Coarctation of the aorta in neonates and young infants: surgical experience.
A retrospective analysis of repair of aortic coarctation in young infants was conducted. Between April 1997 and December 2000, 21 patients under 4 months of age underwent repair of coarctation. Their mean age and weight were 41   42 days (range, 2 to 120 days) and 3.6   0.7 kg (range, 2.6 to 4.9 kg). The indications for surgery were congestive heart failure and/or shock. Diagnosis was made by 2-dimensional echocardiography with Doppler color flow imaging. Preoperative gradients ranged from 25 to 100 mm Hg. Aortic arch hypoplasia was present in 8 patients; 7 patients also had ventricular septal defect. Wide excision of the coarctation segment with extended end-to-end anastomosis was performed in 20 patients, while 1 required a Gore-Tex interposition graft between the left common carotid artery and the descending aorta. Subclavian angioplasty was performed to augment the anastomosis in 1 patient. There was no early mortality. One patient died 2 months after surgery. Follow-up examination revealed recoarctation in 5 patients (23.8%), all of whom underwent successful balloon dilatation. In conclusion, wider excision of the coarctation with extended end-to-end anastomosis reduces the chances of recoarctation. Percutaneous balloon angioplasty for treating recoarctation is effective in immediately reducing pressure gradients.
Narasinga Rao
Pantula
P
Department of Cardiac Surgery, Al Mafraq Hospital, Abu Dhabi, United Arab Emirates.
Kumar
Raghavan Nair Suresh
RN
Anil Kumar
Dharmapuram
D
Mohmoud
Hassan Mohamed
HM
Chandran
Sushil
S
Dhir
Achal Kumar
AK
Saxena
Dileep Kumar
DK
Azhagappan
Sivan Pillay
SP
Pillai
Velayudhan Ramakrishna
VR
Venkitachalam
Chokkanathapuram Gopalakrishnan
CG
Fikree
Mohamed Amin
MA
Nazer
Yousuph Abdul
YA
Cartmill
Timothy Boyd
TB
Mrutyunjaya Rao
Ivatury
I
D000367:Age Factors; D000714:Anastomosis, Surgical; D017130:Angioplasty; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation; D001835:Body Weight; D018618:Echocardiography, Doppler, Color; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies