Indications and techniques for midline approach to aortic coarctation in infants and children.
A variety of techniques have been described for the repair of aortic coarctation. Most of these use operative exposure through a left thoracotomy. There are, however, instances when a median sternotomy provides a more versatile approach and allows for equally acceptable repair. Twelve patients (age, 2 days to 16 years) with coarctation of the aorta serve to illustrate the value of the technique. All but 3 patients were under 3 years old. Five patients had repair of coarctation combined with repair of other congenital cardiac anomalies (atrial and ventricular septal defects, 2 patients; atrial septal defects, 2 patients; and valvular aortic stenosis, 1 patient). Six patients had complicated recurrences of previously repaired coarctations and 1 patient had a primary coarctation that involved the aortic arch. All repairs were accomplished through a median sternotomy with the use of cardiopulmonary bypass and periods of (1) total circulatory arrest (6 patients); (2) reduced flow (4 patients); or (3) normal flow with multiple sites of arterial inflow (2 patients). All patients did well with no operative mortalities and no sequelae to date (8 weeks to 4 years). Examples of various techniques are provided to demonstrate the flexibility obtainable with this method. Median sternotomy can provide a viable approach to difficult problems involving coarctation of the aorta.
Ungerleider
R M
RM
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Ebert
P A
PA
D001017:Aortic Coarctation / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008722:Methods; D012086:Reoperation; D013249:Sternum / Q000601:surgery