AORTIC COARCTATION IN THE 1ST 3 MONTHS OF LIFE - AN ANATOMOPATHOLOGICAL STUDY WITH RESPECT TO TREATMENT

  • 1 January 1985
    • journal article
    • research article
    • Vol. 89  (1) , 121-127
Abstract
Operation for coarctation in infancy is a lifesaving procedure, but it still carries a high mortality,and it is followed frequently by recurrence of stenosis. This is especially true when the procedure is performed in the first 3 mo. of life. To determine a correlation, if any, between anatomy of coarctation and surgical procedures, a series of 42 autopsy specimens from patients < 3 mo. who had aortic coarctation was studied. Concepts of coarctation based solely on a discrete lesion or isthmic hypoplasia were simplistic. The anatomy was much more complex, the findings being relevant to surgical techniques currently in use (resection, end-to-end anastomosis and subclavian flap aortoplasty). Of equal significance, in the cases studied, to the presence of a shelf of ductal tissue within the aortic lumen or hypoplasia of a segment of the arch, was the finding of "waist" lesions. In these cases, the wall of the aorta was constricted to form the obstruction. Such "waists" coexisted with discrete shelves or with shelves and isthmic narrowing. While the danger of extrapolating from autopsy findings to predict clinical results is recognized, surgical procedures might best be tailored to the precise anatomy present. In many cases, a subclavian flap procedure seemed to offer the best chance of success. Cases with anatomy suitable for resection and end-to-end anastomosis were less frequent. Percutaneous angioplasty seemed to offer only palliative options in limited cases.