COARCTATION OF THE AORTA IN INFANTS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 88  (6) , 1012-1019
Abstract
Repair of coarctation of the aorta in the 1st yr of life, by resection and end-to-end anastomosis, was reported to have a high rate of recurrence, and recent studies favor angioplasty techniques. Forty-seven consecutive infants < 1 yr of age, who were operated upon over a 20 yr period, were analyzed. The hospital mortality was analyzed in 3 groups: Group I.sbd.2 of 11 patients (18%) with coarctation; Group II.sbd.1 of 9 patients (11%) with coarctation and ventricular septal defect; Group III.sbd.12 of 27 patients (44%) with coarctation and major intracardiac anomalies. There was no difference in age or body surface area between survivors and nonsurvivors. Repair was performed by a resection and end-to-end anastomosis to the distal aortic arch in 43 and by patch angioplasty in 4. Anastomosis was performed with 5-0 silk suture prior to 1972. Since then, 7-0 polypropylene suture was generally used. Arm/leg pressure gradient was assessed at rest by the Doppler technique in 31 long-term survivors of the end-to-end anastomosis technique; 24 of them had polypropylene suture, and 7 had silk suture. Recurrence of coarctation was defined as arm/leg gradient .gtoreq. 20 mm Hg. Actuarial freedom from recurrence at 5 and 10 yr was 91% in the polypropylene group vs. 57% and 44% in the silk group. Good long-term results with low incidence of recurrent coarctation, achieved by end-to-end anastomosis with fine polypropylene suture, justify continued use of this technique in preference to angioplasty techniques, which sacrifice the left subclavian artery or introduce prosthetic materials. Techniques chosen for coarctation repair should be compared wtih current operative techniques and not older studies.

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