Abstract
The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes. From January 1987 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients. Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis. Surgical treatment of aortic coarctation, even in adult patients, is an efficient therapeutic choice, regardless of the applied surgical technique, with low morbidity and mortality. It reduces efficiently the arterial pressure levels in both immediate and mid-term follow-up.
Highlights
The most common immediate postoperative event was high blood pressure (98%), but it was controlled by intravenous drugs
The presence of aortic coarctation not submitted to surgical correction in adult patients leads to the frequent occurrence of high blood pressure (HBP) in the upper limbs, as well as presenting greater risk of several clinical symptoms
According to general consensus, the aortic coarctation must be corrected in the neonatal period or childhood, in order to avoid the sequels of late treatment, especially those related to hypertension with long-term evolution [4,5,6]
Summary
The presence of aortic coarctation not submitted to surgical correction in adult patients leads to the frequent occurrence of high blood pressure (HBP) in the upper limbs, as well as presenting greater risk of several clinical symptoms. Problems such as acute myocardial infarction, intracranial hemorrhage, aortic rupture and cardiac insufficiency may manifest at various moments, in association with HBP, which could lead to increase mortality, due to the possibility of the occurrence of any of the problems previously mentioned. The aortic coarctation presents asymptomatic evolution, performing the diagnosis from the investigation initiated after detecting HBP. According to general consensus, the aortic coarctation must be corrected in the neonatal period or childhood, in order to avoid the sequels of late treatment, especially those related to hypertension with long-term evolution [4,5,6]
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