Surgery of Aortic Arch Anomalies
DONALD B. EFFLER, M.D.
Department of Thoracic Surgery
F. MASON SONES, M.D.
Department of Cardiovascular Disease
ANOMALIES of the aortic arch represent clinically the most important group of congenital lesions in the heart and great vessels. The clinical importance of these extracardiac anomalies is based on three major factors: (1) accurate diagnosis is possible in most instances, (2) surgical correction is possible in the majority of cases, and (3) definitive surgical therapy may offer a normal life expectancy to the patients.
Aortic arch anomalies are classified in the noncyanotic category of congenital heart disease. In a high percentage of cases early recognition of the condition is possible during infancy and preschool childhood. Most important, it is in this group of congenital lesions that surgery offers a physiologic cure if intervention occurs before irreversible secondary changes have become manifest. In contrast, surgery for intracardiac lesions is usually of a palliative nature in congenital heart disease and should hot be considered curative except in isolated instances.
PATENT DUCTUS ARTERIOSUS
Persistence of the ductus arteriosus occurs more frequently than any of the other aortic anomalies. In 1939 Gross1 reported the first successful ductus ligation; this brilliant surgical feat provided a tremendous stimulation to clinical interest. Ductus surgery is commonplace today, attesting to the importance of Gross’ contribution.
The ductus arteriosus is an integral part of the fetal circulation; with the foramen ovale it shunts most of the blood flow from the right side of the heart and the pulmonary artery into the systemic circulation. Functional closure occurs shortly after birth and eventual obliteration is represented by the ligamentum arteriosum.2