Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect
Abstract
Objective. Tactics of treatment and results of the hypoplasia of the aortic arch correction in newborn babies with complete form of atrio-ventricular septal defect were studied.
Маterials and methods. During period from 2011 tо 2019 yrs in 21 patients correction of hypoplasia of aortic arch and atrio-ventricular septal defect were performed. The investigated group consisted of patients with a two-ventricular physiology. The patients, suffering imbalanced form of atrio-ventricular septal defect and with variants of hypoplasia in left parts of the heart, were excluded from the investigation. There were 9 (42.9%) boys and 12 (57.1%) girls. Average age of the patients have constituted (2.3 ± 1.1) mo (from 0.06 до 7.7 mo). Average body mass of the patients have constituted (3.8 ± 1.0) kg (from 2.0 до 5.9 kg). The aortic arch segment was considered a hypoplastic one if a Z-score (Standard Score - standard estimation) shift have constituted lesser than 2.0.
Results. Hospital lethality have constituted 14.2%. Three newborn babies died: 2 - after first stage of correction, and 1 - after second stage of correction. All the patients, to whom a one-staged correction was done, have survived. The causes of lethality were not connected with method of the aortic arch reconstruction. While performance of echocardiography before discharge from the hospital the pressure gradient on place of the aortic arch plasty have constituted (13.6 ± 6.8) mm Hg at average. Average follow-up period have constituted (2.6 ± 2.1) yrs (from 2 mo tо 8.1 yr). In late follow-up period lethality was absent. In 2 (9.5%) patients in postoperative period reoperations on aortic arch and mitral valve were performed. Tracheal compression as well as the main bronchi compression, neurological complications in late follow-up period were absent.
Conclusion. For the patients, suffering complete form of atrio-ventricular septal defect in conjunction with hypoplasia of aortic arch the staged correction constitutes a more favorable option, owing good immediate and late results. A staged approach in the treatment is indicated for newborn babies, suffering hypoplasia of distal aortic arch and competent atrio-venticular valves or with small regurgitation. Оne-stage correction is indicated in hypoplasia of aortic arch, pronounced regurgitation on common atrio-ventricular valve and pronounced heart failure.
References
Hraska V, Walters HL 3rd. Management of complete atrioventricular canal defect with aortic arch obstruction: an unresolved debate. World J Pediatr Congenit Heart Surg. 2010;1(2):199-205. doi: 10.1177/2150135110371136. PMID: 23804821.
Kobayashi M, Takahashi Y, Ando M, Hatai Y, Park IS, Kikuchi T. Single-stage repair of complete atrioventricular septal defect and coarctation of the aorta in neonate. Jpn J Thorac Cardiovasc Surg. 2004;52(8):383-5. doi: 10.1007/s11748-004-0016-0. PMID: 15384714.
Shuhaiber J, Shin AY, Gossett JG, Wypij D, Backer CL, Hanley FL, et al. Surgical management of neonatal atrioventricular septal defect with aortic arch obstruction. Ann Thorac Surg. 2013;95(6):2071-7. doi: 10.1016/j.athoracsur.2012.11.069. Epub 2013 Feb 14. PMID: 23415240.
Devlin PJ, Jegatheeswaran A, McCrindle BW, Karamlou T, Blackstone EH, Williams WG, et al. Pulmonary artery banding in complete atrioventricular septal defect. J Thorac Cardiovasc Surg. 2020;159(4):1493-503.e3. doi: 10.1016/j.jtcvs.2019.09.019. Epub 2019 Sep 24. PMID: 31669019.
Alsoufi B. Commentary: Pulmonary artery banding in infants with atrioventricular septal defect, valid strategy or backward move? J Thorac Cardiovasc Surg. 2020;159(4):1504-6. doi: 10.1016/j.jtcvs.2019.10.013. Epub 2019 Oct 15. PMID: 31761350.
Зelik M, Gцkdemir M, Cэndэk N, Цzkan M. Hybrid approach: an alternative prior to corrective surgery in a patient with arch hypoplasia and complete atrioventricular septal defect. Turk Gogus Kalp Damar Cerrahisi Derg. 2018;26(3):473-5. doi: 10.5606/tgkdc.dergisi.2018.15417. PMID: 32082782; PMCID: PMC7018266.

This work is licensed under a Creative Commons Attribution 4.0 International License.