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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 December;39(6):773-5

VASCULAR PAPERS 

    TECHNICAL NOTES

Fash­ioning of ­aortic isth­mo­plasty ­patch. A mat­he­mat­ical ­model

Shatapathy P., Mandana K. M.

From the Depart­ment of Car­di­o­vas­cular and Tho­racic Sur­gery Kas­turba Med­ical Col­lege and Hos­pital Man­ipal ­Academy of ­Higher Edu­ca­tion, Man­ipal, ­India

Back­ground. ­Patch enlarge­ment of the ­aortic ­isthmus in con­gen­ital coarc­ta­tion of the ­aorta (­aortic isth­mo­plasty) has ­been exten­sively per­formed ­since its intro­duc­tion in 1957. ­Even ­after ­forty ­years, the ­size and ­shape of the pros­thetic ­patch ­used as an ­on a ­graft is ­still deter­mined, ­most of the ­time, empir­i­cally ­through eye­balling. Not infre­quently, it has ­resulted in an ­ugly ­looking ­repaired ­aortic seg­ment or ­with a sig­nif­i­cant ­residual sys­tolic gra­dient ­across it. ­These ­twin prob­lems ­have ­called for a math­e­mat­ical ­model for ­designing the ­patch ­more pre­cisely.
­Methods. The ­model envis­ages a ­patch of the ­shape of an asym­metric ­octagon ­whose ­cranio-­caudal ­length ­equals the dis­tance ­from a ­point 8 mm on the prox­imal ­aorta to a ­point 8 mm on the ­distal ­dilated ­aorta on ­either ­side of the ­coarcted seg­ment. The ­side to ­side ­length of the ­patch is deter­mined by ­first sub­tracting the cir­cum­fer­ence of the nar­rowest ­part of the ­coarcted seg­ment ­from the cir­cum­fer­ence of the ­distal ­dilated por­tion of the ­aorta and ­then ­adding 4 mm ­more. The ­larger ­slant ­sides of the ­octagon are ­obtained by ­joining the ­four ­smaller ­sides, of 8 mm in ­length ­each. ­Since ­July 1993 ­this math­e­mat­ical ­model has ­been ­employed in 7 ­patients to pre­pare the ­exact ­size and the ­shape of the ­tightly ­woven low ­porosity ­Dacron ­patch.
­Results. In ­each ­instance a ­neat cylin­drical ­aorta was ­obtained ­without any mea­sur­able ­post-­repair sys­tolic pres­sure gra­dient ­across the ­repaired ­site.
Con­clu­sions. In ­view of ­these ­very sat­is­fying ­results, we ­believe ­that ­this math­e­mat­ical ­model of tail­oring the ­patch has suc­ceeded in con­verting the ­patch-aor­to­plasty pro­ce­dure for coarc­ta­tion of the ­aorta ­into a pre­cise and hemo­dy­nam­i­cally ­fully cor­rec­tive oper­a­tion.

language: English


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