Related Experiment Videos
Goretex patch aortoplasty for coarctation in children: nuclear magnetic resonance assessment at 7 years
A Bertolini1, P Dalmonte, P Tomà
1Department of Thoracic and Cardiovascular Surgery, Istituto G. Gaslini Children's Hospital, Genoa, Italy.
Insights
Goretex patch aortoplasty is a safe and effective surgical repair for coarctation of the aorta in children. Long-term follow-up and nuclear magnetic resonance imaging show excellent results with no recoarctation or aneurysms.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Engineering
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical intervention.
- Traditional repair methods may have limitations, necessitating alternative techniques.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of Goretex patch aortoplasty in pediatric patients.
- To assess the durability of the repair using advanced imaging modalities.
Main Methods:
- Retrospective analysis of 56 children undergoing Goretex patch aortoplasty for coarctation of the aorta (1979-1990).
- Surgical technique involved left thoracotomy and Goretex patch implantation.
- Postoperative assessment included clinical evaluation, Doppler ultrasound, exercise testing, and nuclear magnetic resonance (NMR) imaging.
Main Results:
- Low mortality rate (1.8%) with no early deaths.
- Excellent long-term outcomes with no recoarctation or aneurysm formation in 26 patients assessed by NMR imaging.
- Minimal residual arm-leg systolic gradient in a small number of patients post-exercise testing.
Conclusions:
- Goretex patch aortoplasty is an effective and safe surgical option for pediatric coarctation of the aorta.
- NMR imaging is valuable for assessing the long-term structural integrity of the repair site.
Abstract:
From 1979 to 1990, 56 children ranging between 4 days and 16 years of age (mean 73 +/- 51 months) underwent Goretex patch aortoplasty for coarctation of the aorta. The mean weight at operation was 20.2 +/- 3.5 kg (range 3.3-42 kg). Forty-two patients had primary repair, and the remaining 14 had reoperation for recoarctation. The aorta was opened through a standard left thoracotomy, the posterior fibrous ridge was partially excised when it was prominent, and a large patch from a Goretex tube was sutured into place. The postoperative complications were as follows: paradoxical hypertension in 14 cases, massive haemorrhage due to aortic wall rupture in a diabetic child, and intestinal bleeding in 1 case. There were no early deaths and only 1 case of late death, which was not related to coarctation repair (mortality rate 1.8%). The average follow-up was 48 +/- 26 months. Continuous wave-Doppler examination at rest showed no arm-leg systolic gradient in 52 cases and a gradient of about 15 mmHg in 4 cases. Graded exercise testing showed only 1 case with an arm-leg gradient higher than 35 mmHg. Nuclear magnetic resonance (NMR) imaging, performed on 26 patients at a mean of 7 years from operation, showed excellent morphology and size of the aortoplasty. No cases of recoarctation or late aneurysm formation were found. We conclude that Goretex patch aortoplasty can be performed effectively and safely in children. Nuclear magnetic resonance provides high resolution imaging of the coarctation repair site.