The Annals of Thoracic Surgery, Vol 40, 274-279, Copyright © 1985 by The Society of Thoracic Surgeons
Isthmus flap aortoplasty: an alternative to subclavian flap aortoplasty for long-segment coarctation of the aorta in infants
JW Brown, AC Fiore and H King
The ideal operation for infants with coarctation of the aorta remains
controversial. Subclavian flap aortoplasty is the most popular technique
for this age group. The 5 to 20% recurrence rate is attributed to regrowth
of the coarctation web or inadequate length of the subclavian flap,
particularly when the aortic isthmus is long and narrow. Severe arm
ischemia following subclavian flap aortoplasty, although rare, is a
disturbing complication. The purpose of this study is to report the results
with a new technique we call isthmus flap aortoplasty for coarctation of a
long segment of the aorta in infants. This technique avoids the limitations
of subclavian flap aortoplasty. A short segment of aorta, including the
ductal entrance and coarctation web, was resected in 4 infants (mean age,
35.5 days) with long-segment coarctation. The posterior wall of the long
isthmus was opened longitudinally to the level of the transverse aortic
arch. The descending aorta was mobilized and advanced to the level of the
aortic arch where the posterior half was sutured. The anterior flap of
attached isthmus was then sewn into a longitudinal incision made in the
anterior wall of the descending aorta. All infants survived this procedure
and had no gradient at completion of the repair. The mean transconduit
gradient at rest was zero and rose to 7.0 +/- 0.93 mm Hg after angiography
at a mean follow-up of 42 months. Aortograms demonstrated that the
reconstructed area had grown in girth and attained a normal caliber in each
child.(ABSTRACT TRUNCATED AT 250 WORDS)
