FIRST EXPERIENCE OF SURGICAL TREATMENT OF NEONATAL COARCTATION WITH AORTIC ARCH HYPOPLASIA

Purpose. To analyze the outcomes of aortic arch reconstruction in neonates with coarctation of the aorta (CoA) and hypoplastic arch.

Materials and methods. 14 neonates with CoA and hypoplastic arch underwent surgical repair from January, 2011 to July 2013. The age group of patients was from 2 day to 28 days (16±8 days). The average weight was 3245±667 grams. The average body surface, calculated using the Dubois formula, was 0,20±0,03 m². Preductal CoA with hypoplastic arch were diagnosed in 13 (92 %) patients. The descending and ascending aorta as well as the segments of the arch were measured with echocardiography and MSCT. Additionally to the “segmental” approach in diagnosis of aortic arch hypoplasia, the Z-score was used to assess the degree of hypoplasia; the degree of stenosis was calculated by the ratio of aortic segment diameters, the deviation from the standard values. All patients underwent median sternotomy. The site of arterial cannulation depended on the diameter of the ascending aorta. 7 (50 %) patients underwent xenopericardium patch augmentation of tubular hypoplasia of the aorta, other 50 % – underwent aortic arch reconstruction with their own aortic tissue segments (method of McKenzie E.D.).

Results. The in-hospital mortality was 21%. 6 (42 %) patients had no complications in the postoperative period. The patients received cardiotonic drugs in therapeutic doses. 7 patients received high doses of cardiotonics to treat biventricular heart failure, all of them had concomitant CHD with subsequent delayed sternal closure. There was no significant pressure gradient across the reconstructed area in all the patients in the early postoperative period (a direct method of measurement based on the difference of radial and femoral artery pressure). The pressure gradient across the area of plasty, measured with echocardiography before the discharge, was from 3 to 12,5 mm Hg (the average value – 8,5±1,2 mm Hg). There were no CNS complications. The average follow-up period was 10±2,5 months. The monitoring visits in the outpatient department did not reveal any significant gradient across the area of the intervention. Echocardiography and MSCT with segemental assessment were performed to evaluate the aortic arch reconstruction in 10 months. 7 out of 11 patients reported normal development of the aortic arch.

Conclusions. 1. Cardiopulmonary bypass with antegrade cerebral perfusion allows to push down safely the edge of the ascending aorta during the main stage and to place an adequate end-to-side anastomosis or to perform patch augmentation of the aortic arch. 2. Hypoplastic arch is commonly complicated by other CHDs, that allows to perform single-stage or palliative repair of associated anomalies.

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