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![]() Preferred single stage repair with end-to-end or end-to-side anastomosis, patch augmentation, subclavian-flap aortoplasty or extended resection with primary anastomosis and also VSD closure. Methylprednisolone 10mg/kg 12hrs and 6hrs pre surgery in neonates. Calcium infusion if there is Di-George Syndrome (see inotropes)ĮCG, CXR, CUS, FBE, xlotting, UECs, FISH, PRBC(4), FFP (2), platelets (2), cryoprecipitate (2).Careful fluid resuscitation – this is an obstructive lesion, not hypovolaemic!.Dopamine (5-10 mcg/kg/min), dobutamine (5-10 mcg/kg/min) or adrenaline (0.02-0.1 mcg/kg/min) may be required to stabilise for a low CO.Balanced circulation with PDA open and/or VSD present (aim SpO2 75-85%).Hypoventilation to higher the PVR and to lower the SVR. Intubate and sedate to lower the oxygen consumption. Commence Prostaglandin E1 (20ng/kg/min) to maintain systemic perfusion.Hypertension of upper limbs is usually not present before Day 5, but usually after PDA closure with signs of CCF of various degree.ĬXR: cardiomegaly and pulmonary congestion.Ĭardiac catheterisation (diagnostic and interventional) This in turn causes increased PBF and severe CCF with systemic hypotension. This leads to CCF (in extreme: myocardial ischemia) and shunt reversal along the PFO (and VSD if present). With PDA closure there is an acute increase in LV afterload, a decreased CO, increased LVEDP. Genetic association to Di-George-Syndrome. Most of them are associated with a VSD or other defects. Type C (2%): proximal to left carotid artery. Type B (78%): between left subclavian and left carotid artery. Type A (20%): IAA distal to left subclavian artery. Definition: obstructive anomaly of the aortic arch.
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