[Bypass grafting of left subclavian artery to descending thoracic aorta for relative stenosis of bypass graft after total correction for type A IAA with VSD].

A 4-year-old child underwent one-stage total correction for type A IAA with VSD in 1975 as the first successful case in Japan. At age 21, a gradual rise in her upper limb pressure to 190 mmHg prompted repeat catheterization, which showed a pressure gradient across the EPTFE graft of 58 mmHg. Under general anesthesia in the right lateral position, the patient's left thorax was reopened. The EPTFE graft had undergone patchy calcific degeneration and was significantly hardened. An 18-mm Toray graft preclotted with fibrin glue was anastomosed to the left subclavian artery in side-to-end fashion. Its distal end was anastomosed to the descending aorta distal to the EPTFE bypass during a 20-minute aortic occlusion. The postoperative recovery was uneventful and the pressure gradient between the upper and lower limbs fell to 0 at discharge. We chose this method for reoperation of type A IAA and CoA because of the reduced need for dissection and better effectiveness.