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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luca A. Vricella Duke E. Cameron Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vricella, L. A. Articles by Cameron, D. E. Search for Related Content PubMed Articles by Vricella, L. A. Articles by Cameron, D. E. Related Collections Congenital - acyanotic

Letters to the Editor

Reply to Troise et al.: Subclavian flap aortoplasty in neonates and infants

Division of Cardiac Surgery, The Johns Hopkins University Hospital, Baltimore, United States

Received 13 August 2007; accepted 14 August 2007.

^_* Corresponding author. Address: Division of Cardiac Surgery, Johns Hopkins University, 600 N. Wolfe St. – Blalock 618, Baltimore, MD 21287, United States. Tel.: +1 443 287 1262; fax: +1 410 955 3809. (Email: lvricella{at}jhmo.edu).

Key Words: Congenital cardiac surgery • Aortic coarctation

We read with great interest the Letter to the Editor by Troise et al. [1] concerning our recently published review of a 20-year experience with subclavian flap aortoplasty for treatment of aortic coarctation in neonates and infants [2]. We congratulate the group at the University of Bari on their results and agree with an individualized approach to aortic coarctation based on morphology. We believe that the size and Doppler-flow acceleration across the mid-aortic arch should guide the surgical approach, and is preferable to routine resection and anastomosis that involves a diminutive and fragile aortic arch in the small neonate. Following subclavian flap repair, the mid-aortic arch with a mild gradient often grows, and we concur with reserving sternotomy with repair on hypothermic cardiopulmonary bypass with selective cerebral perfusion for patients with a diffusely hypoplastic aortic arch or those needing concomitant intracardiac repair. In cases of mild stenosis between the right brachiocephalic artery and left common carotid with diminutive distal aortic arch and isthmus, a reverse subclavian flap followed by an end-to-end anastomosis can be considered.

References

1. Troise DE, Tagliente MR, Balducci G, Arciprete PM. Letter to the Editor. Eur J Cardiothorac Surg 2007;32:824.[Free Full Text]
2. Barreiro CJ, Ellison TA, Williams JA, Durr ML, Cameron DE, Vricella LA. Subclavian flap aortoplasty: still a safe, reproducible and effective treatment for infant coarctation. Eur J Cardiothorac Surg 2007;31(4):649-653.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luca A. Vricella Duke E. Cameron Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vricella, L. A. Articles by Cameron, D. E. Search for Related Content PubMed Articles by Vricella, L. A. Articles by Cameron, D. E. Related Collections Congenital - acyanotic