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1. #Screening recommendations for interrupted aortic arch Patch#
2. #Screening recommendations for interrupted aortic arch free#

The undersurface of the arch was incised and the aortotomy carried along the lesser curvature of the arch down the medial side of the ascending aorta, stopping just above the sinotubular junction (Fig. The descending thoracic aorta was splayed open medially for 8–10 mm and the corners trimmed. The subclavian artery was sacrificed if there was ductal tissue encroaching into its origin. The arch was transected above and below ductal insertion, and all visible ductal tissue excised (Fig. ACP was performed at 20☌ at a flow of 30 ml/kg/min. The descending thoracic aorta was dissected for at least 2 cm distal to the ductal insertion (Fig. The ductus was divided and extensive dissection of the arch, its branches and the descending thoracic aorta was performed while cooling. The pulmonary and aortic ends of the ductus arteriosus were ligated after commencing CPB. For isolated aortic arch repair, a single venous cannula was inserted into the right atrial appendage. Venous cannulation was determined by the need for concomitant procedures. Arterial cannulation was performed either through the distal ascending aorta or a side graft sutured to the innominate artery, depending on the diameter of the ascending aorta. Deep hypothermic circulatory arrest was utilized for a short period during Norwood procedures as per the surgeon’s preference. All procedures were performed via median sternotomy using CPB and deep hypothermia at 20☌ with ACP.

The operative technique is illustrated in Fig.

#Screening recommendations for interrupted aortic arch Patch#

In this study, we present the mid-term outcomes of our standardized patch augmentation technique for repair of hypoplastic/interrupted aortic arch (IAA) (central figure). There is no established standard technique for repair of a hypoplastic arch. The incidence of reported recurrent arch obstruction after univentricular and biventricular repair is 2–40%. Recurrent arch obstruction is one of the most important complications after arch surgery and can lead to hypertension, systemic ventricle hypertrophy, raised pulmonary artery pressures and eventually, cardiac failure.

The goals of surgical repair of hypoplastic aortic arch are to completely relieve obstruction, while preserving growth potential of the repaired aorta and minimizing the risk of re-obstruction.

#Screening recommendations for interrupted aortic arch free#

Repair of IAA may not always be possible by direct native aortic anastomosis and patch augmentation may be required for a tension free anastomosis. While coarctation of the aorta and hypoplasia of the distal arch are usually repaired via a thoracotomy approach avoiding the detrimental effects of cardiopulmonary bypass (CPB), hypoplasia involving the proximal aortic arch is usually repaired through a median sternotomy on CPB using hypothermia and circulatory arrest with or without antegrade cerebral perfusion (ACP). The most extreme form includes complete interruption of the aortic arch (IAA). Hypoplasia of the aortic arch ranges from narrowing of the distal arch and isthmus near the insertion of the ductus arteriosus to hypoplasia of the entire aorta.