Massachusetts Chapter of the American College of Surgeons

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Tissue Expander Stimulated Lengthening of Arteries for the Treatment of Midaortic Syndrome in Children
Gabriel J. Ramos-Gonzalez, MD1, Khashayar Vakili, MD1, Deborah R. Stein, MD2, Michael A. Ferguson, MD2, Diego Porras, MD3, James E. Lock, MD3, Gulraiz Chaudry, MD4, Ahmad Alomari, MD4, Steven J. Fishman, MD1, and Heung Bae Kim, MD1
1Department of Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States; 2Division of Nephrology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States; 3Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States; 4 Division of Interventional Radiology, Boston Children’s Hospital and Harvard Medical School

Background: Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta. Patients refractory to medical and interventional treatment are traditionally managed surgically with use of prosthetic graft material for bypass or patch angioplasty. We report our early experience with a novel approach using a tissue expander (TE) to lengthen the normal native arteries in children with MAS allowing for primary aortic repair without the need for prosthetic graft material.

Methods: We conducted a retrospective review of patients with MAS undergoing the Tissue Expander Stimulated Lengthening of Arteries (TESLA) procedure at our institution from 2010 to 2014. Data are presented as mean [range].

Results: Five patients aged 4.8 years [3-8] underwent the TESLA procedure. Stages of this procedure include: I) insertion of retroaortic tissue expander, II) serial TE injections, and III) final repair with excision of aortic stenosis and primary end-to-end aortic anastomosis. Stage II was completed in 4 months [1-9] with 12 [7-20] tissue expander injections. Goal lengthening was achieved in all patients. Stage III could not be completed in one patient due to extreme aortic inflammation, which precluded safe excision of the aortic stenosis and required use of a prosthetic bypass graft. The other four patients completed Stage III with 2 [1-3] additional vessels also requiring reconstruction (renal or mesenteric arteries). At 3.2 years [1-6] of follow up all patients are doing well.

Conclusion: The TESLA procedure allows for surgical correction of MAS without the need for prosthetic grafts in young children who are still growing.


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