Several problems have been reported following coarctectomy, especially in cases involving longsegment coarctation COA . Although residual COA, proximal arch kinking, and airway compression may occur after coarctectomy, avoiding the use of artificial materials provides a better chance for the subsequent growth of the aorta. We successfully performed a modified end-to-end anastomosis with subclavian flap aortoplasty for a two-month-old boy with COA. A two-month-old boy was admitted to our hospital for nocturnal tachypnea and a feeding disorder. The initial echocardiography showed a preductal long COA beyond the left subclavian artery. A perimembranous VSD, a patent foramen ovale, and a patent ductus arteriosus were also noted. The left ventricular function was mildly depressed with an ejection fraction of 59%. Enhanced CT revealed a long-segment COA with a length of 15 mm. The blood pressure gradient between the upper and lower limbs was 40 mmHg. The operation was performed at the age of 2 months. The 4th intercostal space was opened through a posterolateral left thoracotomy incision. The distal end of the isthmus was so ligated as to maintain blood perfusion to the lower body through the PDA. The arch was clamped between the left carotid and the left subclavian artery LSCA . The LSCA and the isthmus were divided as distally as possible, and the two distal ends were longitudinally incised and sutured to each other in a side-to-side fashion using a 7 0 polypropylene continuous suture. After complete resection of the ductal tissue, a newly created distal arch was anastomosed to the descending aorta. The left ventricular ejection fraction was increased to 74% at discharge. Catheterizations 3 years after the surgery did not reveal any stenosis or deformity in the aorta at normal PA pressure. The patient has been doing well and is free of complications 7 years after the surgery. At present, end-to-end anastomosis and aortic arch advancement with or without cardiopulmonary bypass are widely used procedures for coarctectomy ; however, a modified end-to-end anastomosis is still a viable option for cases involving long-segment coarctation. Jpn. J. Cardiovasc. Surg. 46 : 66 69 2017 long-segment coarctation ; coarctectomy ; modified end-to-end anastomosis ; subclavian flap aortoplasty ; thoracotomy
A Successful Surgical Treatment of Ebsteinʼs Anomaly by Hetzerʼs Procedure in an AdultMitsutaka Nakao, Kiyozou Morita, Yoshihiro Ko, Takayuki Abe and Kazuhiro Hashimoto(Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan) A 29-year-old woman, who had been diagnosed with Ebsteinʼs anomaly associated with paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White(WPW)syndrome, was referred to our hospital for treatment of congestive heart failure and tachycardia. She had undergone a catheter ablation for WPW syndrome at the age of 28 years. Subsequently, surgical treatment for Ebsteinʼs anomaly was indicated because of persistent symptoms of heart failure due to tricuspid regurgitation(TR). The echocardiogram and pathologic findings corresponded to Ebsteinʼs anomaly of the Carpentier type B classification, with severe displacement of the septal and posterior leaflets resulting in moderate TR. A mobile anterior leaflet of sufficient size without a cleft enabled us to successfully perform Hetzerʼs procedure. In this procedure, the large mobile anterior leaflet was approximated to the opposing true tricuspid annulus with a mattress suture of 3-0 polypropylene passed from the anterior leaflet annulus to the true tricuspid annulus at the site of atrialized right ventricle near the coronary sinus. The postoperative course was uneventful, and the cardiothoracic ratio reduced from 56% to 48% with mild TR. In this adult case of Carpentierʼs type B adult Ebsteinʼs anomaly, Hetzerʼs procedure allowed reconstruction of the tricuspid valve mechanism of "leaflet-to-septum" coaptation at the level of the true annulus by approximating the anterior leaflet. This was, effective in reducing the patientʼs moderate TR. We conclude that this procedure is a simple and reproducible method for repairing the tricuspid valve in Ebsteinʼs anomaly, especially for cases with a large mobile anterior leaflet.
Congenital coronary arteriovenous fistula CAVF is a rare type of congenital heart disease. Because of variation in the age, symptoms, and associated pathologies of the patients, precise diagnosis is important before surgery. Although operative techniques are comparatively easy, detailed treatment planning for abnormal pathology is mandatory. For this purpose, multidetector CT MDCT has recently become a key diagnostic modality for visualizing and understanding the origin, course, and drainage of CAVFs. We report 3 patients who required surgery for CAVF as their main cardiac problem. At operation, detection of abnormalities was obvious and easy, because the MDCT information was quite accurate and identical to the actual heart. Closure of the CAVF was performed in all 3 patients, with addition of tricuspid annuloplasty and coronary bypass surgery in one patient and pulmonary vein isolation in one patient. The results were satisfactory.KEY WORDS: congenital coronary arteriovenous fistula, multidetector computed tomography, non-invasive examination J Jpn Coron Assoc 2015; 21: 218 222
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