Surgical Treatment Of Aortic Coarctation Research Articles

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis.

Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients' data in both groups. All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (p = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (p < 0.001). In the long-term, period mortality was not statistically significantly different (p = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, p = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316-14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014-1.153)). Hospital mortality was higher among LBW patients (p = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge.

Outcome of surgical repair for aortic coarctation with coexisting descending aortic aneurysm in adult patients

Objective: To evaluate the efficacy of surgical treatment of aortic coarctation combined with descending aortic aneurysm in adult patients. Methods: This is a retrospective cohort study. Adult patients with aortic coarctation who were hospitalized in Beijing Anzhen Hospital from January 2015 to April 2019 were enrolled. The aortic coarctation was diagnosed by aortic CT angiography, and the included patients were divided into the combined descending aortic aneurysm group and the uncomplicated descending aortic aneurysm group based on descending aortic diameter. General clinical data and surgery-related data were collected from the included patients, and death and complications were recorded at 30 days after surgery, and upper limb systolic blood pressure was measured in all patients at discharge. Patients were followed up after discharge by outpatient visit or telephone call for their survival and the occurrence of repeat interventions and adverse events, which included death, cerebrovascular events, transient ischemic attack, myocardial infarction, hypertension, postoperative restenosis, and other cardiovascular-related interventions. Results: A total of 107 patients with aortic coarctation aged (34.1±15.2) years were included, and 68 (63.6%) were males. There were 16 cases in the combined descending aortic aneurysm group and 91 cases in the uncomplicated descending aortic aneurysm group. In the combined descending aortic aneurysm group, 6 cases (6/16) underwent artificial vessel bypass, 4 cases (4/16) underwent thoracic aortic artificial vessel replacement, 4 cases (4/16) underwent aortic arch replacement+elephant trunk procedure, and 2 cases (2/16) underwent thoracic endovascular aneurysm repair. There was no statistically significant difference between the two groups in the choice of surgical approach (all P>0.05). In the combined descending aortic aneurysm group at 30 days after surgery, one case underwent re-thoracotomy surgery, one case developed incomplete paraplegia of the lower extremity, and one case died; and the differences in the incidence of endpoint events at 30 days after surgery were similar between the two groups (P>0.05). Systolic blood pressure in the upper extremity at discharge was significantly lower in both groups compared with the preoperative period (in the combined descending aortic aneurysm group: (127.3±16.3) mmHg vs. (140.9±16.3) mmHg, P=0.030, 1 mmHg=0.133 kPa; in the uncomplicated descending aortic aneurysm group: (120.7±13.2) mmHg vs. (151.8±26.3) mmHg, P=0.001). The follow-up time was 3.5 (3.1, 4.4) years. There were no new deaths in the combined descending aortic aneurysm group, no transient ischemic attack, myocardial infarction or re-thoracotomy surgery, and one patient (1/15) suffered cerebral infarction and 10 patients (10/15) were diagnosed with hypertension. The differences in the occurrence of endpoint events during postoperative follow-up were similar between the two groups (P>0.05). Conclusion: In experienced centers, long-term prognosis of patients with aortic coarctation combined with descending aortic aneurysm is satisfactory post surgical intervention.

Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies

ObjectiveOne-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent (hybrid).MethodsBetween January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results.ResultsAll the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5 ± 14.0 years which was older than hybrid group (27.9 ± 8.5 years, P = 0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4 to 119.7 mmHg and 148.4 to 111.6 mmHg, the median peak systolic gradient decreased from 68.0 to 10 mmHg and 46.5 to 10 mmHg respectively (P = 0.09). And the mean upper-lower limbs gradient decreased from 21.7 to 5.9 mmHg and 21.0 to 2.7 mmHg respectively (P = 0.104). The mean follow-up time was 76.92 ± 18.7 in bypass group and 85.4 ± 20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups.ConclusionsThe bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.

Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

Two Staged Surgical Treatment of Aortic Coarctation Accompanied by Aortic Stenosis in a 63-Year-Old Patient

Aortic coarctation is a congenital vascular lesion, usually diagnosed and corrected in childhood or early adulthood. Most of the untreated patients with aortic coarctation die before the age of 50 years. Coarctation with cardiac lesions is a complex clinical situation that necessitates surgical treatment of different pathologies with different strategies.&#x0D; In this, study we report two-staged surgical treatment of aortic coarctation with severe aortic stenosis consist of aortic valve replacement and aorto-subclavian bypass in a 63-year-old male patient.

Critical coarctation of the aorta: diagnostic capabilities and methods of surgical treatment of aortic coarctation in newborns

Critical coarctation of the aorta in newborns usually presents with severe narrowing of the cavotricuspid isthmus and space adjacent to the arterial duct, limiting blood flow to the thoracic aorta. Patient survival depends on duct patency. Rapid deterioration and development of multiple organ failure usually result from spontaneous closure of the patent arterial duct. This deterioration is due in part to reduced renal perfusion and results in fluid and acid retention, causing heart failure and metabolic acidosis. This may be alleviated by the administration of intravenous prostaglandin E1, with a temporary improvement in distal aortic blood flow and the overall condition of the patient. Primary repair is associated with a high risk of unfavourable outcomes due to severe systemic outflow obstruction and multiple organ failure. Therefore, as a bridge to subsequent radical surgery, palliative stenting is the preferred method in newborns with critical aortic coarctation in the decompensated state.Received 16 January 2020. Revised 29 March 2020. Accepted 30 March 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and design: S.M. Ivantsov, A.V. Voitov, Yu.Yu. KulyabinDrafting the article: K.A. RzaevaCritical revision of the article: I.A. Soynov, A.V. Gorbatykh, Yu.N. Gorbatykh, A.V. Bogachev-ProkophievFinal approval of the version to be published: K.A. Rzaeva, I.A. Soynov, A.V. Gorbatykh, Yu.Yu. Kulyabin, A.V. Voitov, S.M. Ivantsov, Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in infants and children. A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. Three hundred forty-one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10-143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end-to-end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty-day mortality was 1.4%. At a median follow-up of 10.2 years (IQR, 6-15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. Surgical repair of CoAo by EEEA without CPBP is a safe and low-risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long-term, and only a few require antihypertensive therapy.

Extra-anatomical bypass grafting of the thoracic aorta in a female patient with an infected pseudoaneurysm

Presented herein is the remote (more than 15-year follow up) result of successful surgical treatment of aortic coarctation complicated by septic aortitis and a false aneurysm of the anastomosis between the graft and the aortic arch. In 2002, after correction of aortic coarctation the woman was admitted to our Clinic with an incompetent proximal anastomosis and an infected aortic pseudoaneurysm. Taking into consideration the general and local septic process, repeat reconstruction of the thoracic aorta was impossible due to the risk for generalization of the infectious process and fatal complications. Therefore, the woman was subjected to extra-anatomical bypass grafting of the thoracic aorta with a synthetic graft from the ascending aorta to the infrarenal portion of the abdominal aorta in order to isolate the infection focus to be followed by removal thereof. The postoperative period turned out uneventful, with no complications. After 15 years, the woman was examined again, with her condition being stable. The findings of contrast-enhanced magnetic resonance imaging demonstrated complete patency of the extra-anatomical bypass graft. The carotid-subclavian anastomosis functioned well, without narrowed portions. No infectious complications after the carried out operations were observed. Using extra-anatomical bypass grafting with exclusion from circulation and removal of the infected portion of the aorta along with the graft is one of reliable variants of treatment for such a severe complication as an infected false aneurysm.

Качество жизни детей после оперативного лечения коарктации аорты

The questionnaire study outcomes of children after surgical correction of aortic coarctation are presented in the article. Factors influencing the patients' quality of life after surgical treatment of congenital heart disease are identified. Objective: to evaluate the quality of life in children after surgical treatment of aortic coarctation. Materials and methods. In total 36 children aged from 6 to 15 years after surgical treatment of aortic coarctation were interviewed. The English version of the Pediatric Quality of Life Inventory™ 3.0 Cardiac Module (PedsQL Cardiac Module) was used to assess the quality of life. Results. In 68.88% of cases children considered their life to be full, 27.77% (10 patients) incomplete, 8.33% (3 patients) found it difficult to answer. All patients noted the physical activity limitation by doctors and parents; 52.77% of respondents emphasized the communication problems and psychological difficulties; in 41.66% of cases, the children reported overprotection by their parents; in 33.33% of cases, there was an arterial hypertension; 27.77% of respondents reported about deterioration of the general sense of well-being, 25.00% of patients had learning difficulties due to congenital heart disease. Conclusions. Despite the satisfactory surgical treatment outcomes, the patients noted a decrease in their quality of life due to various factors. The most significant were as follows: disturbance in well-being, physical activity limitation, constant control by parents, the need for medical treatment and regular visits to doctors.

Quality of life after surgical treatment of coarctation in long-term follow-up (CoAFU): Predictive value of clinical variables.

We sought to analyze the quality of life and the predictive value of clinical variables from previous follow-up study in patients late after surgical treatment of aortic coarctation on the quality of life. All patients, who have participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for the health-related quality of life questionnaire SF-36 from January 2013 through December 2014. From 273 eligible patients, we received data from 135 patients, 9 of them died during the follow-up time at the median age of 46years (range 30-64years). Seventy-four patients did not participate in the study, other 64 patients moved to remote or unknown areas and could not be contacted. Quality of life was good in the fields of physical role and pain. However, patients reported a significant impairment in general health and in health transition, depending on the age. Arterial hypertension and variables from echocardiography or exercise testing from the COALA study were not predictive on functional health status. Quality of life in patients late after aortic coarctation repair is fairly good compared with healthy controls. Impairments in general health and health transition depend mainly on age, can be explained due to numerous comorbidities and reinterventions in long-term. The predictive value of the commonly assessed clinical variables on quality of life is limited.

Cellular/intercellular interrelations in various parts of aorta after reconstructive treatment of aortic stenosis in infants

Aim. The article focuses on the evaluation of cellular/intercellular relationships in various parts of the aorta after reconstructive treatment of aortic stenosis in infants.Methods. Medical histories and protocols of autopsies of three newborns were studied after surgical treatment of aortic coarctation. The operations were performed in children at 8th, 10th and 15th day after birth. In two cases, resection of the aortic lumen narrowing, botulinum duct ligation and formation of a direct aortic anastomosis were performed. In one observation, a closed balloon dilatation of the aorta in the area of constriction was used. When performing autopsy, the size of the heart, the perimeter of the aorta at the surgical sites and various parts of the aorta were examined. The fragments of the wall of the aortic sections were cut out and fixed in 10% neutral formalin. Histologic sections were prepared in a conventional way followed by staining them with hematoxylin-eosin or picrofuxin by Van Gieson, while elastic fibers were stained with rezorcin-fuchsin by Hotchkiss and Periodic acid–Schiff (PAS) in order to detect mucopolysaccharides.Results. Cellular/intercellular relationships in various parts of the aorta following aortic coarctation in infants have some morphological features. Morphometric examination of the heart and aorta showed a significant increase in the volume and mass of the heart compared with the normal values due to myocardial hypertrophy of the right and left ventricles of the heart. An uneven narrowing of the aortic lumens was most pronounced in the arch and isthmus as compared to the ascending and thoracic parts of aorta. Morphological examination of the aortic wall in the constriction zones demonstrated the presence of coagulation necrosis, lysis of elastic, collagen fibers with surrounding hyperplasia of smooth myocytes, newly formed thin-walled capillary vessels. Outside the coarctation zone, the most significant changes characterized by the development of hypoelastosis, non-uniform accumulation of acid mucopolysaccharides were observed in the walls of the arch and the ascending aorta. Conclusion. In infants with coarctation of the aorta, dilatation of the ascending aorta with compensatory hypertrophy of the heart is observed, and a muscle-fibrous tissue, rich in smooth myocytes and newly formed thin-walled vessels, tends to develop in stenotic zones. The risk of restenosis development is believed to depend on the prevalence and severity of proliferative processes of the cellular elements of the aorta, which allows us to consider early surgical interventions to prevent irreversible destructive changes as justifiable.Received 2 February 2017. Accepted 27 May 2017.Funding: The study required no additional funding and sponsorship.Conflict of interest: The author declares no conflict of interest.AcknowledgementsThe author expresses his gratitude towards Professor S.V. Shlyk, Dr. Sci. (Medicine), Rector of Rostov State Medical University, Professor N.I. Volkova, Dr. Sci. (Medicine), Pro-Rector for Research of Rostov State Medical University and the researchers of the Molecular/Biological &amp; Optical Research Methods Department.

STAGED SURGICAL TREATMENT OF SUBJECT WITH AORTIC COARCTATION IN COMBINATION WITH ABERRANT RIGHT SUBCLAVIAN ARTERY

We present the results of a staged surgical treatment of a subject with a rare congenital disorder – aortic coarctation in combination with an aberrant right subclavian artery. The choice of an implantation of the aberrant right subclavian artery into the right common carotid artery as the first stage of surgical reconstruction contributed to the prevention of the spinal complications connected with multiple clamping of two subclavian arteries in one-staged surgical treatment of aortic coarctation . It is concluded that the chosen method of the surgical correction is not standard and is characterized by a high level of technical complexity and allows to radically correct the complex congenital heart disease.

Adolescent coarctation of aorta treated with subclavian-descending aorta bypass grafting.

Aortic coarctation in older children most frequently represents cases of re-coarctation following previous transcatheter or surgical therapy or missed cases of native coarctation. We describe three cases of adolescents – two girls and one boy – with aortic coarctation, operated between January, 2012 and December, 2013. Computed tomography angiography was performed as an essential diagnostic procedure. Hypertension was detected, and weaker arterial pulses in the lower limbs were noted in all cases. All operations were performed via left posterolateral thoracotomy. Aortic coarctation was treated surgically, with left subclavian-lower descending thoracic aorta bypass grafting. Postoperative course was uneventful in all cases. No residual brachial-ankle pressure gradient was observed, and all patients have remained in good condition after the operation. Surgical treatment of aortic coarctation in adolescent patients can be achieved by resection with end-to-end anastomosis, interposition of a graft or bypass graft across the area of coarctation when the distance to be bridged is too long for end-to-end repair. The extra-anatomic subclavian-descending aortic bypass grafting provides good results in adolescent patients, particularly in those with complex coarctation.

Late complications and treatment options of aortic coarctation operated in childhood

The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.

Does posterolateral thoracotomy with cardiopulmonary bypass play a role in the surgical management of aortic coarctation?

Objectives: The aim of this study was to evaluate the surgical treatment of aortic coarctation (CoA) using cardiopulmonary bypass (CPB) and posterolateral thoracotomy.

Hybrid treatment for correction of pseudoaneurysm after surgical treatment of aortic coarctation

The need for a new surgical procedure for correction of postoperative pseudoaneurysm of aortic coarctation makes the procedure especially challenging for the surgeon.ta abstract.

Endovascular Treatment of Long-Term Complications Following Surgical Repair of Aortic Coarctation

Surgical treatment of aortic coarctation has a high success rate. However, irrespective of the surgical technique used, a significant percentage of patients develop late complications affecting the aortic wall. Reoperation to repair these complications is a complex procedure and is associated with high mortality. Recently an endovascular approach has been proposed as a promising alternative for managing these patients. Here we report a series of four patients, three of whom had an aortic aneurysm, while one had recoarctation several years after undergoing aortic coarctation surgery. All successfully underwent endovascular treatment, without complications. We describe our experience with this complex procedure and discuss a number of associated technical considerations, including vascular access, occlusion of the supraaortic arteries, and the use of intravascular ultrasound.

Technique of interventional repair in adult aortic coarctation

Surgical treatment of aortic coarctation has increased life expectancy and reduced mortality. Unfortunately, the average lifespan after repair remains only 35 to 50 years, and significant morbidity persists as a result of aneurysm formation, hypertension, accelerated coronary disease, and stroke. Follow-up studies have revealed restenosis rates of 30% and persistent hypertension at rest and during exercise, sometimes with compromised cardiac function. The less invasive nature of nonsurgical repair using transcatheter therapies has led to balloon angioplasty and, recently, stent implantation as an emerging concept for the treatment of aortic coarctation. This review focuses on advances in the management, current indication, and techniques of interventional repair in aortic coarctation.

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

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.

Surgical treatment of aortic coarctation with intracardiac anomaly in infants and toddlers

To review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers. From January 2000 to December 2006, 84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment. Mean age of the patients was 13.5 months, with a range from 1 month to 3 years. Mean body weight was 7.3 kg, with a range from 3.3 to 15 kg. Twelve patients complicated with complex intracardiac anomaly. Seventy-two patients complicated with ventricular septal defect and other simple anomaly. Twenty-one patients had hypoplasia of the aortic arch. Sixty-two patients had one-stage repair. Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients. Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients. Twenty-two patients had staged repair. Operational techniques for aortic coarctation include 42 patients of patch aortoplasty, 30 patients of resection and end-to-end anastomosis, 6 patients of subclavian flap aortoplasty, 3 patients of vascular bypass, and 1 patient of balloon dilation. In all 49 patients of one-stage operation through median sternotomy, selective cerebral perfusion was used in 43 patients, deep hypothermia low flow was applied in 4 patients, deep hypothermia circulatory arrest was performed in 2 patients. There were 8 hospital deaths. The mortality is 9.5%. Among 8 deaths, 3 patients were misdiagnosed. Surgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers. One-stage repair through median sternotomy can be applied to most of the patients. Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.