GROWTH-POTENTIAL IN THE NEW AORTIC-ARCH AFTER NON-END-TO-END REPAIR OF AORTIC-ARCH INTERRUPTION IN INFANCY

Background. Complete repair of infants with interrupted arch and ventr icular septal defect through a midline incision has been the preferred method for more than 20 years. End-to-end anastomosis can result in r estenosis if there is excess tension. Two methods of reducing this ten sion have been described, and the subsequent growth of the new aortic arch is demonstrated. Methods. In 2 infants (5 and 9 months old) the d uct was used to create a new aortic arch. In 3 other younger infants t he left carotid artery was divided, turned down, and anastomosed to th e descending aorta to form the new arch, These operations were perform ed through the midline at the same time as the ventricular septal defe ct was closed. Results. All 5 patients are well now 8 to 19 years post operatively. One patient required reoperation for stenosis at the anas tomotic site, but all have subsequently shown good growth on follow-up angiographic and magnetic resonance imaging studies. Conclusions. Alt hough end-to-end repair is best, these alternative methods have shown very satisfactory aortic growth into adult life.