| Extended end-to-end repair and enlargement of the entire arch in complex coarctation. | |
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MedLine Citation:
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PMID: 10197683 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Treatment of hypoplasia of the entire arch in coarctation is a surgical challenge. The current approaches have technical difficulties, high recurrence rates, and increased morbidity and mortality. METHODS: Over a 14-month period, a combined extended end-to-end repair with patch enlargement of the concavity of the entire arch was performed in 6 neonates and 1 infant. Through a midsternotomy and using cardiopulmonary bypass and hypothermia, extended end-to-end repair was performed initially leaving the proximal anastomosis open. The enlarging polytetrafluoroethylene patch was then sutured starting at the incised descending aorta distal to the extended end-to-end repair and continued retrogradely through the transverse arch to the ascending aorta proximal to the aortic cannulation site. One neonate had a patent ductus arteriosus and another had ventricular septal defect closure. One neonate had arterial switch and 3 had Norwood-type procedures performed with the enlarging patch extended to the pulmonary artery anastomosis. The remaining infant had arch enlargement performed after an arterial switch procedure and extended end-to-end repair. RESULTS: All patients did well and showed no residual gradient up to 1 year follow-up. Two patients successfully had bidirectional Glenn shunt at 9 months of age, and one had closure of residual arterial septal defect at 8 months of age. CONCLUSION: The combined extended end-to-end repair and arch enlargement procedure should minimize recurrence rates because of a tension-free enlargement of the entire aortic arch and elimination of the coarctation ridge and ductile tissues. Combined with the arterial switch and Norwood-type procedures, the approach results in a large neoaorta. |
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Authors:
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D A Vitullo; S Y DeLeon; L C Graham; B W Eidem; P T Roughneen; J J Javorski; F Cetta |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 67 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 1999 Feb |
Date Detail:
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Created Date: 1999-04-23 Completed Date: 1999-04-23 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 528-31 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois 60153, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Surgical* Aorta, Thoracic / surgery Aortic Coarctation / diagnosis, surgery* Aortography Blood Vessel Prosthesis Implantation Echocardiography Female Follow-Up Studies Heart Defects, Congenital / diagnosis, surgery Humans Infant Infant, Newborn Male Polytetrafluoroethylene Suture Techniques Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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9002-84-0/Polytetrafluoroethylene |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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