COARCTATION IN THE 1ST YEAR OF LIFE - PATTERNS OF POSTOPERATIVE EFFECT

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  • 1 January 1983
    • journal article
    • research article
    • Vol. 86  (1) , 9-17
Abstract
From 1975-1982, 31 infants were operated upon in the 1st yr of life for aortic coarctation and congestive heart failure. Operations performed were resection and end-to-end anastomosis (RETE) in 14, subclavian flap aortoplasty (SFA) in 6, patch aortoplasty (PA) in 5 and other procedures in 6. Of the 31, 30 (97%) survived the operation. To assess the effect of operation, 26 infants were studied noninvasively with Doppler arm-to-leg pressure measurements at rest and with stress. Preoperatively, the medium arm-to-leg gradient at rest was 77 mm Hg. Serial postoperative Doppler studies demonstrated progressive changes in arm-to-leg pressure gradients: 69% had residual arm-to-leg gradients that spontaneously resolved, 13% had residual gradients that persisted, 13% had progressive increase in gradient and 1 child had neither early nor later gradient. Stress testing often unmasked gradients not present in the resting state. No differences were noted among the 3 surgical groups: RETE, SFA and PA. Surgical survival is expected. The effect of the operation is dynamic, with 4 patterns defined as follows: complete relief of coarctation, transient residual coarctation, persistent residual coarctation, and recurrent coarctation. Optimal surgical therapy seems to be an eclectic approach. Physiological evaluation of coarctation in infants can be obtained by Doppler techniques in conjunction with stress testing.