Faculty Collaboration Database

Aortic arch repair in children with PHACE syndrome. J Thorac Cardiovasc Surg 2016 Sep;152(3):709-17

Date

05/11/2016

Pubmed ID

27160940

DOI

10.1016/j.jtcvs.2016.03.082

Scopus ID

2-s2.0-84975709026 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: PHACE syndrome is characterized by infantile hemangioma and developmental abnormalities of the brain, arteries of head and neck, and aortic arch.

METHODS: We retrospectively reviewed The PHACE Syndrome International Clinical Registry to identify children with PHACE who had operative repair of aortic arch obstruction at Children's Hospital of Wisconsin.

RESULTS: Seven patients (median 11 months, range 1 week-6 years) with PHACE required aortic arch reconstruction from 1996 to 2015. All needed complex surgical approaches (4 conduit grafts, 2 patch aortoplasties, 1 subclavian flap) to relieve the obstruction because of long-segment transverse and proximal descending aortic arch dysplasia that included multiple areas of stricture with adjacent aneurysmal dilatation. Aberrant origin of a subclavian artery was found in 6 of 7. The 3 children who had surgery after age 1 showed significant progression of the arch obstruction and/or adjacent aneurysmal segment dilatation after their initial infant evaluation. No deaths or perioperative complications occurred despite associated cerebrovascular arterial dysplasia in 5 of 7. Recurrent arch obstruction developed in 3 of 7 at an intermediate follow-up interval of 6.2 years (2 had interposition graft replacement at 8 and 11 years due to somatic growth; 1 had repeat patch aortoplasty 11 months after initial repair secondary to recurrent stenosis).

CONCLUSIONS: Extensive aortic arch reconstruction is commonly required in children with PHACE syndrome and coarctation due to the bizarre nature of the obstruction. Complete preoperative imaging is needed to fully characterize the aortic and cerebrovascular arterial anomalies. Recurrent obstruction is common given the non-native tissue techniques needed to relieve the arch anomaly.

Author List

Caragher SP, Scott JP, Siegel DH, Mitchell ME, Frommelt PC, Drolet BA

Authors

Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
John P. Scott MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aorta, Thoracic
Aortic Coarctation
Child
Child, Preschool
Eye Abnormalities
Female
Humans
Infant
Infant, Newborn
Male
Neurocutaneous Syndromes
Recurrence
Registries
Reoperation
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures
Wisconsin