Double Aortic Arch with TOF
Transcript of Double Aortic Arch with TOF
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Double Aortic Arch with TOF and Anorectal
MalformationDepartment of CTVS
P.G.I.M.E.R. & Dr. RML HospitalNew Delhi
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Patient2 ½ yr. / Female
Underwent colostomy for ARM in neonatal period.
Referred to RMLH for intracardiac repair prior to colostomy closure.
LT. Kidney congenitally absent. (KFT normal)
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Echo & Cath StudyTOF.Adequate sized PAs.Val.+Inf. PS (PG-65).Double Aortic Arch.
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CT Cardiac AngioDouble Aortic Arch (Right dominant) with
mild tracheal compression RCCA and RSCA from rt. archLSCA and LCCA from lt. arch.Right sided DTAB/L SVC with no bridging vein
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Diagnosis & TreatmentTOF/Inf. PS/MPA stenosis/Confluent and
adequate branch PAs/ No MAPCA or CoA or PDA/ normal coronaries/ Double Aortic Arch (Rt. Arch Dominant)/ B/L SVC.
FS-11, HS-7.5
Sx : Total Correction + Lt. arch division.
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Aproach Double Aortic Arch
Isolated Associated with cardiac (Thoracotomy) Anomalies
Backer CL, 1989 (Median Sternotomy) 45 years analysis Zhou Dan etal – 15
cases
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Single Stage with 2 incisions- (AIIMS)
S. Talwar, Anubhav Gupta etal – 2 cases (Division of Arch by posterolateral
thoracotomy and Intracardiac repair via sternotomy)
Two stage
B Pankaj et al - I/C repair f/b –Arch division on POD7
(Intracardiac repair via median sternotomy, could not divide Arch, - Divided Arch via thoracotomy later)
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Our PlanSingle stage procedure via median
sternotomy
If not able to divide Arch, then Intracardiac Repair first , followed by Division of Arch via thoracotomy in second stage.
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Per operative findingsProximal Arch dissected.
CPB to facilitate dissection. RCCA, LCCA, LSCA & Left arch identified.
PDA identified, ligated and divided.
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Intra cardiac Repair
Post Op recovery uneventful
Discharged on POD 4
Follow up – Doing well
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Double Aortic Arch with TOF is rare anomaly and based on review of literature and our experience Single stage procedure is Advocated
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THANK YOU