Interrupted aortic arch and aortopulmonary window: one-stage repair in the first week of life.

Aortic arch interruption associated with an aortopulmonary window is a rare congenital malformation that needs an early diagnosis and surgical treatment to avoid irreversible pulmonary lesions. Here we describe a case of a successful one-stage surgical repair in a 3-day-old neonate, without the use of prosthetic material, for the correction of the aortic arch interruption.

Aortic coarctation with hypoplastic arch in neonates: a spectrum of anatomic lesions requiring different surgical options.

Hypoplasia of the transverse aortic arch is frequently associated with isthmic coarctation in many patients referred for operation in early infancy, and the surgical technique should be adjusted to suit each type of anatomic lesion. Referring to the anatomic description of hypoplastic aortic arch reported by Moulaert and associates, between January 1988 and July 1991 we operated on 32 consecutive infants (< or = 3 months old) using a surgical approach based on the echocardiographic and angiographic findings; 20 patients (62%) were younger than 2 weeks of age and 20 patients (62%) had associated intracardiac lesions. According to the location, extension, and size of the hypoplasia of the aortic arch, we had three groups of patients: in group 1 (21 patients) we performed resection and extended end-to-end anastomosis, as previously described in 1985; in group 2 (5 patients) we performed resection, posterior end-to-end anastomosis, and anterior subclavian flap enlargement; and in group 3 (6 patients) we performed direct side-to-end anastomosis between ascending and descending aorta through a median sternotomy. One patient died during the postoperative course in group 3. With a mean follow-up time of 26 months we had 4 cases (13%) of "residual" or "recurrent" coarctation in group 1, successfully repaired at 2 months of age by an anterior approach in 2 patients and by percutaneous angioplasty in the others. In conclusion, hypoplastic aortic arch in neonates represents a common difficulty, and optimal reconstruction of the entire aortic arch is mandatory to reduce operative mortality and incidence of recoarctation, especially when there are complex associated intracardiac lesions or left ventricular dysfunction.

Successful surgical repair of an aortico-left ventricular tunnel in a two day old child.

Repair of an aortico-left ventricular tunnel was successfully accomplished on the second day of life in a neonate with severe cardiac failure. During pregnancy an echocardiographic diagnosis of aortic insufficiency (AI) was made and the type of the malformation was completely clarified after birth. Repair was accomplished using an open patch aortoplasty technique as suggested by Bjork.

[Supravalvular aortic stenosis. Analysis of a surgical series of 8 patients]. / La stenosi sopravalvolare aortica. Analisi di una serie chirurgica di 8 pazienti.

Supravalvular aortic stenosis (SAS) is an unusual form of progressive left ventricular outflow tract (LVOT) obstruction, frequently associated with others vascular and physical anomalies. Between July 1980 and July 1986 eight such patients have been operated upon. In seven patients patch aortoplasty (according to McGoon or Doty technique) relieved the stenosis; in one, a two years old boy, with associated severe hypoplasia of the ascending aorta and aortic arch, a left ventricle (LV) - abdominal aorta valved conduit was associated to aortoplasty. One patient died in the operating room with a severe anterior myocardial infarction; seven patients are in good clinical condition at a mean follow-up of 32 months. The aortic supravalvular gradient was dramatically reduced in all patients according with Doppler echocardiography. In our mind, patients with SAS would benefit from an early surgical repair, because of progressive involvement of the aortic valve, coronary arteries and LV. The surgical technique is strictly related to the anatomical situations. Per and postoperative management should rely on the pathophysiology peculiar to this malformation (especially about coronary perfusion). Taking care to these points, the surgical results at a mid term follow-up are now very satisfactory in this cardiac malformation.

[Transposition of the great vessels with interventricular defect and stenosis of the left ventricular efflux channel: anatomical correction by the intraventricular repair technic]. / Trasposizione dei grossi vasi con difetto interventricolare e stenosi della via di efflusso ventricolare sinistra: correzione anatomica secondo la tecnica di riparazione endoventricolare (REV).

New technique of anatomical correction of transposition of the great arteries (TGV) with ventricular septal defect (VSD) and pulmonary stenosis (PS) without using a prosthetic conduit was reported by Lecompte in 1982. We analyse our recent experience with this procedure in three patients and we describe the main advantages and the wide surgical indications with reference to the Rastelli procedure.

The use of absorbable suture: morphological findings in a newborn three months after coarctation repair.

The macroscopic and histological findings in a case of surgical repair of aortic coarctation in a newborn, performed using polydioxanone, a monofilament absorbable suture material, are reported. The persistence of suture material three months after surgery, the lack of severe inflammatory changes, calcification and elastic disruption of the arterial wall, confirm previous experimental data. For these characteristics, the use of polydioxanone in the repair of aortic coarctation in newborns is suggested, in order to avoid recoarctation, the most frequent complication of this surgical therapy.