Abstract
Objective. Evaluation of immediate and immediate long-term results of surgical correction of isolated aortic coarctation and in combination with hypoplasia of the arch in newborns and young children by access through left-sided thoracotomy.
Material and methods. For 4 years, 60 children with coarctation of the aorta, Me=18 days old and weighing Me=3.5 kg, were operated at the Morozov Children’s City Clinical Hospital using access through a left-sided thoracotomy. The majority (66.7%) of the patients were neonates. In 2 cases, the operation was performed for recoarctation of the aorta after previously performed balloon angioplasty of the aorta. Prior to surgery, patients underwent determination of pulsation, non-invasive measurement of blood pressure, echocardiography with measurement of all segments of the aorta, sizes and volumes of the heart cavities, contractility of the left ventricle, and multispiral computed tomography (MSCT) with contrasting of the heart and great vessels.
Results. Duration of stay in the ICU: Me=5.5 days, time spent in the hospital Me=13 days. At the hospital stage, complications were noted in 4 (6.67%) patients, of which 2 patients died. The immediate and immediate long-term results are analyzed. In the postoperative period, according to echocardiography data, a decrease in the systolic pressure gradient on the aortic isthmus was noted (median before surgery = 45 mm Hg, after surgery = 15 mm Hg) with a significant increase in the lumen of the aortic isthmus from 1.8 mm (z-score = –4.98) up to 4 mm (z-score = –2.22). There was a statistically significant increase in the diameter not only of the distal part of the arch (z-score = –1.77±1.21) but also of the proximal part (z-score = –0.62±1.04). Significantly improved contractility of the left ventricle (LVEF increased from 62% to 69%) with a decrease in the index size and volume of the latter. The blood flow in the abdominal aorta was restored in 100% patients. The remote period was followed up in 46 patients with a median follow-up of 18 months. With persistently maintaining a low systolic pressure gradient at the aortic isthmus, statistically significant improvements in the size of the isthmus and aortic arch are noted. The data obtained may indicate that the extended anastomosis does not prevent the growth of the studied aortic areas. During this period, recoarctation of the aorta, which required repeated intervention, occurred in 2 patients.
Conclusions. Resection of coarctation of the aorta with an expanded anastomosis under the arch using the access of left-sided thoracotomy has good immediate and hopeful long-term results. Extended anastomosis makes it possible to grow not only the isthmus, but also hypoplastic segments of the aorta.
References
- Zani A., Cozzi D.A. Giovanni Battista Morgagni and his contribution to pediatric surgery. J. Pediatr. Surg. 2008; 43 (4): 729–33. DOI: 10.1016/j.jpedsurg.2007.12.065
- Ringel R.E., Gauvreau K., Moses H., Jenkins K.J. Coarctation of the Aorta Stent Trial (COAST): study design and rationale. Am. Heart J. 2012; 164 (1): 7–13. DOI: 10.1016/j.ahj.2012.04.008
- Ho S.Y., Anderson R.H. Coarctation, tubular hypoplasia, and the ductus arteriosus. Histological study of 35 specimens. Br. Heart J. 1979; 41 (3): 268–74. DOI: 10.1136/hrt.41.3.268
- Anderson R.H., Lenox C.C., Zuberbuhler J.R. Morphology of ventricular septal defect associated with coarctation of aorta. Br. Heart J. 1983; 50 (2): 176–81. DOI: 10.1136/hrt.50.2.176
- Shinebourne E.A., Tam A.S, Elseed A.M., Paneth M., Lennox S.C., Cleland W.P. Coarctation of the aorta in infancy and childhood. Br. Heart J. 1976; 38 (4): 375–80. DOI: 10.1136/hrt.38.4.375
- Becker A.E., Becker M.J., Edwards J.E. Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation. 1970; 41 (6): 1067–75. DOI: 10.1161/01.cir.41.6.1067
- Kvitting J.P., Olin C.L. Clarence Crafoord: a giant in cardiothoracic surgery, the first to repair aortic coarctation. Ann. Thorac. Surg. 2009; 87 (1): 342–6. DOI: 10.1016/j.athoracsur.2008.08.072
- Vossschulte K. Surgical correction of coarctation of the aorta by an “isthmusplastic” operation. Thorax. 1961; 16 (4): 338–45. DOI: 10.1136/thx.16.4.338
- Backer C.L., Paape K., Zales V.R., Weigel T.J., Mavroudis C. Coarctation of the aorta. Repair with polytetrafluoroethylene patch aortoplasty. Circulation. 1995; 92 (9): II132–6. DOI: 10.1161/01.cir.92.9.132
- Rheuban K.S., Gutgesell H.P., Carpenter M.A., Jedeikin R., Damman J.F., Kron I.L. et al. Aortic aneurysm after patch angioplasty for aortic isthmic coarctation in childhood. Am. J. Cardiol. 1986; 58 (1): 178–80. DOI: 10.1016/0002-9149(86)90270-5
- Waldhausen J.A., Nahrwold D.L. Repair of coarctation of the aorta with a subclavian flap. J. Thorac. Cardiovasc. Surg. 1966; 51 (4): 532–3.
- Pandey R., Jackson M., Ajab S., Gladman G., Pozzi M. Subclavian flap repair: review of 399 patients at median follow-up of fourteen years. Ann. Thorac. Surg. 2006; 81 (4): 1420–8. DOI: 10.1016/j.athoracsur.2005.08.070
- Gross R.E. Treatment of certain aortic coarctations by homologous grafts; a report of nineteen cases. Ann. Surg. 1951; 134 (4): 753–68. DOI: 10.1097/00000658-195110000-00020
- Charlton-Ouw K.M., Codreanu M.E., Leake S.S., Sandhu H.K., Calderon D., Azizzadeh A. et al. Open repair of adult aortic coarctation mostly by a resection and graft replacement technique. J. Vasc. Surg. 2015; 61 (1): 66–72. DOI: 10.1016/j.jvs.2014.06.010
- Amato J.J., Rheinlander H.F., Cleveland R.J. A method of enlarging the distal transverse arch in infants with hypoplasia and coarctation of the aorta. Ann. Thorac. Surg. 1977; 23 (3): 261–3. DOI: 10.1016/s0003-4975(10)64121-5
- Thomson J.D., Mulpur A., Guerrero R., Nagy Z., Gibbs J.L., Watterson K.G. Outcome after extended arch repair for aortic coarctation. Heart. 2006; 92 (1): 90–4. DOI: 10.1136/hrt.2004.058685
- Wright G.E., Nowak C.A., Goldberg C.S., Ohye R.G., Bove E.L., Rocchini A.P. Extended resection and end-toend anastomosis for aortic coarctation in infants: results of a tailored surgical approach. Ann. Thorac. Surg. 2005; 80 (4): 1453–9. DOI: 10.1016/j.athoracsur.2005.04.002
- Gropler M.R.F., Marino B.S., Carr M.R., Russell W.W., Gu H., Eltayeb O.M. et al. Long-term outcomes of coarctation repair through left thoracotomy. Ann. Thorac. Surg. 2019; 107 (1): 157–64. DOI: 10.1016/j.athoracsur. 2018.07.027
- Belyaeva M.M., Ilyin V.N., Kornoukhov O.Yu., Kornoukhov Yu.Yu., Kalinina O.I. Correction of aortic coarctation from lateral access in newborns and infants. Circulation Pathology and Cardiac Surgery. 2018; 22 (4): 12–21 (in Russ.). DOI: 10.21688/1681-3472-2018-4-12-20
- Moulaert A.J., Bruins C.C., Oppenheimer-Dekker A. Anomalies of the aortic arch and ventricular septal defects. Circulation. 1976; 53 (6): 1011–5. DOI: 10.1161/01.cir.53.6.1011
- Morrow W.R., Huhta J.C., Murphy D.J. Jr, McNamara D.G. Quantitative morphology of the aortic arch in neonatal coarctation. J. Am. Coll. Cardiol. 1986; 8 (3): 616–20. DOI: 10.1016/s0735-1097 (86)80191-7
- Karl T.R., Sano S., Brawn W., Mee R.B. Repair of hypoplastic or interrupted aortic arch via sternotomy. J. Thorac. Cardiovasc. Surg. 1992; 104 (3): 688–95. PMID: 1513158.
- Mery C.M., Guzmán-Pruneda F.A., Trost Jr J. G., McLaughlin E., Smith B.M., Parekh D.R. et al. Contemporary results of aortic coarctation repair through left thoracotomy. Ann. Thorac. Surg. 2015; 100 (3): 1039–46. DOI: 10.1016/j.athoracsur.2015.04.129
- Gray W.H., Wells W.J., Starnes V.A., Kumar S.R. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann. Thorac. Surg. 2018; 106 (4): 1214–9. DOI: 10.1016/j.athoracsur.2018.04.025
- Farag E.S., Kluin J., de Heer F., Ahmed Y., Sojak V., Koolbergen D.R. et al. Aortic coarctation repair through left thoracotomy: results in the modern era. Eur. J. Cardiothorac. Surg. 2019; 55 (2): 331–7. DOI: 10.1093/ejcts/ezy241
- Lee M.G., Brink J., Galati J.C., Rakhra S.S., Konstantinov I.E., Cheung M.M. et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann. Thorac. Surg. 2014; 98 (4): 1405– 11. DOI: 10.1016/j.athoracsur.2014.05.007
- Egunov O.A., Krivoshchekov E.V., Bayankina V.M., Kozhanov R.S. The results of surgical treatment of aortic recoarctation in children taking into account the clinical, demographic and anatomical features of the defect. Modern Problems of Science and Education. 2022; 5 (in Russ.). DOI: 10.17513/spno.32142
About the authors
- Aleksey V. Bedin, Cardiovascular Surgeon; ORCID
- Mikhail A. Abramyan, Dr. Med. Sci., Professor of Chair of Pediatrics, Head of Department of Emergency Cardiac
Surgery and Interventional Cardiology; ORCID
- Yuriy N. Shamrin, Dr. Med. Sci., Cardiovascular Surgeon; ORCID
- Mariya M. Kurako, Cand. Med. Sci., Functional Diagnostics Doctor, Ultrasonic Diagnostician; ORCID
- Manolis G. Pursanov, Dr. Med. Sci., Endovascular Surgeon; ORCID
- Kseniya A. Khasanova, Cand. Med. Sci., Radiologist, Head of Department of Radiation Diagnostics; ORCID
- Dariya G. Kovalenko, Radiologist; ORCID
- Yuriy E. Kocharyan, Pediatric Cardiologist; ORCID
