Eur J Cardiothorac Surg 2001;20:431
© 2001 Elsevier Science NL
Reply to Schepens
W. Daenen
Cardiac Surgery and Pediatric Cardiology, University Hospital of Gasthuisberg, Herestraat 49, Leuven B-3000, Belgium
Received 4 May 2001;
accepted 5 May 2001.
Tel.: +32-1634-4260; fax: +32-1634-4616
e-mail: willem.daenen{at}uz.kuleuven.ac.be
I agree with most of the conclusions made by M. Schepens in his letter. With regard to the question of the surgical technique used in the patient with paraplegia, it is obvious that nowadays we would use a left heart bypass to protect the spinal cord. This patient was reoperated in 1992. In those days, the state of the art was not clear for those cases where an aortic cross-clamp time less than 30 min was anticipated [1,2]. I also agree that the primary cause of graft dilatation lies in the knitted graft itself. However, we were able to document that transverse arch hypoplasia predisposes to aneurysm formation in other types of repair [3]. I do not see any reason why this should not be the case in a correction using a distensible graft.
References
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Hamerlijnck R.P., Rutsaert R.R., De Geest R., Brutel de la Riviere A., Defauw J.J., Vermaulen F.E. Surgical correction of descending thoracic aneurysms under simple aortic cross-clamping. J Vasc Surg 1989;9:568-573.[Medline]
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von Oppell U.O., Dunne T.T., De Groot K.M., Zilla P. Spinal cord protection in the absence of collateral circulation: meta-analysis of mortality and paraplegia. J Card Surg 1994;9:685-691.[Medline]
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Bogaert J., Gewillig M., Rademakers F., Bosmans H., Verschakelen J., Daenen W., Baert A. Transverse arch hypoplasia predisposes to aneurysm formation at the repair site after patch angioplasty for coarctation of the aorta. J Am Coll Cardiol 1995;26:521-527.[Abstract]
