title: Long-term follow-up of neonatal coarctation and left-sided cardiac hypoplasia.
abstract: Neonatal coarctation of the aorta (CoA) is often associated with hypoplastic left-sided cardiac structures. Limited data are available regarding the long-term clinical outcomes. Our purposes were to assess the following in neonates with CoA and left-sided cardiac hypoplasia: (1) left-sided cardiac structure growth over time, (2) echocardiographic parameters predicting reintervention, and (3) long-term outcomes and reintervention rates. Data were collected for all patients born with isolated CoA, along with a mitral or aortic Z-score of <-2, who underwent repair before 2 months of age from January 1993 to April 1997. Recent follow-up data were available for 51 of 63 patients (81%) aged 15.4 ± 1.5 years (range 11 to 18). Of the 51 patients, 46 (90%) had a recent echocardiogram, all with normal left ventricular systolic function. The mitral and aortic valve annulus Z-scores increased significantly from the initial measurements: -3.29 ± 1.54 to -0.94 ± 0.58 (p <0.0001) and -3.25 ± 1.98 to 0.08 ± 1.81 (p <0.0001). No significant change was seen from intermediate (6.1 ± 1.6 years) to the latest follow-up examination. Of the 51 patients, 12 (24%) required reintervention at 3 ± 4.5 years; 9 for repeat CoA, 4 for subaortic stenosis, and 2 for aortic stenosis (some in combination). The initial echocardiographic parameters were not associated with reintervention. The overall freedom from reintervention was 76% at 15 years of follow-up. In conclusion, the long-term outcomes after isolated CoA repair with associated left-sided cardiac hypoplasia were excellent. Both aortic and mitral valve sizes had increased substantially by intermediate follow-up but tended to normalize afterward. Although 24% of the patients required reintervention, significant left ventricular inflow or outflow tract obstruction was uncommon.
authors: Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA. robert.gray@imail.org
authors: Robert G
authors: RG
authors: Gray
authors: Lloyd Y
authors: LY
authors: Tani
authors: Hsin Yi
authors: HY
authors: Weng
authors: Michael D
authors: MD
authors: Puchalski
mesh_terms: D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000151:congenital / Q000000981:diagnostic imaging* / Q000401:mortality; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014589:Utah / Q000453:epidemiology