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Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation.

Authors :
Asada, Satoshi
Yamagishi, Masaaki
Maeda, Yoshinobu
Itatani, Keiichi
Fujita, Shuhei
Hongu, Hisayuki
Nakatsuji, Hiroki
Yaku, Hitoshi
Source :
European Journal of Cardio-Thoracic Surgery. Dec2021, Vol. 60 Issue 6, p1408-1416. 9p.
Publication Year :
2021

Abstract

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Pulmonary artery (PA) compression by the neoaorta is a serious complication after the Norwood-type palliation (NP) for hypoplastic left heart syndrome. Either excess patch tailoring or limited use of autologous tissue may cause narrowing of the subaortic space. The chimney technique could theoretically provide a wide subaortic space. METHODS Twenty-nine patients with both pre- and post-NP computed tomography data available of the 37 consecutive patients who underwent NP in our institution were reviewed. Arch height, arch width, sinus of Valsalva diameter, area under the neoaortic arch and arch angle were measured. These patients were divided according to the neo-arch reconstruction technique, chimney reconstruction technique (CR) or conventional direct reconstruction technique (DR). RESULTS Median age and weight at NP were 2.1 months and 3.5 kg, respectively. Twenty-two patients underwent previous bilateral PA banding. During NP, 17 CR and 12 DR were performed. Four patients in the DR group developed PA compression. No neoaortic arch dilatation was found in either group. Post-NP arch width, area under the neo-arch and the arch angle were significantly larger in the CR group. Pre-NP arch height was significantly smaller in DR patients with PA compression than in those without. CONCLUSIONS The chimney technique decreased the risk of PA compression and provided a wider subaortic space and a less acute arch angle. This technique had no short-term effect on the neoaortic root. Small preoperative arch height is a potential risk factor for PA compression in DR, and the chimney technique could be an effective solution. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10107940
Volume :
60
Issue :
6
Database :
Academic Search Index
Journal :
European Journal of Cardio-Thoracic Surgery
Publication Type :
Academic Journal
Accession number :
154008602
Full Text :
https://doi.org/10.1093/ejcts/ezab184