Single-stage surgical modification for neonatal aortic coarctation and ventricular septal defect: a case report

TL;DR

A new surgical method successfully treats a complex heart defect in newborns without using high-risk techniques.

Contribution

A modified single-stage surgical approach that avoids deep hypothermic circulatory arrest in neonates with aortic coarctation and VSD.

Findings

The modified approach achieved successful repair with a short recovery period and no complications.

Avoiding deep hypothermic circulatory arrest reduced neurological risks and CPB duration.

Excellent postoperative cardiac function was confirmed at discharge.

Abstract

Coarctation of the aorta (CoA) with a non-restrictive ventricular septal defect (VSD) is a severe congenital heart defect. Traditional single-stage repair often requires deep hypothermic circulatory arrest (DHCA), increasing surgical risk in neonates.

A 1-day-old male neonate with prenatal diagnosis of CoA and VSD presented with respiratory distress. Imaging confirmed CoA with arch hypoplasia and a large VSD. He underwent a modified single-stage repair via median sternotomy. The innovative approach involved initial aortic arch reconstruction without cardiopulmonary bypass (CPB), followed by VSD closure under mild hypothermic CPB. The chest was closed primarily. Recovery was remarkable: ventilator support 23 h, intensive care unit stay 4 days, and total hospitalization 13 days. Discharge echocardiogram showed excellent cardiac function with no complications.

This modified single-stage approach successfully treated CoA with VSD while avoiding DHCA. The technique’s key advantage lies in performing arch reconstruction without CPB first, significantly reducing CPB duration and eliminating neurological risks associated with DHCA. The excellent postoperative recovery demonstrates this strategy’s potential benefits over conventional methods, offering a promising surgical alternative for managing this complex condition in infants.

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