Follow-up of aortic coarctation repair in neonates.
OBJECTIVE
The purposes of this study were to assess the growth of left heart (LH) structures, to evaluate midterm outcomes, and to define echocardiographic parameters predictive of increased risk of re-intervention in patients born with aortic coarctation and hypoplasia of LH structures that underwent neonatal coarctation repair.


BACKGROUND
Neonatal coarctation is often associated with hypoplasia of LH structures. Although previous studies have shown that coarctation repair can be performed with good results in these neonates, there are little data regarding growth of the LH structures or outcomes in these patients.


METHODS
Patients with isolated coarctation and at least one hypoplastic LH valve (mitral or aortic Z-score <-2) who underwent a neonatal coarctation repair were identified. Clinic charts and the latest echocardiograms were reviewed.


RESULTS
All 55 patients were alive and well, and no patient had clinical evidence of mitral stenosis. Three patients (5%) required re-intervention. Thirty-eight patients had echocardiograms that demonstrated normal left ventricular (LV) size and function with a follow-up duration of 73 +/- 19 months (range 3 to 9 years). Both mitral and aortic annulus Z-scores increased significantly: -3.1 +/- 1.5 to -0.5 +/- 1.6 (p < 0.001) and -3.5 +/- 1.9 to 0.7 +/- 1.6 (p < 0.001), respectively. Nine patients (24%) developed LV outflow tract obstruction by echocardiographic criteria.


CONCLUSIONS
After neonatal coarctation repair with associated LH hypoplasia, LH structures increase substantially in size, and clinical outcomes are excellent at midterm follow-up. Despite initial annular hypoplasia, the need for intervention for mitral or aortic/subaortic stenosis is uncommon.
Puchalski
Michael D
MD
Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA. pcmpucha@ihc.com
Williams
Richard V
RV
Hawkins
John A
JA
Minich
L LuAnn
LL
Tani
Lloyd Y
LY
D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D004452:Echocardiography; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery; D007229:Infant Welfare; D007231:Infant, Newborn; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012086:Reoperation; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014589:Utah; D016277:Ventricular Function, Left / Q000502:physiology