The application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly

Abstract

Background: In the patients with longer-segment aortic arch hypoplasia or interruption with ventricular septal defect, surgery with homograft vessel or autologous pericardial patch to augment descending aortic arch will not result in adverse reactions caused by end-to-end anastomosis. In this study, we retrospectively analyzed primary experience of surgical correction of complicated aortic arch anomaly with autologous main pulmonary artery.

Methods: From July 2010 to March 2016, the twenty-one cases of aortic arch complex anomalies were reconstructed with autologous main pulmonary artery. There were 5 patients with interrupted aortic arch and 16 patients with coarctation of aorta. In patients with interrupted aortic arch, anterior wall of main pulmonary artery was excised to form a conduit whose diameter varied according to the area of patient's body surface. Both ends of the conduit were anastomosed to aortic arch and descending aorta, respectively. In other patients with coarctation of aorta, aortic arch was augmented with tailored pulmonary artery patch in oval shape. The defect of main pulmonary artery was repaired with autologous pericardial patch.

Results: There was only one patient died of multiple organ failure postoperatively. The other twenty patients survived without any neurologic complications. Differences of blood pressure between upper and lower limbs were not significant in all cases. During follow-up period, the echocardiography for all patients in the third, sixth, twelfth, and twenty-fourth months showed that blood flow in the descending aortic arch was fluent and there was no obvious blood pressure gradient.

Conclusions: Autologous main pulmonary artery can be used to repair complicated aortic arch anomalies completely without any anastomotic tension or bronchial obstruction postoperatively. This procedure is feasible and possesses predominant early and mid-term effects, and autologous main pulmonary artery can retain growth capacity during follow-up period. Of course, it is necessary to draw a definite conclusion of this technique during long-term follow-up period.

Keywords: Congenital heart disease; autologous main pulmonary artery; coarctation of aorta; interrupted aortic arch.

Figure 1

Anterior wall of pulmonary artery was resected intactly while retaining the integrity of posterior wall of pulmonary artery and pulmonary valve. Transverse incisions were made 4 mm above pulmonary annulus and in front of arterial duct, respectively. Longitudinal incisions were made near the left and right pulmonary orifices. Anterior wall of pulmonary artery was excised to form a conduit whose diameters varied according to the patient’s body surface area. Both ends of the conduit were anastomosed to the aortic arch and descending aorta, respectively.

Figure 2

After resecting coarctation segment, longitudinal incision was made to extend the bottom of aortic arch, ascending and descending aorta, and then partial connection of the back of descending aortic arch was established. Aortic arch was augmented with tailored pulmonary artery patch in oval shape.