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INVITED REVIEW |
Consultant Paediatric Cardiac Surgeon University of Liverpool, Alder Hey Children NHS Foundation Trust, Liverpool, UK
Antonio F Corno MD, FRCS(Glasgow), FACC, FETCS, Tel: +44-151-2523.713 Fax: +44-151-2525.643 E-mail: Antonio.Corno{at}alderhey.nhs.uk, Senior Lecturer, University of Liverpool, Consultant Paediatric Cardiac Surgeon, Alder Hey Children NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.
The Authors presented their experience with two cases of transposition of the great arteries with aortic arch obstruction, better identifiable within the Taussig-Bing anomaly. In both cases the surgical technique consisted in the reconstruction of the aortic arch and arterial switch, in one of the cases with the added modification for the transfer of the single coronary artery origin. Both patients had a good immediate result, as documented by the available post-operative CT scan images in the first patient and angiography in the second patient.
The Authors have to be congratulated for reporting their experience in a very difficult patient population, where early and late mortality and morbidity are not negligible even in the best cardiac surgery units, because of the well know problems related with the decision-making process among the available surgical options, and then by the difficult peri-operative management of these infants.
A very good early result has been obtained using an adequate intra-operative conduction of the cardio-pulmonary bypass with continuous cerebral perfusion, and avoiding any prosthetic or foreign material for arch reconstruction. The last is a very difficult task to reach in this group of patients, particularly in the presence of a substantial size discrepancy between the great arteries.
The proposed surgical technique is not original, but nevertheless the Authors proved the adaptability of the technique also to the presence of a single coronary artery orifice.
It would be useful to know if these two cases represent a "special" isolated series of two patients within a larger group of patients with the same complex malformation (Taussig-Bing anomaly) and the Authors have introduced their surgical technique in these two infants. If this is the case, it would be useful to the readers to know the approach of the Authors to all patients with Taussig-Bing anomaly with aortic arch obstruction, with and without sub-aortic obstruction. Not only the presence of moderate to severe sub-aortic obstruction can complicate the surgical approach, but the decision-making process can be extremely difficult in the presence of borderline situations, where there are not clear cuts between the advantages provides by one versus another surgical option.
Finally, as underlined by the Authors, this surgical technique provided an early result without apparent residual aortic arch obstruction. These patients will require a very extensive monitoring during the follow-up period in order to rule out not only any potential late recurrence of aortic arch obstruction, but also late appearance of neo-aortic valve regurgitation and coronary arteries problems.
Asian Cardiovasc Thorac Ann 2009;
17:425
© 2009 by SAGE Publications
DOI: 10.1177/0218492309106155
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