Surgical treatment for graft stenosis after repair of an interrupted aortic arch: Report of two cases

We report herein two cases of patients who underwent successful reoperation for graft stenosis after repair of an interrupted aortic arch (IAA). The f irst patient was a 10-year-old girl who suffered from upper limb hypertensi on 9 years after her initial operation. Cardiac catheterization revealed a pressure gradient of 55 mmHg across the repaired arch. At reoperation, a le ft subclavian turndown anastomosis was performed, following which the hyper tension resolved and a cardiac catheterization done 5 years later demonstra ted sufficient growth of the restored arch with no significant gradient. Th e second patient was a 17-year-old boy who suffered from general fatigue an d intermittent hypertension 12 pears after his initial operation. Cardiac c atheterization revealed a gradient of 60 mmHg across the repaired arch. He underwent an extraanatomic ascending to descending aortic bypass employing an additional 18-mm graft, and a postoperative cardiac catheterization show ed no gradient between the ascending and descending aorta. Our experience h as shown that IAA should be repaired without prosthetic grafts if possible. Although extraanatomic bypass is useful for reducing the operative risks a t reoperation, a large graft should be used to avoid the need for a third o peration. For young children expected to outgrow a second graft, performing an endogenous anastomosis, such as a left subclavian turndown anastomosis, should be considered as an alternative.