Page 22 - Journal of Structural Heart Disease Volume 3, Issue 5

Case Report
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superimposed “end-to-end” anastomosis. The pulmo- nary arteries were narrowed to 3 mm in the mouths with cu s made of Gore-Tex material. The postopera- tive period was complicated by cardiac and respiratory failure, but the patient’s condition stabilized by day 20. Radical correction of the ventricular septal defect, cu removal from the pulmonary arteries, and creation of the right ventricular out ow tract using a valve-con- taining xenopericardial graft No. 10 was performed under arti cial blood circulation. The postoperative period was complicated by polyorganic insu ciency, but the child was discharged from the hospital in satis- factory condition 36 days after surgery.
At scheduled follow-up visits 3 and 5 months af- ter the operation, increased pressure gradient at the aortic isthmus was noted, and the child was hospital- ized for surgical correction of this complication at 8 months of age. The child had reduced nutrition with blood pressures of 140/80 mmHg in the right arm, 80/40 mmHg in the left arm, and 60/30 mmHg in the right leg.
Electrocardiography showed right axis deviation. A chest X-ray demonstrated cardiomegaly with a car-
diothoracic ratio of 67%. Echocardiography revealed an enlarged left atrium and thickened left ventricular posterior wall with normal ejection fraction. The aor- tic valve was tricuspid with a dilated ascending aorta. There was moderate prolapse of the mitral valve with moderate regurgitation. The gradient across the long segment narrowing was 86 mmHg. The right ventricle was enlarged. No obstruction was noted across the right ventricular out ow tract or branch pulmonary arteries.
Multislice computed tomography was performed to clarify the anatomy and determine the localiza- tion of the lesion (Figure 1A and 1B). There was ex- pansion of the ascending aorta at the level of the Valsalva sinus to 19-20 mm and at the level of the sinotubular junction to 17 mm; the diameter of the ascending aorta in front of the brachiocephalic trunk was 8 mm. Brachiocephalic vessels originated from separate ostiums; the ostium of the left common ca- rotid artery was located immediately after the origi- nation site of the brachiocephalic vessels, and the last trunk originating from the aortic arch was the left sub- clavian artery, which narrowed at the ostium. There
AB
Figure 1. Multi-slice computed tomography of the heart with contrast injection. Maximum intensity projection (Panel A) and three- dimensional reconstruction (Panel B) showed expansion of the ascending aorta. The left common carotid artery originated near the brachiocephalic trunk. There was prolonged acute stenosis of the aortic arch from the ostium of the left common carotid artery to the aortic isthmus as well as ostial stenosis of the left subclavial artery.
Journal of Structural Heart Disease, October 2017 Volume 3, Issue 5:147-151