Repair of interrupted aortic arch: results after more than 20 years

Schreiber, Christian; Eicken, Andreas; Vogt, Manfred; Günther, Thomas; Wottke, Michael; Thielmann, Matthias; Paek, Sung-Un; Meisner, H; Hess, John; Lange, Rüdiger

doi:10.1016/s0003-4975(00)01858-0

Cited by 87 publications

(60 citation statements)

References 20 publications

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“…In a study conducted on 94 patients after IAA surgery, the reason for a second surgery was mainly due to arch stenosis, bronchial/tracheal compression, or left ventricular outflow tract obstruction. 5) Many surgeons choose an end-to-side anastomosis 6) and pulmonary autograft patch 7) for aortic arch reconstruction in CoA and IAA to reduce aortic anastomotic tension and ensure the patency of the aorta, which could reduce the incidence of postoperative tracheal compression.…”

Section: Discussionmentioning

confidence: 99%

Tracheal Compression Caused by a Mediastinal Hematoma After Interrupted Aortic Arch Surgery

Hua

Lin

et al. 2017

Int. Heart J.

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SummaryCongenital abnormalities of the aortic arch include interrupted aortic arch (IAA), coarctation of the aorta (CoA), and double aortic arch (DAA). Aortic arch repair is difficult and postoperative complications are common. However, postoperative tracheobronchial stenosis with respiratory insufficiency is an uncommon complication and is usually caused by increased aortic anastomotic tension. We report here a case of tracheal compression by a mediastinal hematoma following IAA surgery. The patient underwent a repeat operation to remove the hematoma and was successfully weaned off the ventilator.In cases of tracheobronchial stenosis after aortic arch surgery, airway compression by increased aortic anastomotic tension is usually the first diagnosis considered by clinicians. Other causes, such as mediastinal hematomas, are often ignored. However, the severity of symptoms with mediastinal hematomas makes this an important entity. (Int Heart J 2017; 58: 629-632)

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Section: Discussionmentioning

confidence: 99%

Tracheal Compression Caused by a Mediastinal Hematoma After Interrupted Aortic Arch Surgery

Hua

Lin

et al. 2017

Int. Heart J.

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“…A type B interruption is between the left common carotid artery and the left subclavian artery. The risk of mortality with surgical repair varies from 12 to 30% [Schreiber et al, 2000], with single stage repairs having the lowest rate. Coexisting lesions and the clinical state of the patient prior to surgery affect the operative mortality rate [Powell et al, 1997;Tlaskal et al, 1998;Schreiber et al, 2000].…”

Section: Discussionmentioning

confidence: 99%

“…The risk of mortality with surgical repair varies from 12 to 30% [Schreiber et al, 2000], with single stage repairs having the lowest rate. Coexisting lesions and the clinical state of the patient prior to surgery affect the operative mortality rate [Powell et al, 1997;Tlaskal et al, 1998;Schreiber et al, 2000]. In both patients in this report, a single stage repair was performed, the surgical procedures were uncomplicated and there were no significant preoperative medical problems.…”

Section: Discussionmentioning

confidence: 99%

“…The life-threatening lesions such as interrupted aortic arch and truncus arteriosus are amenable to surgical correction in the neonatal period and surgical mortality continues to decline, currently being between 10 and 30% [Castaneda et al, 1994;Imamura et al, 1999;Schreiber et al, 2000]. A host of other vascular problems in these patients such as tortuous carotid arteries, Raynaud's phenomenon, unexplained hypotension, hypertension, and hypothermia raise the possibility that there may be abnormal autonomic regulation of the vascular system (Robert Shprintzen, RJ, Department of Otolaryngology/ Communication Disorders SUNY-upstate Medical University Syracuse, NY).…”

Section: Introductionmentioning

confidence: 99%

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Vasomotor instability in neonates with chromosome 22q11 deletion syndrome

Shashi

Berry

Hines

2003

American J of Med Genetics Pt A

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Approximately 70% of individuals with chromosome 22q11 deletion syndrome (22q11DS) have congenital heart defects. A host of other vascular problems in these patients, such as tortuous carotid arteries, Raynaud's phenomenon, unexplained hypotension, hypertension, and hypothermia, raise the possibility that there may be abnormal autonomic regulation of the vascular system. So far, however, there has been no formal report of autonomic dysfunction in patients with 22q11 deletion. We present two infants with 22q11DS, who had profound hypotension after uncomplicated surgeries for congenital heart disease. The hypotension was not responsive to vasopressor treatment (and extracorporeal membrane oxygenation in one infant) and resulted in death, due to multiorgan system failure. Obvious causes, such as poor cardiac contractility, prolonged circulatory arrest, neurological abnormality, sepsis and blood loss were excluded. On autopsy, no abnormalities were found that could explain the hypotension. We hypothesize that these infants died of severe hypotension due to abnormal vascular tone and that this is a variable feature in individuals with 22q11 deletion. The autonomic nervous system, which is responsible for the regulation of vasomotor tone, may be variably affected in 22q11DS. This could have implications for the surgical management of patients with 22q11DS. Further studies on this topic would establish or refute the association between 22q11DS and dysautonomia.

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“…Expensive and drastic treatments are required, yet they usually yield imperfect outcomes despite impressive advancements. 3,8,29,39 With greater understanding of how mechanical forces influence cardiovascular development, it may be possible to shift the solution to prenatal, in utero surgery to correct the mechanical environment and to modify the course of growth for the cardiovascular system. This way, it may be possible to tap into the regenerative capabilities of the fetus to assist treatment and improve outcome.…”

Section: Introductionmentioning

confidence: 99%

3D Reconstruction of Chick Embryo Vascular Geometries Using Non-invasive High-Frequency Ultrasound for Computational Fluid Dynamics Studies

et al. 2015

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Recent animal studies have provided evidence that prenatal blood flow fluid mechanics may play a role in the pathogenesis of congenital cardiovascular malformations. To further these researches, it is important to have an imaging technique for small animal embryos with sufficient resolution to support computational fluid dynamics studies, and that is also non-invasive and non-destructive to allow for subject-specific, longitudinal studies. In the current study, we developed such a technique, based on ultrasound biomicroscopy scans on chick embryos. Our technique included a motion cancelation algorithm to negate embryonic body motion, a temporal averaging algorithm to differentiate blood spaces from tissue spaces, and 3D reconstruction of blood volumes in the embryo. The accuracy of the reconstructed models was validated with direct stereoscopic measurements. A computational fluid dynamics simulation was performed to model fluid flow in the generated construct of a Hamburger-Hamilton (HH) stage 27 embryo. Simulation results showed that there were divergent streamlines and a low shear region at the carotid duct, which may be linked to the carotid duct's eventual regression and disappearance by HH stage 34. We show that our technique has sufficient resolution to produce accurate geometries for computational fluid dynamics simulations to quantify embryonic cardiovascular fluid mechanics.

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Repair of interrupted aortic arch: results after more than 20 years

Cited by 87 publications

References 20 publications

Tracheal Compression Caused by a Mediastinal Hematoma After Interrupted Aortic Arch Surgery

Tracheal Compression Caused by a Mediastinal Hematoma After Interrupted Aortic Arch Surgery

Vasomotor instability in neonates with chromosome 22q11 deletion syndrome

3D Reconstruction of Chick Embryo Vascular Geometries Using Non-invasive High-Frequency Ultrasound for Computational Fluid Dynamics Studies

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