title: Reverse subclavian flap and aorto-pulmonary window technique for repair of interrupted aortic arch and truncus arteriosus.
abstract: We report a surgical strategy for repairing an interrupted aortic arch (IAA) with truncus arteriosus (TA) by using a reverse subclavian flap and an aorto-pulmonary (A-P) window technique for preserving the pulmonary artery architecture. A 10-day-old neonate with type B IAA and type I TA with echocardiographic evidence of a significant distance between the ascending and descending aorta underwent surgical repair at the Bristol Royal Hospital for Children. The superior part of the arch was reconstructed using a reverse subclavian flap and the undersurface with a pulmonary homograft patch. The ascending aorta was separated from the pulmonary arteries using a Gore-Tex patch (A-P window type of repair) without disconnecting the branch pulmonary arteries, in order to preserve their architecture. The continuity between the right ventricle and the pulmonary artery bifurcation was established using a 12 mm Contegra conduit. The postoperative course was uneventful, and the neonate was discharged after 12 days. At follow-up, the patient remains well, gaining weight, with no echocardiographic evidences of obstruction. Reverse subclavian flap with homograft patch combined with and 'A-P window' technique for preservation of the pulmonary artery architecture is a useful and effective surgical strategy for neonates presenting with IAA associated with TA.
authors.affiliation: Bristol Heart Institute, Bristol Royal Hospital for Children, Bristol, UK. paolo.desiena@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: de Siena
authors.forename: Chanaka
authors.initials: C
authors.lastname: Rajakaruna
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Parry
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
mesh_terms: D000015:Abnormalities, Multiple; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D006801:Humans; D007231:Infant, Newborn; D013524:Surgical Flaps; D016896:Treatment Outcome; D014339:Truncus Arteriosus, Persistent / Q000601:surgery*