Nishioka Masahiko, Fuchigami Tai, Akashige Toru
Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Kyobu Geka. 2019 Sep;72(9):647-654.
Direct anastomosis such as end-to-end anastomosis or extended aortic arch anastomosis are the most commonly used technique to repair aortic coarctation or interrupted aortic arch. Direct anastomosis of the aorta sometimes results in restenosis and/or bronchial compression. To avoid these complications, we have used the technique of the aortic reconstruction using an 0.6% glutaraldehyde-fixed autologous pericardium.
The procedure was performed in 6 patients;4 with aortic coarctation and 2 with aortic interruption. Prognosis, aortic diameter, and the aortic shape measurement on 3-dimensional computed tomography( 3D-CT) were examined postoperatively.
There were no early or late deaths. There was no case of recurrent aortic arch obstruction and/or bronchial compression, The postoperative A/T ratio was 0.48±0.04 on 3D-CT.
Reconstruction of the aortic arch with a 0.6% glutaraldehyde-fixed autologous pericardium in an aortic coarctation and interruption showed excellent early and midterm outcomes. There were no complications such as bronchial compression or recoarctation. We believe that this technique leads to a higher success for reconstructing the arch to a near to normal morphology and avoiding the so-called Gothic arch, which has been reported to be associated with late complications of hypertension.
直接吻合术，如端端吻合术或主动脉弓延长吻合术，是修复主动脉缩窄或主动脉弓中断最常用的技术。主动脉直接吻合有时会导致再狭窄和/或支气管受压。为避免这些并发症，我们采用了使用0.6%戊二醛固定的自体心包进行主动脉重建的技术。
该手术对6例患者实施；4例为主动脉缩窄，2例为主动脉中断。术后通过三维计算机断层扫描（3D-CT）检查预后、主动脉直径和主动脉形态测量。
无早期或晚期死亡病例。无复发性主动脉弓梗阻和/或支气管受压病例，术后3D-CT上的A/T比值为0.48±0.04。
在主动脉缩窄和中断中，用0.6%戊二醛固定的自体心包重建主动脉弓显示出良好的早期和中期结果。无支气管受压或再缩窄等并发症。我们认为，该技术能更成功地将主动脉弓重建为接近正常的形态，避免所谓的哥特式弓，据报道其与高血压的晚期并发症有关。
