Pseudoaneurysm and aorto-bronchial fistula following balloon dilation of recoarctation.

This case report documents the successful surgical repair of an aorto-bronchial fistula and a giant aortic pseudoaneurysm at the proximal anastomosis of a dacron interposition tube graft that was balloon dilated for recurrent coarctation. Balloon dilation for recoarctation of a dacron interposition tube graft may lead to serious complications.

Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusion.

OBJECTIVES: Optimal cerebral and visceral protection is crucial in aortic arch surgery. The main method for this protection has traditionally been deep hypothermic circulatory arrest (DHCA). Recently, antegrade cerebral perfusion with moderate hypothermia has become the preferred strategy for adult patients and some children undergoing aortic arch surgery. Continuous cerebral perfusion should reduce the incidence of neurological complications, but the degree of damage to organs and systems resulting from the lack of blood flow distal to the aortic arch remains unclear. Here, we aimed to evaluate the efficacy and safety of methods of protecting the brain and internal organs during aortic arch surgery in infants. METHODS: We performed a retrospective review of 62 patients who underwent aortic arch reconstruction to assess their neurological status and internal injuries after different methods of cerebral protection. RESULTS: Surgical correction of aortic arch congenital abnormalities was performed under DHCA in 27 patients (Group I), and unilateral selective antegrade cerebral perfusion (SACP) was performed in 35 patients (Group II). In Group I, 30.8% of patients had neurological complications, whereas in Group II 5.9% had neurological complications. The odds ratio for a neurological event was significantly lower in Group II compared with Group I-0.14 [(95% CI 0.02-0.63), P = 0.02]. However, incidence of renal dysfunction was significantly higher in the second group than the first: 21 (61.2%) vs 5 (19.2%) cases, respectively [odds ratio 6.49 (95% CI 1.41-38.26), P = 0.02]. CONCLUSIONS: Aortic arch reconstruction accompanied by SACP has a lower risk of neurological complications compared with DHCA. However, the high incidence of renal complications with SACP requires further study.

Left main coronary artery stenting in a neonate after arterial switch operation for transposition of the great arteries.

Anatomical correction of transposition of the great arteries (TGA) with an intramural coronary artery is associated with high risk of coronary complications such as vessel injury and stenosis. Here, we report on a case of left main coronary artery stenting in a neonate with single coronary artery after repair for TGA.

Reverse subclavian flap repair and maintenance of antegrade blood flow within the left subclavian artery in neonates with aortic coarctation and distal arch hypoplasia.

Surgical palliation for aortic coarctation with aortic arch hypoplasia in neonates and infants has been used in the clinic as the most beneficial treatment for this disorder. This technique allows the correction of aortic coarctation by the use of "extended" anastomosis without cardiopulmonary bypass, which expands the hypoplastic distal aortic arch via the use of a reverse subclavian flap repair. This technique maintains antegrade blood flow within the left subclavian artery.