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J Thorac Cardiovasc Surg 2002;123:1221-1222
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Fukuoka Children's Hospital, Fukuoka, Japan

Reply to the Editor:

We were encouraged by the letter from Vricella and Black to know that other surgeons besides us are interested in neonatal arch reconstruction under moderate hypothermia. Direct cannulation of the innominate artery to perfuse both the brain and the heart under moderate hypothermia is a useful technique and is also used in the patients with coarctation or interruption of the aortic arch in our hospital. ¹ The ascending aorta and the arch in hypoplastic left heart syndrome are sometimes very small in diameter; therefore, we prefer the expanded polytetrafluoroethylene graft to a conventional arterial cannula to obtain abundant retrograde flow.

Reconstruction of the arch in the hypoplastic left heart syndrome sometimes demands rather long time, and the safety limit of circulatory arrest time of the lower part of the body under moderate hypothermia is unknown. We believe that there is no reason to hesitate in cannulating the descending aorta. It is not technically difficult. We used the technique in 70 neonates and infants with arch reconstruction (hypoplastic left heart syndrome in 30, interruption of the aortic arch in 17, and coarctation of the aorta in 23) between 1998 and 2001, and no complication from this technique, such as bleeding or injury of other organs, has been encountered.

Vricella and Black use the "open distal" method instead of descending aortic cannulation. Even though they have observed copious bleeding from the open descending aorta, collateral blood flow from the upper body to the lower body might not perfuse the lower body organs because of the low perfusion pressure when the descending aorta is open. It seems to us that clamping the descending aorta is recommended even when descending cannulation is not used.

12/8/123523

Reference

1. Imoto Y, Kado H, Shiokawa Y, Kanegae Y, Fukae K, Iwaki H, et al. Primary repair of aortic coarctation and interruption using cannulation of the descending aorta and the innominate artery. Jpn J Pediatr Cardiol Card Surg. 2000;16:142-7.
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hideaki Kado Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Imoto, Y. Articles by Kado, H. Search for Related Content PubMed Articles by Imoto, Y. Articles by Kado, H.