Long-term outcome of left ventricular outflow tract after biventricular repair using Damus-Kaye-Stansel anastomosis for interrupted aortic arch and severe aortic stenosis

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Abstract

I nterrupted aortic arch (IAA) with a ventricular septal defect (VSD) is rare but lethal in association with subaortic stenosis. The primary biventricular repair for this lesion consists of left ventricular outflow tract (LVOT) reconstruction by Damus-Kaye-Stansel (DKS) anastomosis and intracardiac rerouting through the VSD, along with concomitantly performed right ventricular out-flow tract (RVOT) and aortic arch reconstruction (Yasui procedure 1 ; Figure 1, A). In this study, we reported long-term follow-ups in 2 patients and estimated the transition of LVOT diameter. Clinical Summaries PATIENT 1. An IAA (type B) was diagnosed in a 36-day-old boy weighing 3.4 kg, as was a perimembranous VSD. The sub-aortic diameter was 2.6 mm, and the aortic valve (diameter, 3.9 mm) was bicuspid. In primary biventricular repair, LVOT recon-struction consisted of intracardiac rerouting from the VSD (8 mm) to the pulmonary artery by using a Teflon patch and a DKS anastomosis. RVOT reconstruction was performed by the Rastelli procedure with a 14-mm Hancock valved conduit (Medtronic, Inc, Minneapolis, Minn). Aortic arch reconstruction was performed with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft anastomosis between the ascending and descending aorta. When the patient was aged 5 years 9 months, a conduit replacement for a re-RVOT reconstruction with a 16-mm ePTFE graft was required because of weight gain. When he was 7 years old, we performed an additional 12-mm ePTFE graft anastomosis between the left common carotid artery and the descending aorta. The follow-up period is now 16 years, and New York Heart Association is class I. PATIENT 2. An IAA (type B) was diagnosed in a 42-day-old

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Takabayashi, S., Kado, H., Shiokawa, Y., Fukae, K., & Nakano, T. (2005). Long-term outcome of left ventricular outflow tract after biventricular repair using Damus-Kaye-Stansel anastomosis for interrupted aortic arch and severe aortic stenosis. Journal of Thoracic and Cardiovascular Surgery, 130(3), 942–944. https://doi.org/10.1016/j.jtcvs.2005.05.030

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