Modified repair of interrupted aortic arch utilizing retroesophageal right subclavian artery based on a neonatal hybrid approach in hypoplastic left heart complex.
OBJECTIVE
Interrupted aortic arch (IAA) combined with an aberrant right subclavian artery (ARSA) is frequently associated with a hypoplastic ascending aorta. Neonatal surgical therapy carries a high risk particularly for aortic arch obstructions during the further follow-up.


METHODS
We performed a modified reconstruction of the aortic arch utilizing the ARSA as a natural substitute in a staged surgical approach. In a novel approach, the distal part of the ARSA is reimplanted into the brachiocephalic trunk.


RESULTS
In three patients, a novel arch reconstruction was successfully performed during complete biventricular repair. In a follow-up of 60 to 87 months, the reconstructed aortic arch has grown without any signs of obstruction in all three patients.


CONCLUSIONS
Utilizing the ARSA for surgical aortic arch repair is a satisfactory solution, when postnatal borderline left heart obstruction associated with IAA and ARSA is postponed by an initial hybrid approach.
Department of Pediatric Cardiac Surgery, Childrens Heart Center, Giessen, Germany. Klaus.Valeske@chiru.med.uni-giessen.de
Klaus
K
Valeske
Matthias
M
Mueller
Nizar
N
Hijjeh
Andreas
A
Boening
Dietmar
D
Schranz
Hakan
H
Akintuerk
D000015:Abnormalities, Multiple; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000254:growth & development / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005865:Gestational Age; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D012092:Replantation; D013348:Subclavian Artery / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures