç: Yenidoğan ve bebeklerde aortik ark rekonstrüksiyonları düşük mortalite ve morbidite oranlarıyla yapılabilmektedir.

Keywords

• Arkus aorta hipoplazisi
• cerrahi düzeltme

References

1. 1. Ma ZL, Yan J, Li SJ, Hua ZD, Yan FX, Wang X, et al. Coarctation of the aorta with aortic arch hypoplasia: midterm outcomes of aortic arch reconstruction with autologous pulmonary artery patch. Chin Med J (Engl) 2017;130:2802-7.
2. 2. Rüffer A, Bechtold C, Purbojo A, Toka O, Glöckler M, Dittrich S, et al. Aortic arch obstruction neonates with biventricular physiology: left-open compared to closed inter-atrial communication during primary repair-a retrospective study. J Cardiothorac Surg [Internet] 2015;10:1-9.
3. 3. Poncelet AJ, Henkens A, Sluysmans T, Moniotte S, de Beco G, Momeni M, et al. Distal aortic arch hypoplasia and coarctation repair: a tailored enlargement technique. World J Pediatr Congenit Heart Surg 2018;9:496-503.
4. 4. Roussin R, Belli E, Lacour-Gayet F, Godart F, Rey C, Bruniaux J, et al. Aortic arch reconstruction with pulmonary autograft patch aortoplasty. J Thorac Cardiovasc Surg 2002;123:443-50.
5. 5. Kostelka M, Walther T, Geerdts I, Rastan A, Jacobs S, Dähnert I, et al. Primary repair for aortic arch obstruction associated with ventricular septal defect. Ann Thorac Surg 2004;78:1989-93.
6. 6. Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the task force of the pediatric council of the American Society of Echocardiography. J Am Soc Echocardiogr 2006;19:1413-30.
7. 7. Backer CL, Mavroudis C. Congenital heart surgery nomenclature and database project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg 2000;69(4 Suppl):1998-9.
8. 8. Karl TR, Sano S, Brawn W, Mee RBB. Repair of hypoplastic or interrupted aortic arch via sternotomy. J Thorac Cardiovasc Surg 1992;104:688-95.

9. 9. Rao RP, Connolly D, Lamberti JJ, Fripp R, El Said H. Transverse aortic arch to descending aorta ratio: A new echocardiographic parameter for management of coarctation of the aorta in the infant. Congenit Heart Dis 2012;7:160-9.
10. 10. Langley SM, Sunstrom RE, Reed RD, Rekito AJ, Gerrah R. The neonatal hypoplastic aortic arch: Decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2013;16(1):43-51.
11. 11. Tulzer A, Mair R, Kreuzer M, Tulzer G. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg 2016;152:1506-13.
12. 12. Dave H, Rosser B, Reineke K, Nguyen-Minh S, Knirsch W, Pretre R. Aortic arch enlargement and coarctation repair through a left thoracotomy: Significance of ductal perfusion. Eur J Cardiothoracic Surg 2012;41:906-12.
13. 13. Bechtold C, Purbojo A, Schwitulla J, Glöckler M, Toka O, Dittrich S, et al. Aortic arch reconstruction in neonates with biventricular morphology: increased risk for development of recoarctation by use of autologous pericardium. Thorac Cardiovasc Surg 2015;63:373-9.
14. 14. Bromberg BI, Beekman RH, Rocchini AP, Snider AR, Bank ER, Heidelberger K, et al. Aortic aneurysm after patch aortoplasty repair of coarctation: A prospective analysis of prevalence, screening tests and risks. J Am Coll Cardiol 1989;14:734-41.
15. 15. Bernabei M, Margaryan R, Arcieri L, Bianchi G, Pak V, Murzi B. Aortic arch reconstruction in newborns with an autologous pericardial patch: Contemporary results. Interact Cardiovasc Thorac Surg 2013;16:282-5.
16. 16. Kornilov IA, Sinelnikov YS, Soinov IA, Ponomarev DN, Kshanovskaya MS, Krivoshapkina AA, et al. Outcomes after aortic arch reconstruction for infants: Deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion. Eur J Cardiothoracic Surg 2015;48:e45-50.
17. 17. Lodge AJ, Andersen ND, Turek JW. Recent advances in congenital hear surgery: alternative perfusion strategies for infant aortic arch repair. Curr Cardiol Rep 2019;21.
18. 18. Plymale JM, Frommelt PC, Nugent M, Simpson P, Tweddell JS, Shillingford AJ. The infant with aortic arch hypoplasia and small left heart structures: echocardiographic indices of mitral and aortic hypoplasia predicting successful biventricular repair. Pediatr Cardiol 2017;38:1296-304.