JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Robert H. Anderson
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ilbawi, A. M.
Right arrow Articles by Anderson, R. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ilbawi, A. M.
Right arrow Articles by Anderson, R. H.

J Thorac Cardiovasc Surg 2007;134:99-105
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Morphologic study of the ascending aorta and aortic arch in hypoplastic left hearts: Surgical implications

André M. Ilbawi, BSEa,*, Diane E. Spicer, BS, PAb, Saroja Bharati, MDc, Andrew Cook, PhDd, Robert H. Anderson, MDd

a University of Pennsylvania, School of Medicine, Philadelphia, Pa
b Congenital Heart Center, University of Florida College of Medicine. Gainesville, Fla
c Advocate Hope Children’s Hospital. Oak Lawn, Ill
d Cardiac Unit, Institute of Child Health, University College, London, United Kingdom.

Received for publication October 20, 2006; revisions received January 14, 2007; accepted for publication January 29, 2007.

* Address for reprints: André Ilbawi, BSE, Box 399, Suite 100, Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104-6087. (Email: ailbawi{at}mail.med.upenn.edu).

Objectives: The ascending aorta and aortic arch in patients with hypoplasia of the left heart are hypoplastic as a result of diminished blood flow. In this study, the presence and degree of obstruction owing to areas of narrowing or infolding within the diminutive aorta are quantified, and their surgical significance is discussed.

Methods: Ninety-six specimens with hypoplasia of the left heart were studied and measurements were taken at specified sites to evaluate areas of narrowing. Quantitative assessments of infoldings and their contribution to obstruction of flow are made.

Results: Narrowing of the distal ascending aorta was found in 60 (62.5%) specimens, with a decrease in circumference of the distal ascending aorta (0.72 ± 1.06 mm) present when compared with its midpoint (P < .05). Tissue infolding at the orifice of the brachiocephalic artery and its junction with the distal ascending aorta was observed in 56 (58.3%) hearts, with major infolding in 29 (30.2%) and minor infolding in 27 (28.5%). Tissue infolding at this site correlated with a smaller ascending aorta (P < .001) but not with narrowing in the distal ascending aorta (P = .53). Ductal coarctations were detected in 77 (81.1%) specimens. Their presence correlated with a smaller diameter of the ascending aorta (P < .05), and their severity correlated with the presence of aortic and mitral valvular atresia (P < .05).

Conclusions: Important areas of obstruction in the ascending aorta in patients with hypoplasia of the left heart were found, and their pathogenesis is discussed. The findings highlight the importance of incorporating the ascending aorta into the aortic reconstruction at the time of initial palliation for patients with hypoplasia of the left heart.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The American Association for Thoracic Surgery.