Coarctation of the aorta: Review of 234 patients and clarification of management problems

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Two hundred thirty-four patients with coarctation of the aorta who were managed between 1948 and 1978 were reviewed. Their ages ranged from 1 day to 72 years. Only 6 percent of the patients who had surgical correction between ages 1 and 5 years had residual hypertension. In contrast, 21 percent of those operated on before age 1 year (all with residual or recurrent coarctation), 30 percent of those operated on between ages 6 and 18 years, 47 percent of those operated on between ages 19 and 40 years and 50 percent of patients over 40 age years at the time of operation had residual postoperative hypertension. These data suggest that the optimal time for elective surgical correction of coarctation is between the ages of 1 and 5 years. Preoperative congestive heart failure was present in 67 percent of patients under age 1 year, in 67 percent of those over age 40 years and in only 4 percent of those aged 1 to 40 years. Eight of the 29 infants with preoperative heart failure had residual postoperative failure related in most to associated congenital cardiac anomalies. Six of the 16 patients with preoperative heart failure who were over age 40 years at correction had residual failure, although even in these patients heart failure was improved. Bacterial endocarditis, cerebral vascular accident, myocardial infarction and aortic dissection were present in 2, 6, 3 and 2 percent of patients, respectively; these complications occurred more frequently with advancing age and occurred in 13 patients who had had prior coarctation repair. Additional congenital heart lesions were present in 34 percent of the patients. Of those under age 1 year, 67 percent had a clinically significant patent ductus arteriosus with or without ventricular septal defect or aortic stenosis. After age 1 year, 27 percent of the patients had associated cardiac lesions, and no patient had a clinically significant patent ductus or ventricular septal defect. Aortic stenosis or insufficiency was present in 33 patients. When identified during infancy, aortic stenosis was often clinically significant. Thereafter, only eight patients had clinically significant aortic valve disease at the time of this review, and only two of these patients were younger than age 40 years.