title: Everting closure for interrupted aortic arch, ventricular septal defect, and severe subaortic stenosis.
abstract: Interrupted aortic arch with ventricular septal defect in the neonate is sometimes complicated by severe subaortic stenosis from posterior deviation of the infundibular septum. We have developed a novel approach to the treatment of this condition. The infundibular septum is penetrated from the right-ventricular side to the left-ventricular outflow tract. It is compressed with patch fixation. The lower margin of the infundibular septum is everted. Three consecutive neonates were treated. The smallest diameters of the left-ventricular outflow tract were 3,4, and 2.5 mm. All patients survived the operation and were discharged from the hospital. They remained well 2 to 7 years after the repair and were in normal sinus rhythm without a left bundle branch block or any significant pressure gradient between the upper and lower extremities. Follow-up two-dimensional and Doppler echocardiography demonstrated no residual shunt, no left-ventricular outflow-tract pressure gradient, and no aortic regurgitation. This technique provides effective widening of the left-ventricular outflow tract, and is more safely and easily performed than conventional methods.
authors.affiliation: Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: K
authors.initials: K
authors.lastname: Tajima
authors.forename: Y
authors.initials: Y
authors.lastname: Sakai
authors.forename: T
authors.initials: T
authors.lastname: Shimomura
authors.forename: M H
authors.initials: MH
authors.lastname: Song
authors.forename: Y
authors.initials: Y
authors.lastname: Suenaga
authors.forename: M
authors.initials: M
authors.lastname: Murase
mesh_terms: D001011:Aorta / Q000002:abnormalities*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male