Abstract
Interrupted aortic arch (IAA) is a rare condition, most commonly associated with a ventricular septal defect. Without treatment it is lethal but the use of prostaglandin E1 infusion allows perfusion of the lower body via the duct and a degree of temporisation. Echocardiographic diagnosis is often sufficient but in selected cases computed tomography or angiography may be necessary. Depending on the interruption site and other anatomic features, the repair can be done via thoracotomy or sternotomy. A staged procedure with pulmonary banding or a hybrid strategy are also part of the armamentarium. Most groups will favour a complete repair via sternotomy as soon as the patient is stabilised. The arch is reconstructed with a direct anastomosis and patch augmentation is frequent. Cerebral perfusion techniques are increasingly prevalent. The early results have continued to improve but there is a significant decline in survival and functional status in the long-term, attesting to the chronicity of this condition.
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References
Jonas RA. Management of interrupted aortic arch. Semin Thorac Cardiovasc Surg. 2015;27:177–88.
Todman SH, Eltayeb O, Ruzmetov M, et al. Outcomes of interrupted aortic arch repair using the carotid artery turndown procedure. J Thorac Cardiovasc Surg. 2013;145:176–82.
Kapravelou E, Anderson D, Morgan GJ. Hybrid strategy for high-risk neonates with interrupted aortic arch: a can well worth kicking? Int J Angiol. 2018;27:50–3.
Goldberg CS, Bove EL, Devaney EJ, et al. A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: outcomes for infants with functional single ventricle. J Thorac Cardiovasc Surg. 2007;133:880–7.
Algra SO, Jansen N, van der Tweel I, et al. Neurological injury after neonatal cardiac surgery: a randomized controlled trial of two perfusion techniques. Circulation. 2014;129:224–33.
Suzuki T, Ohye RG, Devaney EJ, et al. Selective management of the left ventricular outflow tract for repair of interrupted aortic arch with ventricular septal defect: management of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg. 2006;131:779–84.
Luciani GB, Ackerman RJ, Chang AC, et al. One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: a novel approach. J Thorac Cardiovasc Surg. 1996;111:348–58.
Tchervenkov CI, Jacobs JP, Sharma K, et al. Interrupted aortic arch: surgical decision making. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005:92–102.
Jonas RA, Quaegebeur JM, Kirklin JW, Blackstone EH, Daicoff G. Outcomes in patients with interrupted aortic arch and ventricular septal defect. A multiinstitutional study. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg. 1994;107:1099–109.
McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg. 2005;129:343–50.
Jegatheeswaran A, McCrindle BW, Blackstone EH, et al. Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons’ Society study. J Thorac Cardiovasc Surg. 2010;140:1059–75.
Jacobs JP, Jacobs ML, Mavroudis C, et al. Executive summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database—Eighth Harvest—(January 1, 2004–December 31, 2007). Durham, NC: The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center; 2008.
Uzzaman MM, Khan NE, Davies B, Stickley J, Jones TJ, Brawn WJ, et al. Long-term outcome of interrupted arch repair with direct anastomosis and homograft augmentation patch. Ann Thorac Surg. 2018;105:1819–26.
O’Byrne ML, Mercer-Rosa L, Zhao H, et al. Morbidity in children and adolescents after surgical correction of interrupted aortic arch. Pediatr Cardiol. 2014;35:386–92.
Joynt CA, Robertson CMT, Cheung P, et al. Two-year neurodevelopmental outcomes of infants undergoing neonatal cardiac surgery for interrupted aortic arch: a descriptive analysis. J Thorac Cardiovasc Surg. 2009;138:924–32.
Langley SM, Sunstrom RE, Reed RD, Rekito AJ, Gerrah R. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2013;16:43–51.
Yasui H, Kado H, Nakano E, et al. Primary repair of interrupted aortic arch and severe aortic stenosis in neonates. J Thorac Cardiovasc Surg. 1987;93:539–45.
Lacour-Gayet F, Sauer H, Ntalakoura K, et al. Ross-Konno procedure in neonates: report of three patients. Ann Thorac Surg. 2004;77:2223–5.
Hickey EJ, Yeh T Jr, Jacobs JP, et al. Ross and Yasui operations for complex biventricular repair in infants with critical left ventricular outflow tract obstruction. Eur J Cardiothorac Surg. 2010;37:279–88.
Alsoufi B, Schlosser B, McCracken C, et al. Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk. J Thorac Cardiovasc Surg. 2016;151:412–20.
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Stoica, S.C. (2020). Congenital Aortic Arch Interruption and Hypoplasia. In: Raja, S. (eds) Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24174-2_103
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DOI: https://doi.org/10.1007/978-3-030-24174-2_103
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