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