Modified Reversed Blalock-Park Technique Utilizing the Aberrant Right Subclavian Artery for the Management of Mild Aortic Coarctation

Abstract

The Blalock-Park procedure has historically been performed for coarctation of aorta and interruption of the aortic arch. We report a case of left bronchial stenosis following palliative surgery for unbalanced complete atrioventricular septal defect. The patient had tracheomalacia, mild aortic coarctation, and an aberrant right subclavian artery. Upon further examination, the left bronchial stenosis was identified as compression of the left bronchus by the contiguous descending aorta from an undivided ductus arteriosus and the aberrant right subclavian artery, as well as cardiac enlargement due to the palliative surgery. Aortopexy via left thoracotomy was performed. Intraoperatively, severe narrowing of the aortic isthmus was observed, leading to a reversed modified Blalock-Park procedure instead of dividing the aberrant right subclavian artery. This decision was based on concerns about potential future stenosis exacerbation, limiting perioperative medication management, and reoperation risks.journal articl