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Published on: December 11, 2017
Follow-up of aortic coarctation repair in neonates
Michael D Puchalski1, Richard V Williams, John A Hawkins
1Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA. pcmpucha@ihc.com
Insights
Neonatal coarctation repair with hypoplastic left heart structures leads to significant growth of these structures and excellent midterm outcomes. Re-intervention for stenosis is uncommon, indicating successful surgical repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Neonatal coarctation often presents with hypoplastic left heart (LH) structures.
- Limited data exist on LH structure growth and long-term outcomes post-neonatal coarctation repair.
Purpose of the Study:
- Assess LH structure growth after neonatal coarctation repair.
- Evaluate midterm clinical outcomes.
- Identify echocardiographic predictors of re-intervention risk.
Main Methods:
- Retrospective review of patients with isolated coarctation and hypoplastic LH valves (Z-score <-2).
- Analysis of clinical charts and echocardiograms.
- Assessment of LH structure growth and re-intervention rates.
Main Results:
- All 55 patients survived with no mitral stenosis; 5% required re-intervention.
- Significant increases in mitral and aortic annulus Z-scores observed (-3.1 to -0.5 and -3.5 to 0.7, respectively).
- 24% developed LV outflow tract obstruction by echocardiographic criteria.
Conclusions:
- Neonatal coarctation repair with LH hypoplasia results in substantial LH structure growth.
- Midterm clinical outcomes are excellent.
- Intervention for mitral or aortic/subaortic stenosis is infrequent despite initial hypoplasia.
Objectives:
The purposes of this study were to assess the growth of left heart (LH) structures, to evaluate midterm outcomes, and to define echocardiographic parameters predictive of increased risk of re-intervention in patients born with aortic coarctation and hypoplasia of LH structures that underwent neonatal coarctation repair.
Background:
Neonatal coarctation is often associated with hypoplasia of LH structures. Although previous studies have shown that coarctation repair can be performed with good results in these neonates, there are little data regarding growth of the LH structures or outcomes in these patients.
Methods:
Patients with isolated coarctation and at least one hypoplastic LH valve (mitral or aortic Z-score <-2) who underwent a neonatal coarctation repair were identified. Clinic charts and the latest echocardiograms were reviewed.
Results:
All 55 patients were alive and well, and no patient had clinical evidence of mitral stenosis. Three patients (5%) required re-intervention. Thirty-eight patients had echocardiograms that demonstrated normal left ventricular (LV) size and function with a follow-up duration of 73 +/- 19 months (range 3 to 9 years). Both mitral and aortic annulus Z-scores increased significantly: -3.1 +/- 1.5 to -0.5 +/- 1.6 (p < 0.001) and -3.5 +/- 1.9 to 0.7 +/- 1.6 (p < 0.001), respectively. Nine patients (24%) developed LV outflow tract obstruction by echocardiographic criteria.
Conclusions:
After neonatal coarctation repair with associated LH hypoplasia, LH structures increase substantially in size, and clinical outcomes are excellent at midterm follow-up. Despite initial annular hypoplasia, the need for intervention for mitral or aortic/subaortic stenosis is uncommon.
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