Management of arch hypoplasia after successful coarctation repair

Maryann M. DeLeon, Serafin Y. DeLeon, Jose A. Quinones, Patrick Roughneen, Kathy E. Magliato, Dolores A. Vitullo, Frank Cetta, Timothy J. Bell, Elizabeth A. Fisher

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background. Pronounced arch obstruction can be seen after a well-repaired coarctation, and this probably results from the failure of a somewhat hypoplastic arch to grow or from clamp injury at the time of the initial repair, or from both causes. Because of mediastinal adhesions and minimal collateral circulation, use of extraanatomic bypass grafts appears to be the preferred approach. Methods. Six children or young adults presented with arch obstruction over a 3-year period. Their mean age was 13.5 ± 4 years, and the mean interval from the time of the initial repair was 10 ± 4 years. The mean age of the patients at the time of the initial repair was 3.2 ± 5 years. Symptoms included exertional headache and chest pain. The mean systolic gradients, as shown by echocardiography and cardiac catheterization, were 34 ± 7 mm Hg and 33 ± 6 mm Hg, respectively. Repair was accomplished through a midsternotomy using a polytetrafluoroethylene patch placed in the concavity of the arch, which extended from the ascending to the descending aorta. Dissection was kept close to the aorta and arch to minimize injury to the phrenic and recurrent laryngeal nerves. Cardiopulmonary bypass and moderate hypothermia (25°to 27°C bladder temperature) without circulatory arrest were used. Results. All patients were discharged home 4 to 20 days postoperatively (mean, 7 ± 6 days). All patients were found to be normotensive at a mean follow-up of 1.3 ± 1 years. Postoperative echocardiograms, which were obtained in all patients, revealed no residual gradients. Exercise blood pressure was evaluated in 2 patients and found to be normal. Conclusions. Transsternal arch enlargement using cardiopulmonary bypass and moderate hypothermia without circulatory arrest is an attractive and safe approach for the treatment of arch obstruction after coarctation repair. Unlike the use of extraanatomic bypass grafts, it allows complete relief of the obstruction, unhampered aortic growth, the minimal use of foreign material, and a repair that is protected deep within the mediastinal space.

Original languageEnglish (US)
Pages (from-to)975-980
Number of pages6
JournalAnnals of Thoracic Surgery
Volume63
Issue number4
DOIs
StatePublished - 1997
Externally publishedYes

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Hypothermia
Cardiopulmonary Bypass
Thoracic Aorta
Transplants
Recurrent Laryngeal Nerve
Collateral Circulation
Wounds and Injuries
Polytetrafluoroethylene
Cardiac Catheterization
Diaphragm
Chest Pain
Headache
Echocardiography
Dissection
Young Adult
Urinary Bladder
Exercise
Blood Pressure
Temperature
Growth

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

DeLeon, M. M., DeLeon, S. Y., Quinones, J. A., Roughneen, P., Magliato, K. E., Vitullo, D. A., ... Fisher, E. A. (1997). Management of arch hypoplasia after successful coarctation repair. Annals of Thoracic Surgery, 63(4), 975-980. https://doi.org/10.1016/S0003-4975(96)01384-7

Management of arch hypoplasia after successful coarctation repair. / DeLeon, Maryann M.; DeLeon, Serafin Y.; Quinones, Jose A.; Roughneen, Patrick; Magliato, Kathy E.; Vitullo, Dolores A.; Cetta, Frank; Bell, Timothy J.; Fisher, Elizabeth A.

In: Annals of Thoracic Surgery, Vol. 63, No. 4, 1997, p. 975-980.

Research output: Contribution to journalArticle

DeLeon, MM, DeLeon, SY, Quinones, JA, Roughneen, P, Magliato, KE, Vitullo, DA, Cetta, F, Bell, TJ & Fisher, EA 1997, 'Management of arch hypoplasia after successful coarctation repair', Annals of Thoracic Surgery, vol. 63, no. 4, pp. 975-980. https://doi.org/10.1016/S0003-4975(96)01384-7
DeLeon, Maryann M. ; DeLeon, Serafin Y. ; Quinones, Jose A. ; Roughneen, Patrick ; Magliato, Kathy E. ; Vitullo, Dolores A. ; Cetta, Frank ; Bell, Timothy J. ; Fisher, Elizabeth A. / Management of arch hypoplasia after successful coarctation repair. In: Annals of Thoracic Surgery. 1997 ; Vol. 63, No. 4. pp. 975-980.
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abstract = "Background. Pronounced arch obstruction can be seen after a well-repaired coarctation, and this probably results from the failure of a somewhat hypoplastic arch to grow or from clamp injury at the time of the initial repair, or from both causes. Because of mediastinal adhesions and minimal collateral circulation, use of extraanatomic bypass grafts appears to be the preferred approach. Methods. Six children or young adults presented with arch obstruction over a 3-year period. Their mean age was 13.5 ± 4 years, and the mean interval from the time of the initial repair was 10 ± 4 years. The mean age of the patients at the time of the initial repair was 3.2 ± 5 years. Symptoms included exertional headache and chest pain. The mean systolic gradients, as shown by echocardiography and cardiac catheterization, were 34 ± 7 mm Hg and 33 ± 6 mm Hg, respectively. Repair was accomplished through a midsternotomy using a polytetrafluoroethylene patch placed in the concavity of the arch, which extended from the ascending to the descending aorta. Dissection was kept close to the aorta and arch to minimize injury to the phrenic and recurrent laryngeal nerves. Cardiopulmonary bypass and moderate hypothermia (25°to 27°C bladder temperature) without circulatory arrest were used. Results. All patients were discharged home 4 to 20 days postoperatively (mean, 7 ± 6 days). All patients were found to be normotensive at a mean follow-up of 1.3 ± 1 years. Postoperative echocardiograms, which were obtained in all patients, revealed no residual gradients. Exercise blood pressure was evaluated in 2 patients and found to be normal. Conclusions. Transsternal arch enlargement using cardiopulmonary bypass and moderate hypothermia without circulatory arrest is an attractive and safe approach for the treatment of arch obstruction after coarctation repair. Unlike the use of extraanatomic bypass grafts, it allows complete relief of the obstruction, unhampered aortic growth, the minimal use of foreign material, and a repair that is protected deep within the mediastinal space.",
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AU - DeLeon, Serafin Y.

AU - Quinones, Jose A.

AU - Roughneen, Patrick

AU - Magliato, Kathy E.

AU - Vitullo, Dolores A.

AU - Cetta, Frank

AU - Bell, Timothy J.

AU - Fisher, Elizabeth A.

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