title: Arch reconstruction without circulatory arrest in neonates.
abstract: Between May 2000 and December 2002, 10 neonates underwent arch reconstruction without circulatory arrest. Age at surgery ranged from 1 to 18 days, and body weight ranged from 1.62 to 3.38 kg. The diagnosis was interrupted aortic arch in 4, hypoplastic left heart syndrome in 3, and coarctation complex in 3. A 3 mm polytetrafluoroethylene graft was anastomosed to the innominate artery, and the brain was perfused via this graft while the aortic arch was reconstructed. Regional cerebral oxygen saturation and the right and left radial artery pressures were monitored. There were 2 deaths: one because of low cardiac output syndrome after a Norwood operation; another from multiple organ failure due to preoperatively undetected congenital biliary atresia. Regional cerebral oxygen saturation was kept constant at over 40% during regional cerebral perfusion. There were no neurologic sequelae observed postoperatively. It was concluded that the regional cerebral perfusion technique can be safely applied during neonatal aortic arch reconstruction, and deep hypothermic circulatory arrest should be avoided.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kitasato University, School of Medicine, Kanagawa, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takeda
authors.forename: Toshihide
authors.initials: T
authors.lastname: Asou
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000714:Anastomosis, Surgical; D001015:Aortic Arch Syndromes / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery; D001794:Blood Pressure; D016122:Brachiocephalic Trunk / Q000601:surgery; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D010101:Oxygen Consumption; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene