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Ann Thorac Surg 1987;44:517-522
© 1987 The Society of Thoracic Surgeons

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Articles

Indications and Techniques for Midline Approach to Aortic Coarctation in Infants and Children

From the Department of Surgery, Duke University Medical Center, Durham, NC, and the Department of Surgery, University of California at San Francisco, San Francisco, CA

Accepted for publication May 5, 1987.

^* Address reprint requests to Dr. Ungerleider, Duke University Medical Center, P. O. Box #3178, Durham, NC 27710

A variety of techniques have been described for the repair of aortic coarctation. Most of these use operative exposure through a left thoracotomy. There are, however, instances when a median sternotomy provides a more versatile approach and allows for equally acceptable repair. Twelve patients (age, 2 days to 16 years) with coarctation of the aorta serve to illustrate the value of the technique. All but 3 patients were under 3 years old. Five patients had repair of coarctation combined with repair of other congenital cardiac anomalies (atrial and ventricular septal defects, 2 patients; atrial septal defects, 2 patients; and valvular aortic stenosis, 1 patient). Six patients had complicated recurrences of previously repaired coarctations, and 1 patient had a primary coarctation that involved the aortic arch. All repairs were accomplished through a median sternotomy with the use of cardiopulmonary bypass and periods of (1) total circulatory arrest (6 patients); (2) reduced flow (4 patients); or (3) normal flow with multiple sites of arterial inflow (2 patients). All patients did well with no operative mortalities and no sequelae to date (8 weeks to 4 years). Examples of various techniques are provided to demonstrate the flexibility obtainable with this method. Median sternotomy can provide a viable approach to difficult problems involving coarctation of the aorta.

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