The Neonatal Hypoplastic Aortic Arch: Decisions and More Decisions

• Published in: Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual Vol. 16; no. 1; pp. 43 - 51
• Main Authors: Langley, Stephen M., Sunstrom, Rachel E., Reed, Richard D., Rekito, Andrew J., Gerrah, Rabin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Aorta, Thoracic - abnormalities; Aorta, Thoracic - surgery; Aortic Coarctation - diagnostic imaging; Aortic Coarctation - mortality; Aortic Coarctation - surgery; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Female; Follow-Up Studies; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Imaging, Three-Dimensional; Infant, Newborn; Male; Pediatrics; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Risk Assessment; Sternotomy - methods; Survival Rate; Thoracotomy - methods; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 1092-9126
• DOI: 10.1053/j.pcsu.2013.01.008

Neonatal patients with hypoplasia of the aortic arch constitute a heterogeneous group with a wide spectrum of severity. The milder end of the spectrum comprises patients with aortic coarctation and isthmus hypoplasia. At the other end of the spectrum are patients with severe transverse arch hypoplasia or hypoplastic left heart syndrome. The aim of this paper is to discuss the various strategies and surgical approaches available for this group of patients, focusing on the surgical decisions that influence individual patient management. Many of the things discussed are applicable to any neonatal arch problem. We also describe and discuss in detail our surgical technique for patients who undergo neonatal repair of a hypoplastic aortic arch via median sternotomy.