2021 Volume 30 Issue 2 Pages 63-67
An 11-year-old boy had undergone a Norwood procedure at infancy for functional single ventricle and systemic ventricular outflow tract obstruction, and a total cavopulmonary connection (i.e., Fontan procedure) with an extracardiac conduit at the age of 2 years. Residual aortic coarctation was detected by catheterization at the age of 11 years, which indicated surgery. Contrast-enhanced computed tomography revealed archery hypoplasia after the bifurcation of the brachiocephalic artery, narrowing of the aorta to the minimal diameter of 5 mm after the bifurcation of the left subclavian artery, and dilatation after the stenotic segment. An ascending–descending aortic bypass via a posterior pericardial approach was performed through median sternotomy under partial extracorporeal circulation using the off-pump technique. The postoperative course was uneventful without complications. Advantages of ascending–descending aortic bypass for residual aortic coarctation include prevention of recurrent laryngeal nerve injury, alleviation of respiratory complications, and avoidance of highly invasive assisted circulation such as deep hypothermia-induced circulatory arrest. On the other hand, the disadvantages specific to this procedure include esophageal injury, phrenic nerve injury, and steal phenomenon in the cerebral or coronary circulation. In addition, late follow-up is necessary because of concerns about size mismatch of blood vessel prostheses in association with somatic growth of children.
