Intermediate term follow-up of the end-to-side aortic anastomosis for coarctation of the aorta Adel K Younoszai, MD, Vadiyala Mohan Reddy, MD, Frank.

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Presentation transcript:

Intermediate term follow-up of the end-to-side aortic anastomosis for coarctation of the aorta Adel K Younoszai, MD, Vadiyala Mohan Reddy, MD, Frank L Hanley, MD, Michael M Brook, MD The Annals of Thoracic Surgery Volume 74, Issue 5, Pages 1631-1634 (November 2002) DOI: 10.1016/S0003-4975(02)03902-4

Fig 1 End-to-side aortic anastomosis for coarctation of the aorta as seen through the left lateral posterior thoracotomy. (A) Basic anatomy. (A = artery; AAo = ascending aorta; DA = ductus arteriosus; DAo = descending aorta [dashed lines indicate lines of incision]). (B) Surgical procedure. Cross clamps are placed across the proximal descending aorta and proximal arch to include the left head and neck vessels. The ductus arteriosus is ligated and excised with the coarctation, and the distal aortic arch is tied off. (C) Resulting repair. The descending aorta has been pulled up to the undersurface of the proximal arch and anastomosed in an end-to-side fashion. (Reprinted with permission from The Society of Thoracic Surgeons [Ann Thorac Surg 1996, 61, 840–4] [2].) The Annals of Thoracic Surgery 2002 74, 1631-1634DOI: (10.1016/S0003-4975(02)03902-4)

Fig 2 Kaplan-Meier analysis of freedom from reintervention. The freedom from reintervention after 5 postoperative months is 94.7% (standard error, 3.7%). (Post-op = postoperatively.) The Annals of Thoracic Surgery 2002 74, 1631-1634DOI: (10.1016/S0003-4975(02)03902-4)

Fig 3 Representative two-dimensional echocardiograms of the aortic arch visualized from the suprasternal notch. (A) Preoperatively there is narrowing of the isthmus and a tight juxtaductal coarctation (arrow). (B) After repair with the end-to-side aortic anastomosis, the aortic contour is smooth without narrowing. The arrow indicates the suture line of the anastomotic site. The Annals of Thoracic Surgery 2002 74, 1631-1634DOI: (10.1016/S0003-4975(02)03902-4)

Fig 4 Representative cineangiograms of the aortic arch before and after the end-to-side aortic anastomosis. (A) Viewed from the left anterior oblique projection. Preoperatively the aortic arch is hypoplastic with a discrete posterior shelf (arrow) just distal to the take-off of the left subclavian artery. (B) Viewed from the lateral projection. Postoperatively the aortic arch has remodeled to form a normal contour. The Annals of Thoracic Surgery 2002 74, 1631-1634DOI: (10.1016/S0003-4975(02)03902-4)