日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: In many cases of cyanotic congenital heart disease with pulmonary atresia or stenosis, the ascending aorta is larger than normal. This enlarged aorta reduces the retroaortic space and makes corrective surgery difficult. To overcome this problem, we devised an aortic extension using only the self-aortic tissue.

Methods: Between 2005 and 2013, we performed this procedure in five patients: four with a functional single ventricle and one with pulmonary atresia and ventricular septal defect. Operative data, prognosis, and change in the aortic diameter were examined postoperatively.

Results: Mean patient age at the time of surgery was 18.2±7.6 months (range, from 7 months to 2 years) and mean body weight was 8.4±0.9 (range, 7.1–10.0) kg. The aortic extension procedure was performed in approximately 30 min in all cases. The ratio of the maximum to peripheral diameter of the ascending aorta was 1.64±0.22 preoperatively and was significantly reduced to 1.01±0.36 postoperatively. No stenosis or re-enlargement was observed over 53.8±38.3 (range, 32–130) months postoperatively.

Conclusion: This aortic extension procedure without the use of a prosthetic graft or autograft enlarges the retroaortic space by extending and plicating the ascending aorta and allows decompression of the central pulmonary artery and bronchus. It also has potential for growth of the aorta.