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European Journal of Cardio-Thoracic Surgery, Vol 12, 466-469, Copyright © 1997 by European Association for Cardio-thoracic Surgery
C Schreiber, D Mazzitelli, JC Haehnel, HP Lorenz and H Meisner
OBJECTIVE AND METHODS: The records of 95 patients with interrupted aortic
arch, admitted to our center from 1975 to 1995, were reviewed. We were
particularly interested in the long term results and evaluated the impact
of the preoperative state on the outcome after surgery. RESULTS: Using the
'Celoria and Patton' classification, 13% were type A, 84% type B and 3%
type C. Among various associated anomalies were ventricular septal defects
and left ventricular outflow tract obstructions, either subvalvular or due
to a hypoplastic annulus or a bicuspid valve. We have also seen complex
malformations such as truncus arteriosus communis, double outlet right
ventricle and transposition of the great arteries. Preoperative
neurological disorders, among them the Di George's syndrome, were found in
29% of the cases. Our long term results show 52 patients to be alive, of
which 89% are in good clinical condition. Due to improved operative
techniques and changes in the management of neonates respectively, early
mortality was 17% between 1985 and 1995 compared to 42% between 1975 and
1985. Reoperations were necessary due to arch stenosis, compression of the
bronchus or left ventricular outflow tract obstruction. CONCLUSIONS:
Nevertheless, mortality after surgical repair of an interrupted aortic arch
has dropped significantly and the preoperative condition plays an important
role in the outcome. Sepsis, low output, low weight (under 2400 g), severe
left ventricular outflow tract obstruction and complex malformations
impeded surgery in 13% of cases. Immediate surgical intervention is the
only therapy. Arch continuity and repair of associated anomalies could be
achieved in the remaining collective. Most of the children have a good
quality of life. The preoperative condition seems to influence late
neurological disorders.
ARTICLES
The interrupted aortic arch: an overview after 20 years of surgical treatment
Clinic for Cardiac and Vascular Surgery, German Heart Center, Technical University of Munich, Germany.
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