Abstract: Objective To summarize the clinical experiences of resection with patch aortoplasty for infant coarctation of the aorta combined with aortic arch hypoplasia. Methods Between May 2007 and December 2009, 49 patients including 30 males and 19 females with coarctation with hypoplastic aortic arch underwent coarctation resection and patch aortoplasty in Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University. The age of the patients ranged from 23 days to 3 years and 1 month with thirtyfour patients under 6 months, ten between 6 months and 1 year old, and five more than 1 year old. The surgery under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion were performed in 31 cases and circulation arrest in 15 cases; under moderate hypothermia cardiopulmonary bypass in 3 cases. Pericardia patch was used in 31 cases, pulmonary autograft patch in 14 cases and xenograft pericardia patch in 4 cases. The associated intracardiac anomalies were repaired in the same stage. Results One case died from circulation failure during the perioperative period. The operative mortality was 204% (1/49). Low cardiac output syndrome and renal failure respectively occurred in 5 cases and 1 case who were cured afterwards by correspondent treatments. No residual obstruction was detected by echocardiography after the operation. Followup was carried out in fortyeight cases for a minimum of 4 months and a maximum of 3 years. Echocardiographic examination showed that the gradient through the aortic arch was more than 40 mm Hg and computed tomography showed recoarctation in 1 case who underwent reoperation eight months after the operation; the gradient was more than 20 mm Hg in 2 cases who were under continuous observation; all the rest cases had a fine aortic arch morphology and for these patients, the blood velocity at descending aortic arch was not obviously changed during the followup period compared with that right after operation, the computed tomography showed a normal aortic arch geometry. Left bronchus compression was relieved obviously or totally disappeared in patients who suffered from left bronchus stenosis before the operation without any aortic aneurysm detected. Conclusion Coarctation resection with patch aortoplasty is considered as an optimal surgical method for management of infant coarctation with hypoplastic aortic arch.
ObjectiveTo summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease. MethodsClinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle. ResultsCardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05). ConclusionModified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.