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Repair of interrupted aortic arch and associated malformations in infancy indications for complete of partial repair






Annals of Thoracic Surgery 42(1): 17-21

Repair of interrupted aortic arch and associated malformations in infancy indications for complete of partial repair

There is uncertainty regarding the best method of repair of interrupted aortic arch. The question is whether to perform primary definitive repair of this anomaly plus the associated defects versus arch repair only and palliation of the intracardiac defects, usually by pulmonary artery banding. Since 1976, 16 infants with interrupted aortic arch have been treated surgically. They were seen at 5.2 .+-. 3 days of age and weighed 3.2 .+-. 0.7 kg. The interruption occurred between the left carotid and left subclavian arteries (type B) in 9 and between the left subclavian artery and the descending aorta in 8 (type A). Isolated ventricular septal defect (VSD) was the only associated anomaly in 7 and aortopulmonary window, in 4. Two patients had truncus arteriosus type 1. Three had transposition of the great arteries: 1 with VSD and 2 with single ventricle. Prior to 1980, our policy was to palliate all patients. Between 1976 and 1980, 4 infants underwent left thoracotomy with arch repair plus pulmonary artery banding (3, VSD; 7, transposition of the great vessels and single ventricle) with only 1 (25%) survivor. Because of this high mortality, 8 patients with interrupted aortic arch and VSD or aortopulmonary window, seen since 1980, received complete repair with median sternotomy, end-to-end arch anastomosis, and closure of the VSD or aortopulmonary window utilizing profound hypothermia and circulatory arrest. All 8 survived. During that time, 4 additional patients with complicated intracardiac defects (1, transposition of the great vessels and VSD; 2, truncus arteriosus; 1, transposition of the great vessels and single ventricle) underwent end-to-end arch repair and pulmonary artery banding through a left thoracotomy with 1 (20%) survivor. We believe that these data support the continued use of primary complete repair of interrupted aortic arch whenever possible (VSD, aortopulmonary window) and palliation only for those infants with complicated intracardiac defects (transposition of the great vessels, truncus arteriosus, single ventricle) that do not readily lend themselves to primary intracardiac repair in infancy.

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Accession: 006312437

PMID: 2425757



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