Combined Norwood and Rastelli Procedure for Repair of Interrupted Aortic Arch with Subaortic Stenosis

Abstract

A neonate presented with an interrupted aortic arch type B and VSD with dysplastic aortic valve, subaortic stenosis, and aberrant right subclavian artery. We performed a direct anastomosis between the hypoplastic ascending aorta (0 3 mm), the main pulmonary artery and the descending aorta, mimicking a Norwood-type ventricular outlet. The right-ventricular outflow tract was reconstructed with a 8mm PTFE vascular graft. This combination of a modified Norwood with a Rastelli procedure facilitated establishment of a sufficiently large left-ventricular outflow tract via VSD, at the same time maintaining a biventricular system despite the coexisting anomalies.

Mechanical and microstructural analysis of a radially expandable vascular conduit for neonatal and pediatric cardiovascular surgery

“…For the purposes of extrapolating percentages, 40,000 CHDs per year are estimated . Repeat surgeries affect an estimated 6700–8700 children every year in the US, and cost the healthcare system hundreds of millions of dollars . The primary clinical application for an expandable conduit is most likely a nonvalved conduit.…”

“…The secondary market is a valved conduit for RVOTR. The annual US population for RVOTR was estimated at 3100 …”

“…The annual US population for RVOTR was estimated at 3100. 4,[47][48][49][50][51][52][53][54][55][56] There is abundant data in pediatric cardiology literature on the safety of balloon dilation across surgical anastomotic sites without any change in the standard operating and suturing procedure. Balloon angioplasty has been performed in COA for 30 years 61 with more success in postoperative lesions 62 and excellent results at 20 years follow-up.…”