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J Thorac Cardiovasc Surg 2006;131:478-479
© 2006 The American Association for Thoracic Surgery

Brief Communication

Repair of symptomatic neoaortic aneurysm after third-stage palliation for hypoplastic left heart syndrome

^a Loyola University Stritch School of Medicine, Chicago
^b Christ Medical Center, Department of Pathology, Oak Lawn, Ill
^c The Heart Institute for Children, Hope Children Hospital, Oak Lawn, Ill

Received for publication June 30, 2005; revisions received September 28, 2005; accepted for publication September 29, 2005.

^_* Address for reprints: Jeffrey H. Shuhaiber, MD, Department of Surgery, Loyola University Stritch School of Medicine, 614-G Laflin, Chicago, IL 60612 (Email: jeffrey01@mac.com).

The first 20% of the full text of this article appears below.

Clinical Summary

A 4-year-old child with hypoplastic left heart syndrome had successfully undergone stage 3 surgical palliation. Dilatation of the neoaorta (28 mm) was first noticed 24 months after a stage 1 Norwood procedure. Progressive enlargement was documented by serial echocardiographic evaluation. At pre-Fontan cardiac catheterization the neoaorta was 32 mm at the mid-ascending level and the pulmonary valve (neoaortic valve) was 27 mm with mild-to-moderate insufficiency. Four months after the extracardiac Fontan procedure the child had syncopal episodes during exercise associated with pallor and weakness. Thorough neurologic evaluation was unrevealing. Holter monitor recordings and electrophysiologic studies were essentially negative except for mild sick sinus syndrome with no inducible arrhythmias. Hematologic work-up was within normal limits. Cardiac catheterization showed complete occlusion of the left pulmonary artery and interval growth of the aneurysm to 55 mm (23 mm increase) in diameter over 20 months (Figure 1, A and B). Follow-up cardiac catheterization after 1 month of warfarin sodium (Coumadin) and aspirin therapy revealed complete recanalization of the occluded pulmonary artery yet persistent compression by the neoaortic aneurysm. Thrombophilia work-up was within normal limits. The patient underwent successful stent placement of the . . . [Full Text of this Article]

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