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Ann Thorac Surg 1985;40:274-279
© 1985 The Society of Thoracic Surgeons

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Articles

Isthmus Flap Aortoplasty: An Alternative to Subclavian Flap Aortoplasty for Long-Segment Coarctation of the Aorta in Infants

From the Section of Cardiothoracic Surgery, Indiana University Medical Center, Indianapolis, IN.

^* Address reprint requests to Dr. Brown, Section of Cardiothoracic Surgery, 545 Barnhill Dr, Indianapolis, IN 46223

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.

Isthmus flap aortoplasty eliminates the coarctation web, adequately bridges the repair with an intact flap, and does not sacrifice the subclavian artery. This study demonstrates that isthmus flap aortoplasty is a promising alternative to subclavian flap aortoplasty in the group of infants with the difficult anatomy of long-segment coarctation.

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