Letter:
To the Editor,
With great interest, I have read the article ”Management of aortic arch
hypoplasia in neonates and infants” by Mehmet A. Onalan et al.1 It was a
privilege for me to read such a well-written paper, and I applaud the
authors’ exceptional efforts. I concur with the article’s conclusion
that one-stage repair with appropriate outcomes can treat aortic arch
reformation in infants and neonates with tubular arch hypoplasia and
that in neonates with co-morbidities, a palliative two-stage approach
should be explored. However, it seemed that a few additional points
would have enhanced the end of the piece.
In the first place, the study’s retrospective nature raises several
problems due to the possibility of recollection bias and incorrect
patient reporting, which may have been mitigated if the investigators
had included current cases at the time. Secondly, doing a
single-centered study may result in bias due to differences in health,
socioeconomic, and environmental variables and the constrained
statistical analysis. Thirdly, the authors should have explained the
surgical technique more thoroughly. Research conducted between 1990 and
1993 showed that 13 infants with severe aortic arch hypoplasia underwent
excision and carotid flap plasty.2 For neonates with substantial aortic
arch hypoplasia, resection combined with carotid flap plasty is regarded
as an effective initial step in a phased repair. In addition, the
patients’ ethnicity should have been indicated by the authors throughout
the research, as this would have revealed more about a diverse
community. As per a study, some patients with aortic arch hypoplasia
suffer from persistent arch blockage, while others acquire hypertension
as a long-term consequence after coarctation surgery.3
A neonate with a hypoplastic aortic arch might provide the surgeon with
several complications. As the complexity of the arch’s architecture and
any related pathologies develops, so make these difficulties.3 In
addition to the technical difficulties inherent in surgical repair, the
decision-making process can be challenging. Imaging that is precise and
exhaustive is a crucial beginning step. Currently, insufficient evidence
raises uncertainty on the optimal surgical plan and method. This is
significant because decisions taken during the neonatal era can affect
not only the immediate management but also the patient’s long-term
outcome. Consequently, it is advised to approach these decisions with
much deliberation, thoroughness, and deliberation.4 Therefore, aortic
arch repair for tubular arch hypoplasia in newborns and children without
accompanying intracardiac lesions can be accomplished with great short-
and long-term outcomes. At intermediate follow-up following patch
aortoplasty, there are few problems associated with the repair site.
Alternative perfusion and surgical methods are required to enhance
outcomes in newborns with intracardiac abnormalities undergoing arch
rebuilding.5