کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
3025717 | 1182801 | 2007 | 5 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Management of Infants with Coarctation and Ventricular Septal Defect Management of Infants with Coarctation and Ventricular Septal Defect](/preview/png/3025717.png)
The management of patients with aortic coarctation and ventricular septal defect (VSD) remains controversial. A 2-stage repair uses staged coarctation repair ± pulmonary artery banding followed by VSD closure with 2 separate operations. This has the advantage of a straightforward coarctation repair (except in the case of proximal arch hypoplasia) and a simpler VSD closure at a later date. A subset of patients will have spontaneous VSD closure that obviates the need for subsequent operation. Disadvantages include a period of palliation between operations and the complications of a pulmonary band. A single-stage approach involves simultaneous coarctation repair and VSD closure on cardiopulmonary bypass with circulatory arrest or regional perfusion during coarctation repair. This has the advantages of complete repair in infancy without palliation and the ability to deal with proximal arch hypoplasia. Disadvantages include a technically more challenging operation and the need for circulatory arrest or regional cerebral perfusion. Some series have suggested a higher risk for recoarctation. An alternative method involves coarctation repair without cardiopulmonary bypass through a thoracotomy followed by VSD closure during the same operation (1 stage, 2 incisions). This affords excellent clinical results with complete repair in infancy. One can avoid prolonged periods of aortic cross clamping, cardiopulmonary bypass, and circulatory arrest/regional perfusion. Compared with the other strategies, there are decreased total intensive care unit and hospital stays.
Journal: Seminars in Thoracic and Cardiovascular Surgery - Volume 19, Issue 3, Autumn 2007, Pages 264–268