초록접수 현황
| 17F-089 | 포스터 발표 |
Repair of Late-presenting Interrupted Aortic Arch With Severe Pulmonary Hypertension using a Pulmonary Autograft Tube
June Lee, Cheul Lee
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
Purpose : The optimal surgical technique for repair of interrupted aortic arch (IAA) remains controversial. We present a case of late-presenting IAA with severe pulmonary hypertension which was repaired using a pulmonary autograft tube.
Methods : A 34-month-old boy was admitted to our hospital for management of type A IAA with a large perimembranous ventricular septal defect(VSD) and dilated main pulmonary artery. Computed tomography (CT) confirmed the findings of echocardiography (Figure 1). Pulmonary vascular resistance was calculated as 8.9 WU·m² at room air. It fell to 5.8 WU·m² with 100% inspired oxygen. The VSD was closed using a bovine pericardial patch with a 5.6 mm fenestration. An autograft tube of diameter 12 mm was made of anterior wall of the main pulmonary artery. The arch was repaired by interposing the pulmonary autograft tube between the descending thoracic aorta and the ascending aorta under selective cerebral perfusion.
Results : The patient could not be weaned from cardiopulmonary bypass because of pulmonary hypertension and right ventricular dysfunction. He underwent extracorporeal membrane oxygenation support for 3 days during which pulmonary hypertension gradually regressed and right ventricular function improved. Echocardiography at discharge revealed left-to-right shunt through a VSD fenestration and normal ventricular function. Postoperative CT showed wide patent aortic arch with natural geometry (Figure 2).
Conclusion : Repair of IAA using a pulmonary autograft tube can be a good option in selected patients because of its ability of maintaining natural arch geometry, growth potential, and possible beneficial effect in preventing left main bronchus compression.
Methods : A 34-month-old boy was admitted to our hospital for management of type A IAA with a large perimembranous ventricular septal defect(VSD) and dilated main pulmonary artery. Computed tomography (CT) confirmed the findings of echocardiography (Figure 1). Pulmonary vascular resistance was calculated as 8.9 WU·m² at room air. It fell to 5.8 WU·m² with 100% inspired oxygen. The VSD was closed using a bovine pericardial patch with a 5.6 mm fenestration. An autograft tube of diameter 12 mm was made of anterior wall of the main pulmonary artery. The arch was repaired by interposing the pulmonary autograft tube between the descending thoracic aorta and the ascending aorta under selective cerebral perfusion.
Results : The patient could not be weaned from cardiopulmonary bypass because of pulmonary hypertension and right ventricular dysfunction. He underwent extracorporeal membrane oxygenation support for 3 days during which pulmonary hypertension gradually regressed and right ventricular function improved. Echocardiography at discharge revealed left-to-right shunt through a VSD fenestration and normal ventricular function. Postoperative CT showed wide patent aortic arch with natural geometry (Figure 2).
Conclusion : Repair of IAA using a pulmonary autograft tube can be a good option in selected patients because of its ability of maintaining natural arch geometry, growth potential, and possible beneficial effect in preventing left main bronchus compression.
첨부파일 : 초록 이준 이철.pptx
책임저자: Cheul Lee
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Republic of Korea
발표자: June Lee, E-mail : sksskdi00n@naver.com