Reoperation for aortic coarctation.
Reoperation for aortic coarctation has become common because of several factors: (1) increased physician awareness that hypertensive cardiovascular disease continues to threaten the prognosis of the patient following coarctectomy and that investigation in some symptomatic individuals after coarctectomy will demonstrate a residual or recurrent coarctation, even many years after the primary repair; (2) the widespread application of stress testing, which can reveal marked arm-to-leg pressure gradients not observed at rest, to the routine postcoarctectomy follow-up examination; (3) improved noninvasive aortic evaluation techniques, such as ultrasound; and (4) higher salvage rates among infants undergoing urgent coarctation repairs and the recognition that these children subsequently are at high risk for recoarctation. A surgical decision-making process characterized by flexibility provides maximum patient safety; no single reoperation technique can be applied in all situations. Individual circumstances may dictate recoarctation repair by resection with end-to-end anastomosis, tube graft interposition, aortoplasty, or tube graft bypass. The need for a temporary aortic shunt or partial left atriofemoral bypass to maintain adequate distal aortic perfusion pressure during the repair means that these methods must be available at all reoperations. Diligent efforts to repair all hemodynamically significant residual and recurrent coarctations are necessary if the natural fate of premature death is to be avoided for patients with these lesions.
D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008722:Methods; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D013348:Subclavian Artery / Q000637:transplantation; D013997:Time Factors