Burbano-Vera Nelson, Zaleski Katherine L, Latham Gregory J, Nasr Viviane G
1 Boston Children's Hospital, Boston, MA, USA.
2 Harvard Medical School, Boston, MA, USA.
Semin Cardiothorac Vasc Anesth. 2018 Sep;22(3):270-277. doi: 10.1177/1089253218775954. Epub 2018 May 10.
Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta and is classified based on the anatomic level of interruption. IAA is associated with a number of intracardiac anomalies with the most common being patent ductus arteriosus, ventricular septal defect, and left ventricular outflow obstruction. There is also a strong association between type B interruption and 22q11 deletion syndrome. The perioperative management of the neonate with IAA begins in the intensive care unit with optimization of end-organ perfusion and function. Survival depends on the prompt initiation of prostaglandin E1 in order to maintain ductal patency, careful management of the patient's ratio of pulmonary to systemic blood flow (Qp:Qs), and a thorough understanding of the physiologic implications of the surgical plan, type of interruption, and associated syndromes and anomalies. This review will focus on the anatomy, physiology, and perioperative anesthetic management considerations specific to the management of IAA.
主动脉弓中断（IAA）定义为升主动脉和降主动脉之间管腔连续性的丧失，并根据中断的解剖水平进行分类。IAA与多种心内异常相关，最常见的是动脉导管未闭、室间隔缺损和左心室流出道梗阻。B型中断与22q11缺失综合征之间也存在密切关联。患有IAA的新生儿围手术期管理始于重症监护病房，旨在优化终末器官灌注和功能。生存取决于及时启动前列腺素E1以维持导管通畅、仔细管理患者的肺循环与体循环血流量比值（Qp:Qs），以及透彻了解手术计划、中断类型、相关综合征和异常的生理影响。本综述将聚焦于IAA管理所特有的解剖学、生理学及围手术期麻醉管理考量。
