ONE-STAGE REPAIR OF INTERRUPTED AORTIC-ARCH, VENTRICULAR SEPTAL-DEFECT, AND SUBAORTIC OBSTRUCTION IN THE NEONATE - A NOVEL-APPROACH

Background: One-stage repair of interrupted aortic arch, ventricular s eptal defect, and severe subaortic stenosis represents a surgical chal lenge, Techniques that use extracardiac conduits to bypass the subaort ic area or involve transaortic or transatrial resection of the conal s eptum have shown limitations and have failed to reduce the high mortal ity rate associated with subaortic obstruction, Methods and results: A new operative approach was used in nine neonates (2.1 to 3.9 kg) who underwent one-stage repair of interrupted aortic arch (type B, eight p atients; type C, one patient), ventricular septal defect, and severe s ubaortic stenosis, All patients had severe subaortic stenosis accordin g to preoperative echocardiography (mean ratio of subaortic to descend ing aortic diameter, 0.63 +/- 0.08), With a transpulmonary (seven pati ents) or transatrial (two patients) approach and without resection of the conal septum, the ventricular septal patch was placed on the left side of the septum to deflect the conal septum anteriorly and away fro m the subaortic area, There were no early or late deaths, Median inten sive care unit and hospital stays were 17 days (6 to 47 days) and 21 d ays (10 to 55 days), respectively, On follow-up echocardiography (1 to 29 months, median 12 months), no patients had significant residual su baortic obstruction and one patient had mild residual arch obstruction (20 mm Hg). Growth of the subaortic region was demonstrated in all pa tients (mean ratio of subaortic to descending aortic diameter, 1.20 +/ - 0.10; <0.001), Conclusions: Relief of severe subaortic stenosis duri ng one-stage neonatal repair of aortic arch interruption and ventricul ar septal defect can be accomplished successfully without resection of the conal septum.