Tubular Hypoplasia of the Transverse Aortic Arch with or without Coarctation

When coarctation is associated with a diffusely hypoplastic transverse aortic arch, coarctation repair alone may not relieve the aortic obstruction because of residual obstruction across the hypoplastic transverse arch. These patients may have an associated ventricular septal

Hypoplastic Transverse Aortic Arch
Figure 61.12. The upper one-half of the anastomosis, both anteriorly and posteriorly, is made with a running suture.
Coarctation The Lateral Ventricles
Figure 61.13. (A) Homograft patch is harvested augment the anastomosis and prevent undue tension from the inner curve of pulmonary artery bifurca- in the lower half of the suture line between the tion. (B) The allograft patch is sewn in place to descending aorta and the proximal ascending aorta.
Figure 61.14. The completed repair showing a widely patent anastomosis with autologous tissue making up one-half of the circumference of the

aortic arch and the pulmonary allograft making up the underside of the aortic arch.

Figure 61.15. The mobilized and divided descend- mosis. An incision is extended into the descending ing aorta with an additional left lateral incision. The aorta and into the proximal ascending aorta. posterior suture line is completed by direct anasto-

Figure 61.16. An elliptical piece of pulmonary allograft is used to augment the anastomosis as well as the proximal ascending aorta and descending aorta.

defect which can be repaired at the same time. During core cooling for deep hypothermia and circulatory arrest, the entire aortic arch is mobilized. Following establishment of circulatory arrest, the ductus arteriosus is ligated and all of the ductal tissue is excised. An incision (dotted line) is carried from the proximal ascending aorta around the hypoplastic transverse aortic arch to the orifice of the ductus arteriosus (Figure 61.17). All of the ductal tissue is excised. A piece of pulmonary allograft is cut from the inner curvature between the left or right branch pulmonary artery and main pulmonary artery. This patch is sewn into place (Figure 61.18). It is important not to make this patch too large as this will result in bulging of the allograft posteriorly and inferiorly into the pulmonary artery. The allograft should be kept taut during the anastomosis. A properly cut patch will result in a reconstructed aortic arch which appears normal in size and shape (Figure 61.19).

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