Aortic arch repair after Norwood procedure in children with hypoplastic left heart syndrome

Abstract

In this article we analyze the impact of aortic arch repair on the development of aortic obstruction when using a Norwood procedure. Patients were divided into two groups. Group 1 included patients who underwent neoaortic plasty performed by using bovine pericardial patches (group 1, n = 6). Group 2 consisted of patients, whose arch was repaired with autologous tissues only, without using bovine pericardial (group 2, n = 12). The groups were comparable by demographic data. To measure the aorta, we used cardiac catheterization data obtained before stage 2 of hemodynamic correction. Angiographic measurements were carried out at the level of distal anastomosis and descending aorta. Coarctation index (CI) was calculated as the ratio between distal anastomosis on neoaorta and descending aorta. Occurrence of aortic obstruction in groups 1 and 2 was 50% (n = 3) and 16.7% (n = 2) respectively (p = 0.137). The aorta at the level of distal anastomosis was greater in group 2 if compared with group 1. Differences between the two groups were not statistically significant. CI for groups 1 and 2 were 0.73±0.16 and 0.9±0.18 respectively (p = 0.08). When comparing patients with the obstruction of the aortic arch and without it, the presence of ductus arteriosus tissue was found out to be associated with stenosis (p = 0.019). The authors believe that the complete excision of coarctation tissue is one of the keys to prevention of postoperative aortic arch obstruction.