Objective To summarize the experiences of single stage repair of persistent fifth aortic arch associated with stenosis and interrupted aortic arch and other cardiac anomalies,and to improve surgical effect of the diseases． Methods From Jan．2000 to May 2008，five patients with persistent fifth aortic arch were operated in this hospita1，the age at operation was 1.8-108.0 months and body weight 3.7-31.0 kg．Three patients had chronic heart failure and respiratory infection repeatedly.All patients received single stage repair. Results There were two early hospital deaths，one patient’s parents gave up all the therapy because of cardiac insufficiency, pulmonary hypertension crisis and severe pulmonary infection; another one died of severe pulmonary hypertension crisis，the low cardiac outflow and left heart failure. Three patients were followed up, followup time was 55.67±48.64 months. The results were excellent,and one patient had been followed up for 8 years,the latest magnetic resonance imaging showed that diameter of the enlarged fifth aortic arch was 9.3 mm. Conclusion Persistent fifth aortic arch operation can achieve good exposure,less incisional wound and excellent recovery through midline sternotomy.Because of systemic hypertension and the affection of associated anomalies the operation should be performed as early as possible.
Abstract: Objective To review the shortterm outcome of modified Nikaidoh operation, aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the treatment of transposition of the great arteries with ventricular septal defect and pulmonary stenosis (TGA/VSD/PS). Methods Between January 2004 and December 2005, 8 consecutive patients had undergone Nikaidoh procedure for the treatment of TGA/VSD/PS at Shanghai Children’s Medical Center. All patients had ventriculoarterial discordance and atrioventricular concordance. Associated lesions included a straddling atrioventricular valve in one patient and hypoplastic left pulmonary artery. The median age at operation was 11.4±7.6months (4 to 29months). Weight of body was 8.0±1.9kg (5.2 to 11.0kg). No patient had previous palliative procedure. The surgical technique used was a modification of the Nikaidoh procedure. Results The median total cardiopulmonary bypass time was 176±50 minutes (range,112 to 250 minutes), and the median aortic crossclamp time was 101±27 minutes (range, 73 to 139minutes). The median length of stay in the intensive care unit was 12±9 days, with a median hospital stay of 19±12 days. There was 1 hospital death as a esult of severe left ventricle failure. There was no residual left ventricular outflow tract obstruction (LVOTO) and right ventricular outflow tract obstruction (RVOTO), but 3 patients with mild to moderate pulmonary regurgitation and 4 patients with moderate. At a median follow-up of 8.8 months (range, 3 to 18months), all patients were alive. All have the normal ventricular function. There were ejection fraction (EF) 0.64±0.02 and fractional shortening (FS) 0.33±0.02. None of the patients developed aortic insufficiency and progressed LVOTO or RVOTO. Conclusions Nikaidoh procedure is a valuable surgical option for TGA/VSD/PS in infant, especially in the presence of “inadequate anatomy” for a Rastelli repair. Big evidence and longer follow-up are required to fully assess the potential longterm benefits of this procedure compared with the Rastelli repair.