초록접수 현황
| 16F-269 | 구연 발표 |
Arch Repair in Unusual Aortic Configuration
Jeong-Jun Park¹, Won Kyoun Park¹, Jong Yoon Park¹, Bo Sang Kwon¹, Chun Soo Park¹, Tae-Jin Yun¹, Jae Suk Baek², Jeong Jin Yu², Young-Hwue Kim², Jae-Kon Ko², Hyun Woo Goo³
¹Department of Thoracic and Cardiovascular Surgery, ²Department of Pediatric Cardiology, ³Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : One of major concerns during arch repair is to prevent airway compression. Majority of arch obstruction patients have a configuration of left arch and left descending aorta. However, some patients have unusual configuration which may cause more challenging surgical technique and a postoperative airway compression. We reviewed our experiences of arch repair in these patients retrospectively since 2013.
Methods : Six patients with unusual aortic configuration underwent arch repair in the neonatal period after preoperative CT evaluation. Aortic arch obstruction was coarctation of aorta in 5 (including 2 HLHS variant) and type B IAA in 1. Aortic configuration were Circumflex retroesophageal left aortic arch in 2, Left aortic arch and right descending aorta crossing vertebrae in 2, right aortic arch and left descending aorta in 1, and right aortic arch and right descending aorta with retroaortic innominate vein in 1. Aortic arch was repaired under selective cerebral perfusion after extensive mobilization of descending aorta. Four patients needed patch material for arch reconstruction including two Norwood operations. Intraoperative bronchoscopy was done routinely.
Results : There was no mortality. There were no additional operations for arch stenosis or airway compression. Two patients on the single ventricle repair tract finished Fontan operation following neonatal Norwood operation.
Conclusion : Individualized arch repair even in unusual aortic configuration provides a good midterm result and preoperative CT scan is very helpful for the surgical planning. Also, extensive mobilization of descending aorta is mandatory and using patch material is helpful, if necessary.
Methods : Six patients with unusual aortic configuration underwent arch repair in the neonatal period after preoperative CT evaluation. Aortic arch obstruction was coarctation of aorta in 5 (including 2 HLHS variant) and type B IAA in 1. Aortic configuration were Circumflex retroesophageal left aortic arch in 2, Left aortic arch and right descending aorta crossing vertebrae in 2, right aortic arch and left descending aorta in 1, and right aortic arch and right descending aorta with retroaortic innominate vein in 1. Aortic arch was repaired under selective cerebral perfusion after extensive mobilization of descending aorta. Four patients needed patch material for arch reconstruction including two Norwood operations. Intraoperative bronchoscopy was done routinely.
Results : There was no mortality. There were no additional operations for arch stenosis or airway compression. Two patients on the single ventricle repair tract finished Fontan operation following neonatal Norwood operation.
Conclusion : Individualized arch repair even in unusual aortic configuration provides a good midterm result and preoperative CT scan is very helpful for the surgical planning. Also, extensive mobilization of descending aorta is mandatory and using patch material is helpful, if necessary.
책임저자: Jeong-Jun Park
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Jeong-Jun Park, E-mail : pkjj@amc.seoul.kr