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Ann Thorac Surg 1985;40:35-40
© 1985 The Society of Thoracic Surgeons

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Articles

Repair of Aortic Coarctation in Infants: Experience with an Intraluminal Shunt

Departments of Surgery and Cardiology, St. Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO

^* Address reprint requests to Dr. Pennington, Department of Surgery, St. Louis University Hospitals, 1325 S Grand Blvd, St. Louis, MO 63104

From 1962 to mid-1984, 63 infants underwent coarctation repair. Cardiac defects were present in 46 (73%). Repair was by subclavian aortoplasty in 35 patients, resection and end-to-end anastomosis in 19, and other techniques in 6. Three patients died before the repair was completed. In 15 patients, an intraluminal shunt was used during subclavian aortoplasty. Prostaglandin E₁ (PGE₁) was infused in 9 patients. Early (thirty-day) mortality was 16% (10 patients): 4 patients who underwent end-to-end anastomosis; 3 during attempted end-to-end anastomosis; 2 who received bypass grafts; and 1 who had subclavian aortoplasty without a shunt. None of the 15 patients who had subclavian aortoplasty with a shunt died. There were no early deaths among the last 25 patients seen. One patient who underwent subclavian aortoplasty without a shunt is paraplegic. There were 10 late deaths among the 53 patients followed from 1 month to 12 years (mean, 3 years). Arm-leg pressure gradients of 20 mm Hg or greater were found in 4 of the patients who had end-to-end anastomosis but not in any of the patients who had subclavian aortoplasty. Improved results of coarctation repair in infants in this study were attributed to PGE₁, subclavian aortoplasty, and use of an intraluminal shunt.

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