Journal of Pediatric Cardiology and Cardiac Surgery

Background: In many cases of congenital cyanotic heart disease with stenosis or atresia of the main pulmonary artery, the ascending aorta is enlarged. This narrows the retroaortic space, making corrective surgery difficult. To overcome this problem, we devised an aortic extension technique using autologous aortic tissues.

Methods: Between 2005 and 2013, we performed the aortic extension technique on five patients, including four with a functional single ventricle and one with pulmonary atresia and a ventricular septal defect. Operative data, prognosis, and pre- to postoperative changes in aortic diameter, which were obtained using aortic angiography, were examined and compared.

Results: The mean patient age at the time of surgery was 18.2±7.6 months (range, from 7 months to 2 years), and the mean body weight was 8.4±0.9 (range, 7.1–10.0) kg. For all patients, aortic extension was performed in approximately 30 min. The preoperative ratio of the maximum to peripheral diameter of the ascending aorta was 1.64±0.22, and this significantly reduced to 1.01±0.36 postoperatively. Thus, enlargement of the retroaortic space was achieved. The patients progressed well, with no stenosis or re-enlargement being observed for over 53.8±38.3 (range, 32–130) months postoperatively.

Conclusions: This aortic extension procedure uses only autologous aortic tissues to simultaneously reduce the aortic diameter while extending the aorta. Because growth is also expected, our method appears to be a useful surgical procedure for reconstructing the large central pulmonary artery and decompressing the bronchus by sufficiently enlarging the retroaortic space.