Aortic arch reconstruction with pulmonary autograft patch aortoplasty

AbstractObjective: The optimal technique for aortic arch reconstruction through median sternotomy is still under debate. We have introduced the technique of pulmonary autograft patch aortoplasty as a reliable alternative. Methods: The outcomes of 51 infants who underwent neonatal repair of interrupted aortic arch (n = 28) or coarctation associated with ventricular septal defect (n = 23) since 1992 were analyzed. The patients were reviewed in three groups according to the aortic arch reconstruction technique: group I underwent direct anastomosis (n = 23), group II underwent homograft or pericardial patch aortoplasty (n = 8), and group III underwent pulmonary autograft patch aortoplasty (n = 20). The pulmonary autograft patch consisted in the anterior wall of the main pulmonary artery, between the supracommissural level and the divided ductus arteriosus. The created defect was replaced with fresh autologous pericardium. Results: All patients except 1 were discharged without significant residual gradient at the level of the aortic arch. At a median delay of 7 months (range 2-51 months), 11 patients (22%) had recurrence of arch obstruction and underwent balloon angioplasty (n = 8) or surgical correction (n = 3). One patient who had undergone direct anastomosis required reoperation for bronchial compression. At a median follow-up of 29 months, the actuarial freedoms from recurrent arch obstruction were 81% for direct anastomosis, 28% for homograft or pericardial patch aortoplasty, and 100% for pulmonary autograft aortoplasty (P =.03 for group III vs group I and P <.0001 for group III vs group II). Conclusions: The aortic arch repair associated with pulmonary autograft patch augmentation resulted in superior midterm outcomes and therefore constitutes a reliable alternative to the direct anastomosis technique. It allowed complete relief of anatomic afterload and diminished the anastomotic tension, thus reducing the risk of restenosis and tracheobronchial compression. We observed a significantly higher rate of recurrence after patch aortoplasty with other materials.J Thorac Cardiovasc Surg 2002;123:443-5

Left-sided lesions after anatomic repair of transposition of the great arteries, ventricular septal defect, and coarctation: Surgical factors

AbstractObjectiveThis study was undertaken to identify potential anatomic and surgical factors creating left-sided lesions, namely recoarctation of the aorta and neoaortic regurgitation, after anatomic repair of transposition of the great arteries with ventricular septal defect and aortic coarctation.MethodsFrom 1983 to September 2002, 109 survivors out of 120 patients were studied. Two-stage repair was performed in 42 patients (group A), and single-stage repair was performed in 67 (groups B and C). Before repair, the diameters of the ascending aorta and main pulmonary artery were measured. In the patients with single-stage repair, coarctation was repaired by extended end-to-end anastomosis in 35 patients (group B) and by pulmonary homograft patch augmentation in 32 patients (group C). The ventricular septal defect was closed through the pulmonary artery in 70 patients and through the right ventricle or atrium in 39 patients. The neoaorto-aortic discrepancy was treated by V-shaped resection of the posterior sinus of Valsalva in 7 cases, pulmonary homograft patch in 32 cases, and anterior splitting of the ascending aorta in all cases. Before discharge from the hospital, neoaortic root and ascending aorta diameters and aortic regurgitation grade were recorded. Neoaortic regurgitation progression and reintervention were the end points of follow-up (97.2 ± 61.2 months).ResultsEarly and late survivals were significantly better in group C (P < .001). Risk factors for neoaortic regurgitation at discharge by univariate analysis were single-stage repair (P < .05) and ventricular septal defect closure through the pulmonary artery (P = .0076). On multivariate analysis, the latter was the only risk factor for neoaortic regurgitation at discharge and at last follow-up. Multivariate analysis showed that higher neoaortic root/ascending aorta ratio and ventricular septal defect closure through the pulmonary artery were risk factors for neoaortic regurgitation evolution at last follow-up. There were 29 reinterventions, 19 for recoarctation of the aorta and 10 for neoaortic regurgitation with or without aortic root dilatation. Group B (P < .05), high neoaortic root/ascending aorta ratio (P < .01), and progressive neoaortic regurgitation (P < .05) were risk factors for recoarctation of the aorta. Group A was a risk factor for aortic valve replacement at 10 years (P < .05).ConclusionNeonatal single-stage repair with pulmonary homograft aortic augmentation remains the optimal approach to transposition of the great arteries with ventricular septal defect and aortic coarctation. It provides better early and late survivals and freedoms from left-sided lesions. Avoidance of late recoarctation of the aorta and progressive neoaortic regurgitation requires meticulous closure of the ventricular septal defect and evenly sized reconstruction of the aorta from root to distal arch

Congenital heart surgery nomenclature and database project: update and proposed data harvest

The floristic study of trees was carriedout in the Protected Natural Area (PNA)Tenancingo-Malinalco-Zumpahuacan. Theidentified specimens comprise 304 species,165 genera and 72 families. The most representative families are Leguminosae with58 species (Fabaceae 15, Mimosaceae 35and Caesalpiniaceae 8), Fagaceae with 23,Burseraceae with 19 and Moraceae with 14;of wich 242 are native, 20 non native and42 endemic. We identified six distinct typesof vegetation: tropical deciduous forest,tropical subdeciduous forest, montane mesophytic forest, oak forest, pine-oak forest andgallery forest. In addition, we detailed 73new species reports for the State of Mexico.The most species richness occurred in thetropical deciduous forest (170) and galleryforest (104).En el estudio florístico de árboles realizadoen el área natural protegida (ANP) Tenancingo-Malinalco-Zumpahuacán, se registróla presencia de 72 familias, 165 géneros y304 especies, de las cuales 10 son coníferas,293 dicotiledóneas y una monocotiledónea.Las familias con mayor número de especies son Leguminosae (58) (Mimosaceae35, Caesalpiniaceae 8 y Fabaceae 15),Fagaceae (23), Burseraceae (19) y Moraceae (14). De las cuales 242 especies sonnativas, 20 no nativas y 42 endémicas aMéxico. Se reportan 73 nuevos registrosde especies para el Estado de México y sedescriben seis tipos de vegetación: bosquetropical caducifolio, tropical subcaducifolio, de encino, de pino-encino, mesófilode montaña y de galería, de los cuales lamayor riqueza de especies se presentó enel bosque tropical caducifolio (170) y en elbosque de galería (104)