One-Stage Repair of an Interrupted Aortic Arch with an Aortopulmonary Window in a Premature Neonate

Bobos, Dimitrios; Kanakis, Meletios; Koulouri, Sofia; Giannopoulos, Nicholas

doi:10.5090/kjtcs.2015.48.6.411

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Mortality rates have shown improvement over time, ranging from 9% to 38% in various series [ 1 , 2 , 7 , 8 ]. Even in low-birth-weight premature neonates, single-staged repair is feasible [ 9 , 10 ]. However, the single-stage reconstruction is associated with a high rate of re-intervention for complications such as aortic arch, bronchial, and pulmonary artery obstructions [ 1 , 2 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Results and Complications After Single-Stage Repair of Aortopulmonary Window and Interrupted Aortic Arch in a 32-Week Preterm and a Full-Term Neonate

Ten,

Chien,

Yeh

et al. 2023

Am J Case Rep

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Case series Patients: Male, newborne • Male, infant Final Diagnosis: Interrupted aortic arch • aortopulmonary window Symptoms: Heart murmur • oliguria • prematurity • respiratory distress Clinical Procedure: Bronchoscopy • cardiopulmonary bypass • surgery Specialty: Cardiac Surgery Objective: Rare disease Background: An aortopulmonary window (APW) is an uncommon congenital defect of the septation between the ascending aorta and pulmonary trunk. The combination of APW and interrupted aortic arch (IAA) is even rarer, with the hallmark characteristics of high peri-operative mortality and postoperative obstruction of the aortic arch, pulmonary artery, and left main bronchus. These complications often need re-interventions. Case Reports: We present 2 cases with diagnoses of APW and IAA that were treated with single-stage repair. Case 1: A male 32-week premature newborn (weight 1789 g) had APW type I and IAA type A. He had severe postoperative aortic arch obstruction on postoperative day 1, and we re-intervened promptly. He was still asymptomatic after 6 years. Case 2: A male term neonate had APW type III and IAA type A. He had left vocal cord paralysis and left bronchial compression postoperatively. We applied prolonged noninvasive respiratory supports. The complications resolved without re-intervention on postoperative day 66. Progressive arch stenosis at anastomosis after operation required close follow-up with echocardiography. Conclusions: These 2 reports highlight the feasibility of single-stage surgical repair while addressing 2 challenges: (1) Recurrent arch stenosis: Lower body weight and direct end-to-side anastomosis without patch augmentation could be risk factors for re-intervention. (2) Bronchial compression: Presentation of the second reported case implied that bronchial compression may not warrant immediate re-intervention unless there is complete obstruction, persistent atelectasis, or recurrent infection. Further studies on long-term outcomes of different surgical procedure would help us to clarify the proper way to avoid re-intervention.

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Section: Discussionmentioning

confidence: 99%

Results and Complications After Single-Stage Repair of Aortopulmonary Window and Interrupted Aortic Arch in a 32-Week Preterm and a Full-Term Neonate

Ten,

Chien,

Yeh

et al. 2023

Am J Case Rep

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“…The association of APW with IAA is rare and represents a life threatening malformation [ 13 ]. Only 3.5%–4.2% of patients with IAA have APW, representing 0.046% of patients with congenital heart disease [ 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Berry syndrome; a successful one-stage repair in neonate periods, evaluation result after 9 years, a case report

Habibie

Busro

Roebiono

et al. 2021

Annals of Medicine &Amp; Surgery

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Backgroud IAA with an intact ventricular septum is distinctly unusual. Combination with an Aortopulmonary Window (APW), ascending aortic origin of the right pulmonary artery and PDA may be present which is called as Berry syndrome, a rare combination of cardiac anomalies, reported to be 0.046%, lethal combination and die shortly after birth. Case Report We report a 9 days-old male neonates weighing 3.85 kg was referred by local hospital to our center and was ventilated with history of respiratory distress and severe infection since he was born. Admitted to our PCICU, 2D echo showed an IAA type A associated with a huge APW type II and restrictif PDA. A PGE1 infusion was started, during the following days the baby experienced several epileptic episodes. After improvement of the clinical condition, surgery was performed on the 20th days of life on year 2011. A successful one-stage repair of such anomalies in which cutting of PDA that arised from PA trunk and distally becoming into descending aorta, extended end to end anastomosis to conduct the ascending aortic blood flow into the descending aorta and intra arterial baffle was used. A 4-0 Gore-Tex baffle was used both to close the APW and separated the RPA from aortic origin with a good result, as his recently grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2. Conclusion Berry syndrome is a rare but well‐identified and surgically correctable anomaly. Early diagnosis and surgical treatment to avoid irreversible pulmonary hypertension is mandatory.

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“…[1][2][3][4] Surgical repair is commonly performed for the treatment of APW with favorable outcomes. [1,[15][16][17] Complications of surgical repair such as aortic or pulmonary artery stenosis, residual APW, and aneurysmal aortic dilatation are possible, albeit rare. [1] Rare cases of percutaneously closed APW have been also reported.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical treatment of aortopulmonary window: Our single-center experience

Yakut

Tokel

Özkan

et al. 2018

Turk Gogus Kalp Dama

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Bu çalışmada aortopulmoner pencereye ilişkin tek merkezli deneyimimiz sunuldu ve klinik bulgular, belirtiler, cerrahi düzeltme teknikleri ve uzun dönem sonuçlar incelendi. Ça lış ma pla nı: Hastanemizde Mayıs 1998-Haziran 2016 tarihleri arasında aortopulmoner pencere tanısı ile izlenen toplam 30 hastanın tıbbi kayıtları retrospektif olarak incelendi. Hastaların klinik özellikleri, ekokardiyografik ve anjiyografik bulguları, cerrahi girişim sonuçları ve takip sırasında tıbbi sorunlar değerlendirildi. Bul gu lar: En sık görülen bulgu ve belirtiler üfürüm, dispne, taşipne, gelişim geriliği ve konjestif kalp yetmezliği bulguları idi. Cerrahi sırasındaki ortalama yaş 8.2±14.4 ay (dağılım 7 gün-60 ay) idi. On sekiz (%60) hastaya ek kardiyak anomali eşlik etmekteydi. On bir hastada basit doğuştan kalp hastalığı, yedi hastada kompleks doğuştan kalp hastalığı vardı. Dört hasta Eisenmenger sendromu (n=3) ve kompleks doğumsal kalp hastalığı (n=1) nedeniyle ameliyat edilemedi. Cerrahi sonrası erken veya geç dönemde ölüm gözlenmedi. Ortalama takip süresi 6.4±4.8 yıl (dağılım 5 ay-16 yıl) idi. Aortopulmoner pencere onarımının yanı sıra, dokuz hastada (%34.6) cerrahi girişimi etkileyen ek kardiyak anomali düzeltildi. Üç yıl sonra bir hasta rezidüel aortopulmoner pencere ve bir diğer hasta pulmoner darlık (valvüler, supravalvüler) nedeniyle yeniden ameliyat edildi. Bu hastalardan birine iki yıl sonra pulmoner balon valvüloplasti uygulandı. Takip sırasında tekrar ameliyat oranı %7.7 (n=2) idi. So nuç: Aortopulmoner pencere ekokardiyografik çalışma sırasında atlanabilen ve düşük cerrahi risk ile onarımı olanaklı olan nadir bir kardiyak anomalidir. Bu nedenle, pulmoner vasküler hastalık gelişmeden önce tanı konması ve tedavi edilmesi önemlidir. Anah tar söz cük ler: Aortopulmoner pencere; doğuştan kalp hastalığı; pulmoner vasküler hastalık; cerrahi tedavi.

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One-Stage Repair of an Interrupted Aortic Arch with an Aortopulmonary Window in a Premature Neonate

Cited by 3 publications

References 12 publications

Results and Complications After Single-Stage Repair of Aortopulmonary Window and Interrupted Aortic Arch in a 32-Week Preterm and a Full-Term Neonate

Results and Complications After Single-Stage Repair of Aortopulmonary Window and Interrupted Aortic Arch in a 32-Week Preterm and a Full-Term Neonate

Berry syndrome; a successful one-stage repair in neonate periods, evaluation result after 9 years, a case report

Diagnosis and surgical treatment of aortopulmonary window: Our single-center experience

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