Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-31T19:41:55.962Z Has data issue: false hasContentIssue false
  • English
  • Français

Repair of aortic coarctation using temporary ascending to descending aortic bypass in children with poor collateral circulation

Published online by Cambridge University Press:  20 January 2005

Jan T. Christenson ,
Jorge Sierra ,
Dominique Didier ,
Maurice Beghetti  and
Afksendiyos Kalangos
Jan T. Christenson
Affiliation:
Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
Jorge Sierra
Affiliation:
Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
Dominique Didier
Affiliation:
Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
Maurice Beghetti
Affiliation:
Department of Pediatric Cardiology, University Hospital of Geneva, Geneva, Switzerland
Afksendiyos Kalangos
Affiliation:
Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

Aortic coarctation can now be repaired surgically with excellent results. Even though rare, injury to the spinal cord resulting in paraplegia remains a major concern. Preoperative evaluation showing the absence of collateral circulation is valuable in order to introduce protective actions. This report describes our experience using a temporary bypass from the ascending to the descending aorta bypass in children undergoing surgical correction of aortic coarctation in the setting of poorly developed collateral circulation.

Between 1990 and 2002, we undertook direct surgical repair in 56 patients with isolated aortic coarctation, 20 as neonates, 11 as infants, and 25 during childhood. From 1998 onwards, we introduced preoperative evaluation of the collateral circulation with magnetic resonance imaging. From that time, we placed a temporary bypass from the ascending to the descending aorta, using a polytetrafluoroethylene tube of 4 to 8 mm diameter, whenever distal pressures were shown to be 25 mmHg or less after test clamping, or when magnetic resonance imaging revealed absence of collateral circulation.

We found excellent correlations between the direct intra-operative measurements of distal pressure and the findings at magnetic resonance imaging. Following introduction of the temporary bypass, we observed no neurological complications, nor were there any complications related to bypass. Freedom from restenosis was 96%.

Preoperative magnetic resonance imaging, therefore, can accurately visualize poor collateral circulation in children with aortic coarctation. The use of a temporary bypass can possibly eliminate the risk of neurological sequels following direct repair of coarctation in children with poorly developed collateral circulation. The temporary bypass is both easy to apply and safe.

Keywords

Cardiopulmonary bypasscollateral circulationparaplegianeonatesinfants
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 1 , February 2004 , pp. 39 - 45
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbott ME. Coarctation of the aorta of the adult type. Am Heart J 1928; 3: 574–579.Google Scholar
Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Cardiovasc Surg 1945; 14: 347–361.Google Scholar
Brewer LA III, Fosburg RG, Mulder GA, Verska JJ. Spinal cord complications following surgery for coarctation of the aorta: a study of 66 cases. J Thorac Cardiovasc Surg 1972; 64: 368–381.Google Scholar
Keen G. Spinal cord damage and operations for coarctation of the aorta: etiology, practice, and prospects. Thorax 1987; 42: 11–18.Google Scholar
Westaby S, Parnell B, Pridie RB. Coarctation of the aorta in adults. Clinical presentation and results of surgery. J Cardiovasc Surg (Torino) 1987; 28: 124–127.Google Scholar
Krieger KH, Spencer FC. Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross clamping? Surgery 1985; 97: 2–7.Google Scholar
Barnes RW, Rittenhouse EA, Kongtahworn C, Doty DB, Rossi NP, Ehrenhaft JL. Reversed intercostal arterial flow in coarctation of the aorta. Ann Thorac Surg 1975; 19: 27–32.Google Scholar
Holmqvist C, Stahlberg F, Hanséus K, et al. Collateral flow in coarctation of the aorta with magnetic resonance velocity mapping: correlation to morphological imaging of collateral vessels. J Magn Reson Imaging 2002; 15: 39–46.Google Scholar
Hughes RK, Reemtsma K. Correction of coarctation of the aorta: manometric determination of safety during test occlusion. J Thorac Cardiovasc Surg 1971; 62: 31–33.Google Scholar
Gott VL. Heparinized shunts for thoracic vascular operations. Ann Thorac Surg 1972; 14: 219–220.Google Scholar
Alexander JC Jr. Maintenance of distal aortic perfusion by heparin-bonded shunt during repair of coarctation of the aorta with minimal collateral circulation. Ann Thorac Surg 1981; 32: 304–306.Google Scholar
Lam CR, Arciniegas E. Surgical management of coarctation of the aorta with minimal collateral circulation. Ann Surg 1973; 178: 693–697.Google Scholar
Kouchoukos NT, Lell WA, Karp RB, Samuelson PN. Hemodynamic effects of aortic clamping and decompression with a temporary shunt for resection of the descending thoracic aorta. Surgery 1979; 85: 25–30.Google Scholar
Robicsek F, Hess PJ, Vajtai P. Ascending-Distal Abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult. Ann Thorac Surg 1984; 37: 261–263.Google Scholar
Cartier R, Orszulak TA, Pairolero PC, Schaff HV. Circulatory support during crossclamping of the descending thoracic aorta. Evidence of improved organ perfusion. J Thorac Cardiovasc Surg 1990; 99: 1038–1047.Google Scholar
Wong CH, Watson B, Smith J, Hamilton JR, Hasan A. The use of left heart bypass in adult and recurrent coarctation repair. Eur J Cardiothorac Surg 2001; 20: 1199–1201.Google Scholar
Servais LJ, Rivelli SK, Daxchy BA, Christophe CD, Dan B. Anterior spinal artery syndrome after aortic surgery in a child. Pediatric Neurology 2001; 24: 310–312.Google Scholar
Wada T, Yao H, Miyamoto T, Mukai S, Yamamura M. Prevention and detection of spinal cord injury during thoracic and thoracoabdominal aortic repairs. Ann Thorac Surg 2001; 72: 80–85.Google Scholar
Smallhorn JF, Huhta JC, Adams PA, Anderson RH, Wilkinson JL, McCartney FJ. Cross-sectional echocardiographic assessment of coarctation in sick neonates and infant. Br Heart J. 1983; 50: 349–361.CrossRefGoogle Scholar
Von Schulthess GJ, Higashino SM, Higgins SS, Didier D, Fisher MR, Higgins CB. Coarctation of the aorta: MR imaging. Radiology 1986; 158: 469–474.Google Scholar
Julsrud PR, Breen JF, Flemlee JP, Warnes CA, Connolly HM, Schaff HV. Coarctation of the aorta: collateral flow assessment with phase contrast MR angiography. Am J Roentgenol 1997; 169: 1735–1742.Google Scholar
Steffens JC, Bourne MW, Sakuma H, O'Sullivan M, Higgings CB. Quantification of collateral blood flow in coarctation of the aorta by velocity encoded cine magnetic resonance imaging. Circulation 1994; 90: 937–943.Google Scholar
Grinda JM, Macé L, Dervanian P, Folliguet TA, Neveux J-Y.Bypass of complex forms of isthmic aortic coarctation in adults. Ann Thorac Surg 1995; 60: 1299–1302.Google Scholar
Karolczak MA, McKay R, Arnold R. Right-sided intrathoracic bypass graft for complex recurrent coarctation of the aorta. Eur J Cardio-thorac Surg 1989; 3: 278–281.Google Scholar
Corno AF, Botta U, Hurni M, et al. Surgery for aortic coarctation: a 30 years experience. Eur J Cardio-thoracic Surg 2001; 20: 1202–1206.Google Scholar
Lerberg DB, Hardesty RL, Siewers RD, Zuberbuhler JR, Bahnson HT. Coarctation of the aorta in infants and children: 25 years experience. Ann Thorac Surg 1982; 33: 159–170.Google Scholar