Coarctation of the aorta in complex congenital heart disease: simultaneous repair via sternotomy

• Published in: European journal of cardio-thoracic surgery Vol. 4; no. 9; pp. 482 - 485
• Main Authors: HEINEMANN, M, ZIEMER, G, LUHMER, I, HAVERICH, A, KALLFELZ, H. C, BORST, H. G
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.01.1990; Elsevier Science
• Subjects: Aorta, Thoracic - surgery; Aortic Coarctation - surgery; Biological and medical sciences; Cardiology. Vascular system; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Heart; Heart Defects, Congenital - surgery; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Medical sciences; Prognosis; Sternum - surgery; Time Factors; Human; Aortic coarctation; Concomitant disease; Treatment; Congenital; Malformation; Heart disease; Surgery; Aorta; Cardiovascular disease; Technique; Child
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/1010-7940(90)90170-5

Coarctation of the aorta (CoA) is often associated with complexcongenital heart disease. Patients with such a combination may not benefitfrom coarctectomy alone. Eight children who presented with complexmalformations of the heart underwent simultaneous repair of CoA andintracardiac surgery via sternotomy. After extensive mobilization of theaortic arch, cardiopulmonary bypass was established. During the coolingphase for deep hypothermic circulatory arrest (six cases), a persistenttemperature gradient between the upper and lower half of the body confirmedthe significance of CoA. One child was operated upon in deep hypothermiawith low flow and one underwent valve repair on cardiopulmonary bypass.Mobilization of the descending aorta enabled CoA resection and end-to-endanastomosis with a running absorbable suture. The average descending aorticcross-clamping time was 15 min. By this time, the patient had been cooledsufficiently for the intracardiac procedure. There were two operativedeaths not related to coarctectomy. The remaining children showed noarm-to-leg pressure gradient. Five were discharged from hospital and onepatient died late from septicaemia. In our hands, this technique has servedto accomplish simultaneous relief of CoA and repair of the intracardiaclesion thus sparing critically ill infants the hazards of repeatedprocedures.