Surgical treatment of coarctation of the aorta using trapezoidal aortoplasty.
OBJECTIVE
Trapezoidal aortoplasty is a technical variant of end-to-end anastomosis, which, based on elements of geometry, aims at increasing the diameter of the aorta at the level of the suture, therefore reducing the occurrence of residual or recurrent pressure gradients in the short and long run.


METHODS
After resecting the coarcted area and ductal tissue, 3 trapezoids are confected in each aortic stump, which, when confronted, create a suture line with a sinusoidal aspect (zigzag). Thirty-three patients underwent surgery with this technique, 22 (66.7%) males, with ages ranging from 3 months to 36 years (mean of 9.84 +/- 9.69).


RESULTS
No immediate or late deaths occurred. Follow-up ranged from 1.1 to 7.6 years (mean of 3.6 +/- 3.4). Most patients became asymptomatic with normal blood pressure levels, enabling the discontinuation of antihypertensive therapy (P<0.0001). A significant reduction in the pressure gradients was observed on Doppler echocardiography and during cardiac catheterization (P<0.001). The analysis of the images of aortography showed good anatomical continuity in the region of the anastomosis, and the morphometric study of the aorta revealed the beneficial effects of the technique indicated by the increase in the caliber of the aorta in the distal segment of the arch, isthmus, and descending portion.


CONCLUSIONS
Trapezoidal aortoplasty showed satisfactory clinical results that allow its application in all cases indicated for end-to-end anastomosis.
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil. j.dinkhuysen@uol.com.br
Jarbas Jakson
JJ
Dinkhuysen
Tarcisio Luiz Valle
TL
de Almeida
Ibraim Masciarelli Francisco
IM
Pinto
Luiz Carlos Bento
LC
de Souza
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001017:Aortic Coarctation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome