[Surgical treatment of patients with tetralogy of Fallot in combination with a double aortic arch].

A late congenital anomaly--double arch of the aorta (DAA)--was combined with Fallot's tetrad (FT) in 4 patients whose ages ranged from 21 months to 11 years. The diagnosis of DAA and FT was established before the operation in 3 patients, in one patient DAA was discovered during the operation. In three children DAA was manifested clinically by dysphagia and stridor. A palliative operation (FT) was carried out through a left posterolateral approach along the third intercostal space. One-stage separation of the vascular ring by cutting the smaller left arch of the aorta at its junction with the descending aorta and formation of anastomosis between this arch and the left pulmonary artery by the end to side method were conducted. In deficient length of the cut arch of the aorta the left subclavian artery was divided; in equal diameter of both arches the lumen of the arch was reduced to 0.5 cm with stitches before formation of the anastomosis so as to prevent hyperfunction of the shunt. In the case in which DAA was not recognized before the operation, an attempt to dilate the hypoplastic segment of the left arch led to rupture of the thinned wall and the patient died from hemorrhage. The advantages of one- and two-stage radical correction of both developmental anomalies (DAA and FT) are still debatable.