Isthmusplasty in the Correction of Adult Coarctation of the Aorta

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Abstract
Thirty-seven unselected patients with coarctation of the aorta (CoA), aged 16–51 years, were operated on using either direct or indirect isthmusplasty. The earlier part of the series (20 patients) was followed up 1–4 years postoperatively, the later part for 3–4 months after operation. One patient died of haemorrhage during the immediate postoperative period. No late deaths have occurred. In addition to routine clinical tests, exercise blood pressure and physical working capacity measurements were made on the patients who could be subjected to maximal physical effort. The leg blood pressure at rest was the same or higher than in the arms in every case postoperatively. The exercise blood pressure responded normally in the majority of patients. Left ventricular hypertrophy by conventional electrocardiographic criteria decreased in most patients. The same was true for the radiologically determined heart volume. The authors consider the operative technique to be safe, effective and applicable to most cases of CoA. A notable exception is a large aneurysm complicating CoA.