open access

Vol 14, No 6 (2019)
Cardiac Surgery
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Aortic arch reconstruction method with ductus-dependent systemic flow preservation in a critical ‘bovine trunk’ aortic coarctation treatment

Ireneusz Haponiuk, Maciej Chojnicki, Konrad Paczkowski, Mariusz Steffens, Anna Romanowicz-Sołtyszewska, Marta Paśko-Majewska, Monika Opacian-Bojanowska, Wiktor Szymanowicz, Paweł Macko, Katarzyna Gierat-Haponiuk, Katarzyna Leszczyńska, Julia Haponiuk
Folia Cardiologica 2019;14(6):641-647.

open access

Vol 14, No 6 (2019)
Cardiac Surgery

Abstract

Introduction. Coarctation of the aorta is a congenital heart defect defined as aortic narrowing at the isthmus. It may occur in association with other defects, which requires a discussion regarding the choice of optimal therapy. Critical aortic coarctation with aortic hypoplasia and so-called bovine trunk anatomy is one of the more challenging forms of this defect, characterized by a common origin of the brachiocephalic trunk and the left common carotid artery, which form a common vessel extending as a direct continuation of the ascending aorta. Therapeutic decisions are made depending on the distance between the ascending aorta and the isthmus and descending aorta, taking into account the typical management of hypoplastic aortic arch.

Material and methods. The clinical presentation in the neonatal period includes weak or absent femoral pulse, pallor, apathy, dyspnea and signs of systemic hypoperfusion with progressive lung edema and acidosis. The diagnosis is mostly based on echocardiography while magnetic resonance imaging or computed tomography allow detailed imaging of the collateral vessels. The most important diagnostic issues are the anatomy of the defect, severity of concomitant aortic isthmus narrowing, and its hemodynamic effect. The medical management is directed at maintaining patency of the ductus arteriosus with prostaglandin E1 infusion and an appropriate balance between peripheral systemic and pulmonary resistance. The recommended treatment of choice is an early surgical correction of the aortic arch defect. The aortic arch reconstruction method with ductus-dependent systemic flow preservation implies resection of the coarctation along with the isthmus narrowing and proximal end-to-side anastomosis, with reconstruction of the inflow to the left subclavian artery using a hypoplastic distal segment of the aortic arch. The operation is performed by the left posterolateral thoracotomy without using extracorporeal circulation.

Conclusions. The prerequisite for selecting a neonate for the proposed procedure is a detailed assessment of aortic arch anatomy, with particular attention to the measurement of the distance between the ascending aorta and the area where the ductus arteriosus connects to the descending aorta. The major advantage of this technique is the ability to perform an off-pump procedure via the lateral access, using only healthy native patient tissues for aortic flow restoration.

Abstract

Introduction. Coarctation of the aorta is a congenital heart defect defined as aortic narrowing at the isthmus. It may occur in association with other defects, which requires a discussion regarding the choice of optimal therapy. Critical aortic coarctation with aortic hypoplasia and so-called bovine trunk anatomy is one of the more challenging forms of this defect, characterized by a common origin of the brachiocephalic trunk and the left common carotid artery, which form a common vessel extending as a direct continuation of the ascending aorta. Therapeutic decisions are made depending on the distance between the ascending aorta and the isthmus and descending aorta, taking into account the typical management of hypoplastic aortic arch.

Material and methods. The clinical presentation in the neonatal period includes weak or absent femoral pulse, pallor, apathy, dyspnea and signs of systemic hypoperfusion with progressive lung edema and acidosis. The diagnosis is mostly based on echocardiography while magnetic resonance imaging or computed tomography allow detailed imaging of the collateral vessels. The most important diagnostic issues are the anatomy of the defect, severity of concomitant aortic isthmus narrowing, and its hemodynamic effect. The medical management is directed at maintaining patency of the ductus arteriosus with prostaglandin E1 infusion and an appropriate balance between peripheral systemic and pulmonary resistance. The recommended treatment of choice is an early surgical correction of the aortic arch defect. The aortic arch reconstruction method with ductus-dependent systemic flow preservation implies resection of the coarctation along with the isthmus narrowing and proximal end-to-side anastomosis, with reconstruction of the inflow to the left subclavian artery using a hypoplastic distal segment of the aortic arch. The operation is performed by the left posterolateral thoracotomy without using extracorporeal circulation.

Conclusions. The prerequisite for selecting a neonate for the proposed procedure is a detailed assessment of aortic arch anatomy, with particular attention to the measurement of the distance between the ascending aorta and the area where the ductus arteriosus connects to the descending aorta. The major advantage of this technique is the ability to perform an off-pump procedure via the lateral access, using only healthy native patient tissues for aortic flow restoration.

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Keywords

congenital heart defects, paediatric cardiac surgery, coarctation of the aorta, aortic arch hypoplasia

About this article
Title

Aortic arch reconstruction method with ductus-dependent systemic flow preservation in a critical ‘bovine trunk’ aortic coarctation treatment

Journal

Folia Cardiologica

Issue

Vol 14, No 6 (2019)

Pages

641-647

Bibliographic record

Folia Cardiologica 2019;14(6):641-647.

Keywords

congenital heart defects
paediatric cardiac surgery
coarctation of the aorta
aortic arch hypoplasia

Authors

Ireneusz Haponiuk
Maciej Chojnicki
Konrad Paczkowski
Mariusz Steffens
Anna Romanowicz-Sołtyszewska
Marta Paśko-Majewska
Monika Opacian-Bojanowska
Wiktor Szymanowicz
Paweł Macko
Katarzyna Gierat-Haponiuk
Katarzyna Leszczyńska
Julia Haponiuk

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