Objective To compare the advantages of reconstructing the aorta by end-to-side anastomosis with extended end-to-end anastomosis for aortic coarctation （CoA） with cardiac lesions in neonates and infants. Methods There were 63 neonates and infants who underwent median full sternotomy for correction of CoA and cardiaclesions from January 2008 to July 2011 in Guangzhou Women and Children’s Medical Center. These patients were divided into two groups： extended end-to-end anastomosis was performed in 24 patients （end-to-end group, 17 males and 7 females with their mean age of 4.6±2.9 months）and end-to-side anastomosis in 39 patients （end-to-side group, 24 males and 15 females with their mean age of 3.4±2.6 months）. We compared the two groups with regard to postoperative mortality, morbidity and difference in blood pressure between the lower and upper extremities. Results The percentage of newborn patient（23.1% vs. 4.2%; χ2=3.979, P=0.045）and presence of pre-operative acidosis（15.4% vs. 0%; χ2=4.080, P=0.048）were significantly higher in end-to-side group than those in end-to-end group. There was no postoperative death in end-to-end group and 1 patient died after surgery in end-to-side group（2.6%）. The average duration of circulatory arrest in end-to-side group was significantly shorter than that in end-to-end group （18.6±2.7 min vs.23.4±3.7 min, F=14.617, P=0.000）. At the time back to cardiac intensive care unit, the percentage of patients whose difference in systolic pressure between radial and femoral artery ＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hg was 20.8%, 45.8% and 33.3% respectively in end-to-end group, and 97.4%, 2.6% and 0% respectively in end-to-side group（χ2=40.380，P=0.000）. Twenty-four hours after surgery, the percentage of patients whose difference in systolic pressure between radial and femoral artery＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hgwas 45.8%, 41.7% and 12.5% respectively in end-to-end group, and 100%, 0% and 0% respectively in end-to-side group （χ2=26.620, P=0.000）. All the surviving 62 patients were followed up for 2-36 months, and there was no patient with angeioma or re-stenosis needing intervention in either group during follow-up. Conclusion End-to-side anostomosis is a safe and effective method for treating CoA with cardiac lesions and eliminating residual stenosis in neonates and infants.
Corresponding author: Y I Ding -hua, E -mail: yidh@fmmu. edu. cnAbstract: Objective To investigate the optimal surgical approaches for coarctation of aorta (CoA ) associated with heart anomalies (CoA -HA ) in infants through analyzing the immediate and long-term outcome post-operation. Methods From May 1998 to November 2006, 29 patients with CoA -HA were admitted to this institute. Subclavian flap angioplasty was performed in three patients, excision of coarctation and end-to-side anastomoses in six pat ients,and end-to-end anastomoses in the remaining 20 pat ients. Their clinical data were retrospect ively reviewed and the long-term follow -up results obtained through telephone o r letters. Results Three patients died of operations, of whom one died of low cardiac output syndrome, one died of sepsis and one died of multiple organs failure. In two months’to eight years’follow -up , no later death and severe neurological complications were found. Two patients suffered from recurrent coarctation, but had no sense of symptoms and free from re-operation. In all pat ients neither systemic hypertension, nor arterial aneurysm and aortic valve regurgitation were found. Conclusions Mortality of surgical corrections is accepted fo r CoA -HA in infants. Preoperative heart dysfunction and prolonged mechanical ventilation are the high risks of operative death. Recurrent coarctation is the major later comp lication.
Abstract: Objective To summarize onestage repair of coarctation of the aorta(CoA) with intracardiac malformation in infants. Methods From January 2001 to January 2006, 28 patients with CoA and associated intracardiac malformation underwent onestage repair. There were 18 patients with preductal and another 10 patients with juxtaductal CoA. Six patients were accompanied by diffuse hypoplasia of aortic arch and 22 patients were associated with patent ductus arteriosus (PDA). Associated cardiac malformation included ventricular septal defect in 16 patients, ventricular septal defect and atrial septal defect in 5 patients, atrioventricular canal defect in 3 patients, transposition of great artery and ventricular septal defect in 2 patients and double outlet right ventricle in 2 patients. Left posterolateral thoracotomy combined with median sternotomy were used in 12 patients and single median sternotomy was used in 16 patients. End to end anastomosis of aorta with removal of the coarctated segment were performed in 20 patients, Gore-Tex patch graft aortoplasty were performed in 4 patients and aortoplasty with left subclavain flap were performed in 4 patients. Results There was no death.The lasting time of intubation was 7h to 13d, and intensive care unit (ICU) staying time was 3 to 18d. Four patients received delayed sternal closure in 48 to 72h after surgery because of cardiac dilatation. Three patients received peritoneal dialysis for acute renal failure following cardiac surgery. Three patients received inhalation of nitric oxide for treatment of postoperative pulmonary hypertension. The systolic pressure difference between lower limb and upper limb measured after operation was 10 to 20mmHg in 18 patients.There were no obvious systolic pressure difference between arm and leg in 8 patients.The systolic pressure of upper limb was higher than that of lower limb in 2 patients, and the pressure difference was 15mmHg and 20mmHg. All patients were followed up from 3 to 50 months. They were all survival except one died of severe tricuspid regurgitation, pulmonary infection and respiratory failure 3 months after surgery which diagnosis was transposition of great artery and ventricular septal defect. The results of other 27 patients were satisfactory. Recoarctation occurred in 1 patient with end to end anastomosis and 1 patient with Gore-Texpatch graft aortoplasty. The pressure difference through the measurement of echocardiography was 25mmHg and 28mmHg. No reoperation were undergone. Conclusion CoA with intracardiac malformation can be repaired by single median sternotomy or left posterolateral thoracotomy combined with median sternotomy in onestage. This operative approach is beneficial, not only with shorten period of therapy and less operative cost, but also advantageous for the recovery of cardiac and pulmonary function.
ObjectiveTo evaluate the effectiveness of covered Cheatham-platinum (CP) stent for treatment of coarctation of aorta (CoA). MethodsBetween January 2007 and September 2013, 15 patients (16 lesions) with CoA underwent covered CP stent implantation, and the clinical data were analyzed retrospectively. Of 15 cases, 8 were male and 7 were female, aged 13-56 years (mean, 27.7 years). Fifteen lesions located beyond the origin of the left subdavian artery, and 1 lesion located between the origin of the left common carotid artery and the origin of the left subdavian artery. Proper covered CP stent and balloon-in-balloon (BIB) catheter were selected according to the data of computed tomography angiography or digital subtraction angiography examination. Under fluoroscopic guidance, the covered CP stent was placed at lesion accurately by expanding the inner balloon and the outer balloon sequentially. The variation of the systolic pressure gradient across the lesion and the stenosis extent of the aorta before and after the procedure were recorded. ResultsFifteen patients were all treated by covered CP stent implantation successfully. The systolic pressure gradient across the lesion decreased from (58.1±19.5) mm Hg (1 mm Hg=0.133 kPa) at preoperation to (6.2±5.6) mm Hg at immediate after CP stent implantation, and the stenosis extent of the aorta decreased from 73.8%±12.8% at preoperation to 16.7%±5.6% at immediate after CP stent implantation, all showing significant difference (t=12.483, P=0.000; t=15.631, P=0.000). All puncture points healed well with no aortic dissection, pseudoaneurysm, or obvious subcutaneous hematoma. All the patients could walk moderately within 48 hours after procedure. The average hospitalization time was 11.1 days (range, 6-18 days). During a mean follow-up of 29.7 months (range, 1-81 months), the symptom of dizziness and exercise tolerance were improved obviously, and the systolic pressures gradient between upper and lower extremity was below 20 mm Hg. The systolic and diastolic pressures at last follow-up were significantly improved when compared with preoperative values (t=7.725, P=0.000; t=3.651, P=0.000). According to radiography, the location and shape of the stent were good, and no aortic dissection, aneurysm, or recoarctation occurred. ConclusionAccording to the initial and midterm results, the covered CP stent is an effective treatment for CoA in adolescents and adults with a low rate of complication. However, long-term results still require further follow-up.