Follow-up echo revealed progressive worsening of pressure gradient across the proximal right PA (peak PG 70 mmHg). The postoperative echocardiography revealed no pressure gradient at the homograft site. Twelve mm pulmonic homograft was used as RV-PA conduit. The ductal tissue was carefully removed, and the subclavian artery and the descending aorta were sewn to the homograft augmented main PA trunk rather than relatively small ascending aorta to avoid potential bronchial obstruction. Both right and left PAs were separately originated from the posterior side of the main PA and were excised en bloc and this area was patched with homograft.
#TRUNCUS ARTERIOSUS WITH INTERRUPTED AORTIC ARCH PATCH#
Right ventriculotomy was carried out and VSD was closed with Dacron patch to rerouting blood flow from left ventricle to truncal valve. Myocardial protection was realized with antegrade cold blood cardioplegia at a core temperature of 28 ☌. Surgical correction was performed on day 6 through a median sternotomy. BCA, brachiocephalic artery LCA, left carotid artery LSCA, left subclavian artery DA, descending aorta. A large truncal vessel arises from the right side heart and the patent ductus arteriosus has a separate branch off of the truncal vessel. It was IAA type B ( Figure 1).įigure 1 Preoperative 3-dimensional CT scan. The truncal valve appears to be more than 75% committed to the right ventricular side of the VSD. Echocardiography allowed the diagnosis of TAC 4A, with interrupted aortic arch (IAA), trivial truncal valve regurgitation. Investigations were in accordance with the ethical standards of the Helsinki Declaration of 1964 and all subsequent revisions.Ī 6-day-old twin male infant weighing 2,760 g was born in our institution at gestational age 38 weeks. We performed surgical removal of the stent and PA reconstruction at 7 months of life. The patient developed the right PA stenosis that was treated by self-expandable PA stenting at 2 months after surgical repair which then caused bronchial obstruction. It is possible to have bronchial compression as complication after the surgery with direct aortic arch anastomosis ( 2).
This occurs in about 10% to 15% of cases ( 1) and has been considered as a risk factor for surgical mortality. One arch abnormality of considerable importance consists of a large ductus arteriosus associated with severe hypoplasia or interruption of the distal aortic arch (IAA). Truncus arteriosus communis (TAC) is a rare congenital heart defect. Received: 23 September 2018 Accepted: 21 November 2018 Published: 27 November 2018. Keywords: Bronchial compression pulmonary artery stenting truncus arteriosus communis (TAC) interrupted aortic arch (IAA) case report Policy of Dealing with Allegations of Research Misconduct.
Policy of Screening for Plagiarism Process.
0 kommentar(er)
