Skip to main content

Advertisement

Log in

Surgical treatment for graft stenosis after repair of an interrupted aortic arch: Report of two cases

  • Case Reports
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

We report herein two cases of patients who underwent successful reoperation for graft stenosis after repair of an interrupted aortic arch (IAA). The first patient was a 10-year-old girl who suffered from upper limb hypertension 9 years after her initial operation. Cardiac catheterization revealed a pressure gradient of 55mmHg across the repaired arch. At reoperation, a left subclavian turndown anastomosis was performed, following which the hypertension resolved and a cardiac catheterization done 5 years later demonstrated sufficient growth of the restored arch with no significant gradient. The second patient was a 17-year-old boy who suffered from general fatigue and intermittent hypertension 12 years after his initial operation. Cardiac catheterization revealed a gradient of 60mmHg across the repaired arch. He underwent an extraanatomic ascending to descending aortic bypass employing an additional 18-mm graft, and a postoperative cardiac catheterization showed no gradient between the ascending and descending aorta. Our experience has shown that IAA should be repaired without prosthetic grafts if possible. Although extraanatomic bypass is useful for reducing the operative risks at reoperation, a large graft should be used to avoid the need for a third operation. For young children expected to outgrow a second graft, performing an endogenous anastomosis, such as a left subclavian turndown anastomosis, should be considered as an alternative.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Schreiber C, Mazzitelli D, Haehnel JC, Lorenz HP, Meisner H (1997) The interrupted aortic arch: an overview after 20 years of surgical treatment. Eur J Cardio-thorac Surg 12:466–470

    Article  CAS  Google Scholar 

  2. Serraf A, Lacour-Gayet F, Robotin M, Bruniaux J, Sousa-Uva M, Roussin R, Planché C (1996) Repair of interrupted aortic arch: a ten-year experience. J Thorac Cardiovasc Surg 12:1150–1160

    Google Scholar 

  3. Karl TR, Sano S, Brawn W, Mee RBB (1992) Repair of hypoplastic or interrupted aortic arch via sternotomy. J Thorac Cardiovasc Surg 104:688–695

    PubMed  CAS  Google Scholar 

  4. Norwood WI, Lang P, Castaneda AR, Hougen TJ (1983) Reparative operations for interrupted aortic arch with ventricular septal defect. J Thorac Cardiovasc Surg 86:832–837

    PubMed  CAS  Google Scholar 

  5. Sell JE, Jonas RA, Mayer JE, Blackstone EH, Kirklin JW, Castaneda AR (1988) The results of a surgical program for interrupted aortic arch. J Thorac Cardiovasc Surg 96:864–877

    PubMed  CAS  Google Scholar 

  6. Irwin ED, Braunlin EA, Foker JE (1991) Staged repair of interrupted aortic arch and ventricular septal defect in infancy. Ann Thorac Surg 52:632–639

    Article  PubMed  CAS  Google Scholar 

  7. Bogers AJJC, Contant CME, Hokken RB, Cromme-Dijkhuis AH (1997) Repair of aortic arch interruption by direct anastomosis. Eur J Cardio-thorac Surg 11:100–104

    Article  CAS  Google Scholar 

  8. Fujioka Y, Kumate M, Aoyagi S, Toyomasu H, Akasu I, Kosuga K, Ohishi K, Koga M, Koike S, Kato H (1977) Successful surgical correction of a type A interrupted aortic arch with ventricular septal defect and patent ductus arteriosus through the median sternotomy (in Japanese with English abstract). Kyobugeka (Jpn J Thorac Surg) 31:626–630

    Google Scholar 

  9. Aeba R, Katogi T, Ueda T, Takeuchi S, Kawada S (1998) Complications following reparative surgery for aortic coarctation or interrupted aortic arch. Surg Today 28:889–894

    Article  PubMed  CAS  Google Scholar 

  10. Monro JL (1989) Reoperations for interrupted aortic arch. In: Stark J, Pacifico AD (eds) Reoperations in cardiac surgery. Springer, Berlin Heidelberg New York, pp 125–141

    Google Scholar 

  11. Jacob T, Cobanoglu A, Starr A (1988) Late results of ascending aorta-descending aorta bypass grafts for recurrent coarctation of aorta. J Thorac Cardiovasc Surg 95:782–787

    PubMed  CAS  Google Scholar 

  12. Heinemann MK, Ziemer G, Wahlers T, Köhler A, Borst HG (1997) Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results. Eur J Cardio-thorac Surg 11:169–175

    Article  CAS  Google Scholar 

  13. Nakamichi T, Katogi T, Ueda T, Aeba R, Yasudo M, Cho Y, Kido M, Omoto T, Kawada S (1997) Extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta. Surgical option applied to reoperation for aortic coarctation or interruption (in Japanese with English abstract). Nippon Kyoubugeka Gakkai Zasshi (J Jpn Assn Thorac Surg) 45:1690–1695

    CAS  Google Scholar 

  14. Hirai M, Imai Y, Takanashi Y, Hoshino S, Terada M, Aoki M, Takeuchi T (1995) Reoperation for coarctation of the aorta and interrupted aortic arch (in Japanese with English abstract). Nippon Kyobugeka Gakkai Zasshi (J Jpn Assn Thorac Surg) 43:1657–1663

    CAS  Google Scholar 

  15. Tsukuda K, Tatsuno K, Mannouji E, Kikuchi T, Takahashi Y (1996) Axillo-iliac bypass grafting for reoperation of graft stenosis after aortic arch reconstruction of type B interruption of the aortic arch: two case reports (in Japanese with English abstract). Nippon Kyobugeka Gakkai Zasshi (J Jpn Assn Thorac Surg) 44:212–215

    CAS  Google Scholar 

  16. Tanaka K, Kumate M, Yasunaga H, Egashira A, Todo K, Takagi J, Kawano T, Kawara T (1998) Three-staged operation in a boy with interrupted aortic arch (in Japanese with English abstract). Nippon Shoni Junkanki Gakkai Zasshi (Acta Cardiol Paed Jpn) 14:560–566

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kosuga, T., Fukunaga, S., Akasu, K. et al. Surgical treatment for graft stenosis after repair of an interrupted aortic arch: Report of two cases. Surg Today 30, 754–758 (2000). https://doi.org/10.1007/s005950070092

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s005950070092

Key Words

Navigation