Objective: Left ventricular outflow tract obstruction remains an early and lat e complication after repair of interrupted aortic arch and ventricular septal de fect. We reviewed our experience with the selective manag...Objective: Left ventricular outflow tract obstruction remains an early and lat e complication after repair of interrupted aortic arch and ventricular septal de fect. We reviewed our experience with the selective management of the infundibul ar septum during primary repair to address left ventricular outflow tract obstru ction. Methods: From 1991 through 2001, all 27 patients presenting with interrup ted aortic arch/ventricular septal defect and posterior deviation of the infundi bular septum were analyzed. Fifteen patients with the smallest subaortic areas u nderwent myectomy or myotomy of the infundibular septum concomitant with interru pted aortic arch/ventricular septal defect repair. Results: Patients undergoing myectomy-myotomy(Group I) had significantly smaller subaortic diameter indexes( 0.83±0.16 cm/m2) when compared with those who had only interrupted aortic arch/ ventricular septal defect repair(group 2: 0.99±0.13 cm/m2, P=.012). Two hospita l deaths occurred in group 1, and 1 occurred in group 2. No late deaths occurred . No patient in group 2 required reoperation. Six group 1 patients required 9 re operations for left ventricular outflow tract obstruction. Five patients underwe nt resection of a new subaortic membrane. Only 1 patient had recurrent muscular left ventricular outflow tract obstruction. Three patients required a second reo peration, primarily related to aortic valve stenosis. Conclusions: Interrupted a ortic arch/ventricular septal defect with posterior malalignment of the infundib ular septum can be repaired with low mortality in the neonatal period. Tailored to the degree of subaortic narrowing, resection or incision of the infundibular septum at the time of primary repair was very effective in preventing or prolong ing the interval to recurrent left ventricular outflow tract obstruction compare d with the published data. However, reoperation for left ventricular outflow tra ct obstruction, often related to the development of a new and discrete subaortic membrane or valvar stenosis, is still required in a subset of patients.展开更多
文摘Objective: Left ventricular outflow tract obstruction remains an early and lat e complication after repair of interrupted aortic arch and ventricular septal de fect. We reviewed our experience with the selective management of the infundibul ar septum during primary repair to address left ventricular outflow tract obstru ction. Methods: From 1991 through 2001, all 27 patients presenting with interrup ted aortic arch/ventricular septal defect and posterior deviation of the infundi bular septum were analyzed. Fifteen patients with the smallest subaortic areas u nderwent myectomy or myotomy of the infundibular septum concomitant with interru pted aortic arch/ventricular septal defect repair. Results: Patients undergoing myectomy-myotomy(Group I) had significantly smaller subaortic diameter indexes( 0.83±0.16 cm/m2) when compared with those who had only interrupted aortic arch/ ventricular septal defect repair(group 2: 0.99±0.13 cm/m2, P=.012). Two hospita l deaths occurred in group 1, and 1 occurred in group 2. No late deaths occurred . No patient in group 2 required reoperation. Six group 1 patients required 9 re operations for left ventricular outflow tract obstruction. Five patients underwe nt resection of a new subaortic membrane. Only 1 patient had recurrent muscular left ventricular outflow tract obstruction. Three patients required a second reo peration, primarily related to aortic valve stenosis. Conclusions: Interrupted a ortic arch/ventricular septal defect with posterior malalignment of the infundib ular septum can be repaired with low mortality in the neonatal period. Tailored to the degree of subaortic narrowing, resection or incision of the infundibular septum at the time of primary repair was very effective in preventing or prolong ing the interval to recurrent left ventricular outflow tract obstruction compare d with the published data. However, reoperation for left ventricular outflow tra ct obstruction, often related to the development of a new and discrete subaortic membrane or valvar stenosis, is still required in a subset of patients.
