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Anatomically corrected malposition of the great arteries (ACMGA) is a rare form of congenital heart disease. This abnormality belongs to conotruncal anomalies. ACMGA is an anomaly in which aorta arises from the left ventricle and pulmonary artery arises from the right ventricle but great arteries are located in parallel relationships. Therefore, diagnosis of this disease is complicated due to frequent diagnostic errors. The aim. To share our experience of late diagnosis of ACMGA in a patientwho was previously mistakenly diagnosed with congenitally corrected transposition of great arteries (CC-TGA). Case report. We present a case of late diagnosis of ACMGA. An 11-day-old newborn was admitted to the Ukrainian Children’s Cardiac Center in 2007. After clinical examination, which included ultrasound examination, the diagnosis of CC-TGA, pulmonary stenosis, ventricular septal defect and atrial septal defect was conϐirmed. The patient was in a stable condition and there were no signs of heart failure. That is whythe patient was discharged. In 2017, cardiac catheterization was performed, and there were doubts about the diagnosis because of untypical anatomical features. In 2022, we performed computed tomography and magnetic resonance imaging. The diagnosis of ACMGA was made. Conclusions. ACMGA is an unusual form of congenital heart disease. The diagnosis of ACMGA is challenging, because its anatomical features are similar to those of CC-TGA. The difference of both these diagnoses is normal anatomy and hemodynamics but abnormal relationship in ACMGA, in contrast to abnormal anatomy in CC-TGA.

Aortic arch surgery in neonatal patients remains problematic despite the constant evolution and improvement of treatment methods. Even after successful correction, complications associated with aortic arch reconstruction are more common in young children. This is especially true for newborns and infants with concomitant complex congenital intracardiac abnormalities. Despite the risk of postoperative complications, the risk of surgical treatment of aortic arch hypoplasia is lower than the cumulative hazards associated with the natural course of this defect. That is why pediatric cardiologists are obliged to constantly monitor the operated patients in order to timely identify and treat complications. The aim. To analyze the complications in the early and remote postoperative periods after the reconstruction of the aortic arch in the neonatal period. Materials and methods. The work is based on a study of 445 patients under 1 year of age, who underwent surgical treatment of aortic arch hypoplasia from 2010 to 2019. The criterion for inclusion in the study group was the presence of isolated hypoplasia of the aortic arch and combination with other defects, which were corrected by two-ventricular repair. The majority of the treated patients were male (284 [63.8% of the total number of patients]). The median age of the patients was 0.7 months (0.3; 2.7). The median body weight of the patients was 3.7 kg (3.25; 4.59). Results. At the hospital stage, 12 patients died, which accounted for 3.1% of the entire cohort of operated patients. Complications occurring at the hospital stage were recorded in 75 (16.8%) patients. In the long term, a complicated course was observed in 72 (16.6%) children. Among them, the most frequent complications were: respiratory failure requiring prolonged mechanical ventilation (36.9%), dilated sternum due to severe heart failure (17.4%), diaphragmatic paresis (8.7%), chylothorax (5.4%). In the long term, 47 (10.5%) patients developed aortic arch restenosis, which required reinterventions. The proportion of patients without reoperations in the follow-up period according to the KaplanMeier analysis was 93.4% after 1 year, 91.2% after 4 years, and 76.5% after 9 years. Residual hypertension requiring medical treatment was reported in 59 (13.2%) patients. Conclusions. Aortic arch hypoplasia is a complex congenital heart disease; its surgical treatment is accompanied by the development of complications both in the early and in the long-term period. The main complications at the hospital stage were respiratory and heart failures which were associated with the presence and correction of concomitant congenital heart defects. The main complication of the follow-up period was reobstruction at the level of the aortic arch. Anatomical correction of reobstruction is safe with both endovascular and surgical treatments.

The problem of the effectiveness of obstruction at the level of the aortic arch is still a matter of discus-sion in the modern literature. Traditionally, by excision of the coarctation part, in the presence of hypoplasia, the incision is extended to a narrowed area and a modification of the classical end-to-end anastomosis is applied in the form of an elongated or expanded variant. Recently, when proximal part is involved in the pathological process, cardiac surgeons have been more likely to use median sternotomy using other types of plastic surgery, including dilation of the narrowed area with a pericardial patch, or pulmonary artery tissue. Accordingly, the analysis of the results of the use of end-to-end anastomosis in young children with aortic arch hypoplasia, especially in view of long-term survival and the level of reoperation, is an important issue of neonatal cardiac surgery. The aim. To evaluate the effectiveness of the use of an extended end-to-end anastomosis after reconstruction of the aortic arch in children under 1 year of age. Materials and methods. The study material included 348 infants who underwent surgical correction of aortic arch hypoplasia through the method of extended end-to-end anastomosis from 2010 to 2020. The operations were performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and the Ukrainian Children’s Cardiac Center. The study group included only patients with two-ventricular physiology. There were 233 male patients (67%) and 115 female patients (33%). The mean age was 1.07 (0.20; 2.30) months, the mean weight was 3.89 (3.30; 4.90) kg, the mean body surface area was 0.23 (0.20; 0.28) m2. Diagnosis of aortic arch hypoplasia was based on two-dimensional echocardiography. Results. According to echocardiography, after surgery there was a significant decrease in the pressure gradient in the aortic arch from 48.3 ± 20.3 to 16 ± 6.9 (p 0.05). The hospital mortality was 1.7% (n = 6). The causes of mortality were not related to the end-to-end aortic arch technique. The duration of follow-up period ranged from 1 month to 9.3 years. Two deaths occurred in the follow-up period. Thirty-two (9.1%) patients developed aortic arch restenosis in the postoperative period. Balloon dilatation of restenosis was performed in 21 patients. Eleven patients underwent repeated aortic arch repair surgery through the median sternotomy. There were no central nervous system complications in the follow-up period. Conclusions. The use of an extended end-to-end anastomosis in the surgical treatment of aortic arch hypoplasia demon strates low hospital mortality and high long-term survival. Indications for the effective use of this type of reconstruction are hypoplasia of the isthmus and distal aortic arch.