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Coarctation of the aorta in infancy and childhood
Insights
Early surgical intervention for neonates with coarctation of the aorta and heart failure is crucial, significantly reducing mortality. Optimal elective treatment for coarctation of the aorta occurs between 6 months and 1 year of age.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Coarctation of the aorta is a critical congenital heart defect affecting newborns.
- A significant proportion of patients present within the first year of life, many as neonates.
Purpose of the Study:
- To present the management and treatment outcomes for 181 children diagnosed with coarctation of the aorta.
- To determine optimal timing for surgical intervention to improve survival and long-term results.
Main Methods:
- Retrospective analysis of 181 pediatric patients with coarctation of the aorta.
- Evaluation of surgical mortality rates based on age at operation and presence of associated anomalies.
Main Results:
- Overall surgical mortality was 21% in 150 operated patients.
- Mortality was significantly higher in infants operated on before 3 months (45% under 6 weeks) compared to older infants.
- Delayed operation after 1 year may lead to persistent systemic hypertension.
Conclusions:
- Early surgical intervention is recommended for neonates with coarctation of the aorta and heart failure.
- Elective surgical repair is best performed between 6 months and 1 year of age to minimize risks and optimize outcomes.
- Associated cardiac anomalies and hypoplasia contribute to higher mortality in young infants.
Abstract:
The management and results of treatment in 181 children with coarctation of the aorta are presented. In this series, 79% of the patients presented in the first year of life and 55% presented as neonates. One hundred and fifty patients were operated on, with a total surgical mortality of 21%. Only one surgical death occurred in those operated on after 3 months of age. The higher mortality in young infants is closely related to associated cardiac anomalies and to the frequency of aortic and isthmal hypoplasia. Our findings suggest that neonates presenting with heart failure and coarctation should be operated on early, as the surgical mortality under 6 weeks is 45%, whereas there is an 86% mortality in neonates who were not operated on. Analysis of follow-up indicates that when operation can be performed electively the optimal period for sugical treatment is between 6 months and 1 year of age. If operation is performed after this age, there may be persistent systemic hypertension despite relief of aortic obstruction.