Aortic arch repair in children with PHACE syndrome

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 152; no. 3; pp. 709 - 717
• Main Authors: Caragher, Seamus P., BS, Scott, John P., MD, Siegel, Dawn H., MD, Mitchell, Michael E., MD, Frommelt, Peter C., MD, Drolet, Beth A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Aorta, Thoracic - abnormalities; Aorta, Thoracic - surgery; aortic arch; Aortic Coarctation - complications; Aortic Coarctation - surgery; Cardiothoracic Surgery; Child; Child, Preschool; congenital cardiac; Eye Abnormalities - complications; Female; Humans; Infant; Infant, Newborn; Male; Neurocutaneous Syndromes - complications; pediatric perioperative management; Recurrence; Registries; Reoperation; Retrospective Studies; subclavian artery; Treatment Outcome; Vascular Surgical Procedures; Wisconsin; magnetic resonance imaging; near-infrared spectroscopy; PHACE; MRI; subclavian artery; P osterior fossa, H emangiomas of the head and neck, A rterial, C ardiovascular, and E ye anomalies, and ventral developmental defects; congenital cardiac; NIRS; deep hypothermic cardiac arrest; aortic arch; pediatric perioperative management; DHCA; MRA; magnetic resonance angiography
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2016.03.082

Abstract Background PHACE syndrome is characterized by infantile hemangioma and developmental abnormalities of the brain, arteries of head and neck, and aortic arch. Methods We retrospectively reviewed The PHACE Syndrome International Clinical Registry to identify children with PHACE who had operative repair of aortic arch obstruction at Children's Hospital of Wisconsin. Results Seven patients (median 11 months, range 1 week-6 years) with PHACE required aortic arch reconstruction from 1996 to 2015. All needed complex surgical approaches (4 conduit grafts, 2 patch aortoplasties, 1 subclavian flap) to relieve the obstruction because of long-segment transverse and proximal descending aortic arch dysplasia that included multiple areas of stricture with adjacent aneurysmal dilatation. Aberrant origin of a subclavian artery was found in 6 of 7. The 3 children who had surgery after age 1 showed significant progression of the arch obstruction and/or adjacent aneurysmal segment dilatation after their initial infant evaluation. No deaths or perioperative complications occurred despite associated cerebrovascular arterial dysplasia in 5 of 7. Recurrent arch obstruction developed in 3 of 7 at an intermediate follow-up interval of 6.2 years (2 had interposition graft replacement at 8 and 11 years due to somatic growth; 1 had repeat patch aortoplasty 11 months after initial repair secondary to recurrent stenosis). Conclusions Extensive aortic arch reconstruction is commonly required in children with PHACE syndrome and coarctation due to the bizarre nature of the obstruction. Complete preoperative imaging is needed to fully characterize the aortic and cerebrovascular arterial anomalies. Recurrent obstruction is common given the non-native tissue techniques needed to relieve the arch anomaly.