Coarctation and VSDOverview and management

options

Mohammad Shihata MDPediatric Cardiac Surgeon, Madinah Cardiac CenterAssistant Professor of Surgery, Taibah University

The First step…..

Is it truly only CoA + VSD ?

Associated Lesions

Hypoplastic Arch

Sub-AS (posterior malalignment,

ridge, or tunnel)

Hypoplastic Aorta

MV abnormalities

The Spectrum of Arch Obstruction and LVOTO

CoA with Valvular StenosisHLHS

HLHS or Variants

IAA/CoA +/-

VSD

Biventricular Repair

1 or 2 stage

Single VentricleNorwood

BCPC TCPC

VSDNormal MV

Complex LVOTO

Yasui (or)Norwood/

Rastelli (or)Ross/Konno +

Arch repair

Type and Size of the VSD

May influence the surgical approach.

Large vs. Small (VSD/ AO)

Posterior malalignment, inlet, muscular, subarterial, or multiple

Surgical Options

Single stage repair:

Arch repair

VSD closure

+/- Subaortic resection

+/- Aortic valvuluplasty

Staged Repair

Stage One

CoA repair

CoA repair + PA Band

Stage Two

VSD closure

VSD closure + Debanding

Debading alone !!

A retrospective analysis of 141 neonates with CoA and VSD based on the initial management strategy.

Group A: Staged repair

Group B: Full repair

Freedom From Secondary VSD Closure

VSD/AO Ratio

Redo Arch Surgery

Development of Sub-AS

One stage (2 incisions)

Patient Characterestics

Operative outcomes

Conclusion Neonates with CoA + VSD need to be carefully

assessed for the presence of associated LVOTO.

Both Primary and staged approaches have acceptable outcomes.

If the VSD is likely to close spontaneously, Coarctation repair alone is preferred.

Thank You