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Ann Thorac Surg 2004;77:1353-1358
© 2004 The Society of Thoracic Surgeons
a Departments of Cardiothoracic Surgery and Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
* Address reprint requests to Dr Wood, Professor Eoin O'Malley National Centre for Cardiothoracic Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
e-mail: freddie{at}woodcts.iol.ie
Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
BACKGROUND: Recurrent coarctation is an ever-present complication of surgical treatment of coarctation of aorta (CoA) among infants. No single operation appears to have a clear superiority.
METHODS: From January 1, 1986, to June 30, 2002, a consecutive series of 181 patients less than 1 year of age (range 1 to 300 days, median 13.5 days) were referred for CoA repair. Neonates accounted for 135 patients, and hypoplastic arch (less than 1 mm/kg plus 1) was present in 107 infants. Coarctation of aorta was simple (group 1) in 71 patients; complicated by ventricular septal defect (group 2) in 62; and complicated by complex congenital heart disease (group 3) in 48. All patients were assessed by right arm/left leg Dynamap pressures and routine follow-up was performed by the cardiologists. Follow-up was complete in all patients (range 6 months to 16 years, median 7.5 years).
RESULTS: The overall hospital/30-day mortality was 0.5% (group 1 = 0, group 2 = 0, group 3 = 1 [2.0%]). Complications other than recoarctation occurred in 5 patients (2.7%). Late mortality occurred in 15 (11 at intracardiac repair). Recoarctation, ie, a gradient of more than 20 mm Hg, occurred in 4 patients (2.2%). All 4 patients were noted to have a gradient of more than 10 mm Hg (right arm/left leg) postoperatively and as such had residual coarctation. All 4 were successfully treated by balloon aortoplasty.
CONCLUSIONS: Extended arch aortoplasty in association with ductal and coarctation excision provides excellent coarctation repair with a low incidence of recoarctation. Recoarctation occurred only in proximal aortic arch hypoplasia or low birth weight. Balloon aortoplasty easily and effectively relieved the recoarctation in all cases.
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