The anatomical variations and surgical treatment of congenital coarctation of aorta in children

Abstract

Objective To investigate the anatomical variations and surgical treatment of congenital coarctation of aorta in children. Methods From May 2012 to Jun 2014, 30 patients (male 22, female 8) between the ages of 12 days to 6 years with congenital coarctation of aorta who received surgical treatment in department of Cardiothoracic Surgery of Nanjing Children′s Hospital were reviewed. According to the international classification criteria for Pediatric Cardiac Surgery Nomenclature, anatomical variations included simple type coarctation (12 patients), coarctation with ventricular septal defect (VSD, 8 patients), coarctation with complex congenital heart disease (5 patients), coarctation with hypoplasia of aortic arch (5 patients). Among the total 30 patients, 20 patients were performed under cardiopulmonary bypass and 8 with the assistance of selective cerebral perfusion, 10 patients were performed without cardiopulmonary bypass, included 2 patients which were carried out through median sternotomy (1 with hybrid occlusion of muscular VSD) and the other 8 patients which were done through left thoracic incision. Results All the patients received the surgical correction of coarctation of aorta and associated cardiac anomalies successfully, surgical duration from 95 to 675 min, mean 165.68 min, 2 patients were dead in this group. One patient was reoperated (surgical sling) because of his high peak airway pressure and being difficult to wean from mechanical ventilation, and he was successfully weaned from respirator and discharged from hospital after reoperation. All the other patients recovered uneventfully and discharged from hospital after recovery. Follow up (0.5-2 years) information of 28 survived patients showed 1 patient with restenosis was found, whose pressure difference between upper/lower limbs was 50 mmHg(1 mmHg=0.133 kPa) and he was still under close follow up, the other patients had normal growth and development, whose pressure difference between upper/lower limbs was less than 10 mmHg. Conclusions Excellent clinical results can be achieved in the children with congenital coarctation of aorta, who underwent different surgical treatments and suitable cardiopulmonary techniques according to the anatomical variations. Key words: Heart diseases; Aortic coarctaion; Congenital; Anatomical variations; Surgery