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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
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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

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