Enlarging angioplasty of the aortic arch with a patch of pulmonary artery autograft in a single stage repair of syndromes of coarctation and interruption of the aortic arch

Single stage repair of syndromes of coarctation and interruption of the aor tic arch is a routine procedure in many surgical centres with good immediat e results. The classical technique of aortic repair is based on the princip les of Crafoord's extended resection anastomosis. Recoarctation is not an u nusual long-term complication. A technique of enlarging angioplasty of the aorta using a patch of pulmonar y artery has been developed and used in 22 neonates with obstruction of the aortic arch associated with ventricular septal defect with an average age and body weight of 15 days and 2.9 Kg respectively. The ventricular septal defect was closed surgically during the same procedure. Total circulatory a rrest was not used in these children and all had aortic repairs with select ive cerebral perfusion with moderate hypothermia (28 -30 degreesC). This technique was used without any procedure-related early morbidity. No e arly or late deaths were observed in this series. Two patients were reopera ted during the first year after the initial procedure : one for residual ve ntricular septal defect and the other for supraventricular pulmonary stenos is. Two patients, one of whom was reoperated, developed supraventricular pu lmonary stenosis with a gradient of over 60 mmHg. These stenoses were obser ved in the first cases operated and were essentially due to the technique o f pulmonary artery reconstruction. Over a median follow-up period of 10 mon ths, no recoarctations were observed : the Doppler ultrasound study showed an isolated mean systolic gradient of 6 +/- 12 mmHg. The authors conclude that angioplasty of the aortic arch with an enlarging patch of pulmonary artery autograft during single stage surgery of syndrome s of coarctation and interruption of the aortic arch provides a harmonious and durable repair of the aortic arch.