Document Detail


Aortic complications after pediatric cardiac transplantation in patients with a previous norwood reconstruction.
MedLine Citation:
PMID:  21444045     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Despite increasing surgical success with staged palliation of hypoplastic left heart syndrome and its variants, some of these children eventually may require cardiac transplantation. Sixteen (7.8%) of 206 children ≤18 years old undergoing primary heart transplantation had a previous Norwood palliation. Two (12.5%) developed significant aortic problems after transplantation related to the initial homograft reconstruction of the aorta. Patient 1 developed acute graft failure requiring extracorporeal membrane oxygenator support post-transplant. During acute retransplantation 2 days later, the new donor aorta was sewn to a remnant of the initial donor aorta rather than to the heavily calcified reconstructed native aorta. Two months later, the patient required reoperation for acute airway compression from an aortic pseudoaneurysm caused by necrosis of the bridge of aortic tissue from the first transplant. Patient 2 had multiple balloon dilatations of recurrent coarctation after transplantation. Eighteen years post-transplant, during work-up for chronic fever and weight loss, computerized tomography showed a mycotic aneurysm of the reconstructed transverse aorta with contained rupture necessitating removal and replacement of the entire reconstructed aorta. Although uncommon, aortic complications in pediatric heart transplant patients with previous Norwood arch reconstruction can present with unusual manifestations requiring heightened vigilance.
Authors:
Kirk R Kanter; William T Mahle; Robert N Vincent; Alexandria M Berg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual     Volume:  14     ISSN:  1092-9126     ISO Abbreviation:  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu     Publication Date:  2011  
Date Detail:
Created Date:  2011-03-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815944     Medline TA:  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu     Country:  United States    
Other Details:
Languages:  eng     Pagination:  24-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardio-Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
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