Interrupted aortic arch surgery9/25/2023 ![]() ![]() Echocardiography showed a 6-mm annulus of the aortic valve (Z-score: −3.6), with a mild degree of pulmonary regurgitation due to main PA root dilatation. CT images confirmed patency of the ductal stent, as well as the adequacy of the PA banding and absence of distal migration ( Fig. Arterial oxygen saturation remained at approximately 80%. At 10 months of age (body weight, 6.6 kg), the patient was re-admitted for second-stage surgery. In the interim, there were no complications. Daily aspirin (15 mg) was prescribed for anticoagulation. There were no postoperative complications, and the patient was discharged 15 days after the procedure. Postoperative arterial oxygen saturation was measured at approximately 88% on room air, and the patient was extubated on the first postoperative day. Ductal stenting was performed by pediatric cardiologists, who inserted a balloon expandable peripheral vascular stent (8×19 mm, Omnilink Elite Abbott Vascular, Santa Clara, CA, USA) through a purse-string suture of the proximal main PA. Bilateral PA banding was done first, utilizing 3.5-mm polytetrafluoroethylene vascular grafts (Gore-Tex W L Gore & Associates Inc., Flagstaff, AZ, USA). The hybrid procedure was performed 10 days after birth in a specially-equipped suite. After multidisciplinary deliberation, the consensus operative strategy called for bilateral pulmonary artery (PA) banding and ductal stenting as a hybrid procedure, thereby avoiding a high-risk neonatal intervention (to address the systemic outflow tract obstruction) and allowing time for potential self-remedial growth. Given the severity of systemic outflow tract obstruction, conventional repair of IAA and closure of the ventricular septal defect seemed unsuitable in this case. LV, left ventricle RV, right ventricle Ao, aorta. Parasternal long axis view illustrating the small aortic valve annulus (black asterisks). ![]()
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