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KMID : 0367220000170020209
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Sejong Medical Journal
2000 Volume.17 No. 2 p.209 ~ p.219
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Single-stage Repair of Coarctation of the Aorta and Ventricular Septal Defect
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Abstract
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Background
This study was undertaken to determine the outcome and need for reinter vention following siuigle-stage repair of coarctation of the aorta and VSD.
Material and Method
Thirty patients undergoing single-stage repair of coarctation of the aorta with VSD using extended anastomosis, from January 1995 to August 2000, in Sejong General Hospital were reviewed retrospectively.
Mean age and body weight at repair were 105±162 days(12-874 days) and 4.5±1.7 kg(2.69.6 kg), respectively.
Total circulatory arrest was done in 15 patients(50%) and mean time was 23±7 minutes. Total bypass and aortic crossclamp time were 166±61 minutes and 56±28 minutes, respectively.
We have used a technique of complete resection of coarctation and extended anastomosis of the descending aorta to the undersurface of the ascending aorta or aortic arch. resection and extended end-to-end anastomosis (REEEA : n=16). resection and extended end-to-side anastomosis (REESA n=12). and resection and extended side-to-side anastomosis (RESSA : n=2).
Closure of VSD was done with a Dacron patch (18) and autologous pericardium (12) .
Other concomitant procedures were division of patent duct-us arteriosus (PDA) (26) , FFO or ASD closure(23), resection of muscle of right ventricular outflow tract (5) , excision of abnormal muscle of left ventricular outflow tract (3) , tricuspid annuloplasty (2) . aortic valvotomy (1). obliteration of aortopulmonary window (1). and angioplasty of the previous banding site of main pulmonary artery (1) .
Aortic arch hypoplasia was present in 28 patients(93% ).
Two patients were on acute renal failure, four on mechanical ventilation, and seven on prostagiandin Ei infusion
All patients underwent echocardiography, 14 MRI, 9 CT & 3-DR, 4 cardiac catheterization.
Result
There were 3 early postoperative deaths(10%) and no late mortality.
The immediate postoperative residual coarctation was not present. Follow up in the 27 survivors comprised 1,034 patient-months (mean, 35 months). Recurrent coarctation has occurred in 5 of 27 patients(18.5%).
The postoperative complications were occurred in 15 patients(50%) including 3 early mortalities.
Conclusion
Single-stage repair of aortic coarctation and VSD using extended anastomosis can be performed with the acceptable operative mortality and provides adequate correction of coarctation and low risk of recoarctation.
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KEYWORD
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