Abstract
Aortic arch obstruction including coarctation and interrupted aortic arch has referred to the critical abnormalities of neonatal period. Ventricular
septal defect (VSD) has been the most frequent intracardiac pathology associated with aortic arch obstruction. The large VSD has resulted in the
fast development of manifested cardiac insufficiency and circulation decompensation which is associated with high mortality within the first year
of life if left without cardiac intervention. Different approaches have been worked out regarding surgical treatment of such patients. Thus separate
repair of aortic arch allows to avoid the use of cardiopulmonary bypass and narrowing of pulmonary artery and consequently to avoid potential
complications associated with them. Nevertheless most neonates after separate aortic arch repair has shown the manifestation of cardiac
insufficiency which demands the revision surgery for closure of VSD within the single hospital stay and leads to increasing number of complications
and period of hospital stay. Repair of aortic arch obstruction in combination with pulmonary artery banding also allows to avoid cardiopulmonary
bypass, circulatory arrest and considerably reduce the amount of needed hemotransfusion, but implies the need for the repeat surgery
in the long-term period in order to close VSD and remove the pulmonary artery banding performed earlier or only remove the pulmonary artery
banding in the presence of spontaneous closure of VSD which also involves the risk of surgical mortality. Synchronous correction of both defects
with use of one or two surgical accesses is the most difficult technically, implies the use of cardiopulmonary bypass, accompanied by long stay
in intensive care unit but this allows to completely normalize the hemodynamics within one procedure and potentially to avoid the need for revision
interventions in the long-term period. By this one creates the conditions to repair the concomitant intracardiac abnormalities. The great
attention has recently been paid to perfusion. The comparative analyses of interventions has been carried out regarding conditions of deep
hypothermia (18-20 °C) with circulatory arrest and regional antegrade low flow cerebral perfusion.
References
1. STS Congenital Heart Surgery Executive Summary Jul 2008 – Jun 2012. Primary Diagnosis Neonates (0–30 days).
2. STS Congenital Heart Surgery Executive Summary Jul 2008 – Jun 2012. Primary Diagnosis Infants (31 days – 1 year).
3. Teo L.L., Cannell T., Babu-Narayan S.V. et al. Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation
referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr. Cardiol. 2011; 32 (8): 1120–7.
4. Crafoord C., Nylin G. Congenital coarctation of the aorta and its surgical treatment. J. Thorac. Surg. 1945; 14: 347–61.
5. Merrill D.L., Webster C.A., Samson P.C. Congenital absence of the aortic isthmus: Report of a case with successful surgical repair.
J. Thorac. Cardiovasc. Surg. 1957; 3: 311.
6. Jonas R.A., Quaegebeur J.M., Kirklin J.W., Blackstone E.H., Daicoff G. Outcomes in patients with interrupted aortic arch and ventricular
sepatiental defect. A multiinstitutional study. Congenital Heart Surgeons Society. J. Thorac. Cardiovasc. Surg. 1994; 107 (4): 1099–109.
7. Quaegebeur J.M., Jonas R.A., Weinberg A.D., Blackstone E.H., Kirklin J.W. Outcomes in seriously ill neonates with coarctation of the
aortaA multiinstitutional study. J. Thorac. Cardiovasc. Surg. 1994; 108: 841–51.
8. Sinha S.N., Kardatzke M.L., Cole R.B., Muster A.J., Wessel H.U., Paul M.H. Coarctation of the aorta in infancy. Circulation. 1969; 40: 385–98.
9. Fesseha A.K., Eidem B.W. et al. Neonates with aortic coarctation and cardiogenic shock: Presentation and outcomes. Ann. Thorac. Surg.
2005; 79 (5): 1650–5.
10. Bonnet D., Patkai J., Tamisier D., Kachaner J., Vouhe P., Sidi D. A new strategy for the surgical treatment of aortic coarctation associated
with ventricular septal defect in infants using an absorbable pulmonary artery band. J. Am. Coll. Cardiol. 1999; 34: 866–70.
11. Brouwer R.M., Cromme-Dijkhuis A.H., Erasmus M.E. et al. Decision making for the surgical management of aortic coarctation associated
with ventricular septal defect. J. Thorac. Cardiovasc. Surg. 1996; 111: 168–75.
12. Gaynor J.W. Management strategies for infants with coarctation and an associated ventricular septal defect. J. Thorac. Cardiovasc. Surg.
2001; 122: 424–6.
13. Isomatsu Y., Imai Y., Shin’oka T., Aoki M., Sato K. Coarctation of the aorta and ventricular septal defect: should we perform a single-stage
repair? J. Thorac. Cardiovasc. Surg. 2001; 122: 524–8.
14. Alsoufi R., Cai S., Coles J.G. et al. Outcomes of different surgical strategies in the treatment of neonates with aortic coarctation and associated
ventricular septal defects. Ann. Thorac. Surg. 2007; 84: 1331–7.
15. Muller W.H. Jr., Dammann J.F., Jr. The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to
reduce pulmonary hypertension and excessive pulmonary blood flow: a preliminary report. Surg. Gynecol. Obstet. 1952; 95: 213–9.
16. Бокерия Л.А., Туманян М.Р., Чечнева В.В. и др. Результаты хирургического лечения новорожденных с дефектом межжелудочковой
перегородки в сочетании с врожденными обструктивными поражениями дуги аорты. Бюллетень НЦССХ им. А.Н. Бакулева РАМН.
2009; 3: 186.
17. Есаян А.А. Хирургическое лечение новорожденных с врожденной обструктивной патологией дуги аорты в сочетании с дефектом
межжелудочковой перегородки: Дис. … канд. мед. наук. М.; 2011.
18. Walters III H.L., Ionan C.E., Thomas R.L., Delius R.E. Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal
defect. J. Thorac. Cardiovasc. Surg. 2008; 135 (4): 754–61.
19. Haponiuk I., Chojnicki M., Jaworski R., Juжciјski J. et al. Delayed closure of multiple muscular ventricular septal defects in an infant after
coarctation repair and a hybrid procedure–a case report. Heart Surg. Forum. 2011; 14 (1): 67–9.
20. Haponiuk I., Chojnicki M., Jaworski R., Steffens M. Hybrid technique for muscular ventricular septal defect closure. J. Card. Surg. doi:
10.1111/jocs.2013.12106
21. Freedom R.M., Benson L.N., Smallhorn J.F., Williams W.G., Trusler G.A., Rowe R.D. Subaortic stenosis, the univentricular heart, and banding
of the pulmonary artery: an analysis of the courses of 43 patients with univentricular heart palliated by pulmonary artery banding.
Circulation. 1986; 73: 758–64.
22. Takayama H., Sekiguchi A., Chikada M. et al. Mortality of pulmonary artery banding in the current era: recent mortality of PA banding. Ann.
Thorac. Surg. 2002; 74: 1219–24.
23. Jonas R.A. Comprehensive surgical management of congenital heart disease. London: Arnold; 2004.
24. Kanter K.R., Mahle W.T., Kogon B.E., Kirshbom P.M. What is the optimal management of infants with coarctation and ventricular septal
defect? Ann. Thorac. Surg. 2007; 84: 612–8.
25. Kostelka M., Walther T., Geerdts I. et al. Primary repair for aortic arch obstruction associated with ventricular septal defect. Ann. Thorac.
Surg. 2004; 78: 1989–93.
26. Shimada M., Hoashi T., Kagisaki K. et al. One-stage repair with separated cardiopulmonary bypass for coarctation of the aorta with left aortic
arch and right thoracic descending aorta. Gen. Thorac. Cardiovasc. Surg. 2012; 60 (9): 575–7.
27. Tlaskal T., Vojtovic P., Reich O. et al. Improved results after the primary repair of interrupted aortic arch: impact of a new management protocol
with isolated cerebral perfusion. Eur. J. Cardiothorac. Surg. 2010; 38: 52–8.
28. Tomoyasu T., Oka N., Miyamoto T., Kitamura T. et al. Surgical strategy for severe aortic hypoplasia and aortic stenosis with ventricular septal
defect and normal left ventricle. Pediatr. Cardiol. 2013; 34 (5): 1107–11.
29. Ungerleider R.M., Pasquali S.K., Welke K.F., Wallace A.S. et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an
analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J. Thorac. Cardiovasc. Surg. 2013; 145 (1): 150–7.
30. Bellinger D.C., Jonas R.A., Rappaport L.A., Wypij D., Wernovsky G., Kuban K.C. et al. Developmental and neurologic status of children
after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N. Engl. J. Med. 1995; 332: 549–55.
31. Bellinger D., Wypij D., duPlessis A., Rappaport L., Jonas R., Wernovsky G., Newburger J. Neurodevelopmental status at eight years in children
with dextra-transposition of the great arteries: the Boston circulatory arrest trial. J. Thorac. Cardiovasc. Surg. 2003; 126: 1385–96.
32. Fuller S., Rajagopalan R., Jarvik G.P., Gerdes M., Bernbaum J., Wernovsky G. et al. Deep hypothermic circulatory arrest does not impair neurodevelopmental
outcome in school-age children after infant cardiac surgery. Ann. Thorac. Surg. 2010; 90: 1985–94.
33. Miyaji K., Miyamoto T., Kohira S., Itatani K. et al. Regional high-flow cerebral perfusion improves both cerebral and somatic tissue oxygenation
in aortic arch repair. Ann. Thorac. Surg. 2010; 90 (2): 593–9.
34. Visconti K.J., Rimmer D., Gauvreau K. et al. Regional low-flow perfusion versus circulatory arrest in neonates: one-year neurodevelopmental
outcome. Ann. Thorac. Surg. 2006; 82: 2207–11.
