LONG-TERM FOLLOW-UP OF PATIENTS WITH REPAIR OF AORTIC 113 COARCTATION IN INFANCY

Abstract

Twenty nine patients who survived surgical repair of thoracic coarctation of the aorta in infancy have been followed 10 - 22 (mean 14.8)years. Preoperatively, all patients had congestive heart failure refractory to medical management; 27/29 were under 6 months of age. Of the 29, 8 had associated left-to-right shunts at ventricular (7) or atrial (1) level. Initial procedure was resection and end-to-end anastomosis with continuous suture. Subacute bacterial endocarditis occurred in 1 patient in this series who had associated aortic valve stenosis. Symptoms of subclavian steal syndrome occurred 9 years postoperatively in 1 patient. No residual hypertension was present in any patient unless associated with recurrence of coarctation. There were no deaths. Follow-up catheterization on 25 patients has been performed with specific attention to recoarctation. Reoperation was required in 10/29 at a mean age of 13 years with reoperation anticipated in at least 4 more patients. At the time of repeat surgery, patch angioplasty was performed in 5/10, resection and end-to-end anastomosis in 2/10, and Dacron tube grafts were used in 3/10. In this series, significant restenosis after coarctation repair in infancy has occurred in 48% of patients (14/29), an additional 5/29 have gradients across the coarctation site of greater than 25 mm Hg. Only 3/29 have neither residual gradient nor recoarctation angiographically proven by postoperative catheterization.