Surgical Correction of Coarctation of the Aorta in the First Year of Life

Abstract

oarctation of the thoracic aorta produces obstruction to left ventricular outflow with myocardial strain that may be intolC erable to the newborn infant, especially when combined with other anomalies such as ventricular septa1 defect and patent ductus arteriosus. The resultant cardiac failure may respond to medical therapy. If so, an elective operation can be performed when the child is several years older and a better operative risk. When response to medical treatment is inadequate or if heart failure recurs after initial improvement, operation must be performed to prevent a fatal outcome. This report describes our experience with 58 infants who required operation for coarctation of the thoracic aorta during the first year of life. CLINICAL MATERIAL During the 11-year period from 1954 through 1964, 58 infants less than one year of age were operated upon at the Texas Children’s Hospital for coarctation of the thoracic aorta. The series included 39 males and 19 females. Mox were in the first 3 months of life (Figs. 1A and 1B). The majority of infants (93%) developed symptoms during the first month of life (Fig. 2). The mean age at onset of symptoms was 21 days. Forty (70%) of these infants were brought to the physician because of congestive heart failure, the most common initial symptom complex. Other initial symptoms were cyanosis or dusky color after straining, crying, or feeding; growth failure; feeding problems; irritability and sweating; and incidental murmur. Principal physical findings were strong brachial pulses with imperceptible or nonpalpable femoral pulses. All infants had a significant difference in blood pressure between the upper and lower extremities. The mean arterial pressure was 150170 mm. Hg in the upper extremities and 89/68 mm. Hg in the lower extremities. The mean arterial pressure by flush method was 120 mm. Hg in the arm and 58 mm. Hg in the leg.