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[Surgical repair of coarctation of the aorta during infancy]
1Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine.
Insights
Surgical repair of coarctation of the aorta in infants showed varying outcomes based on associated cardiac anomalies. Resection and end-to-end anastomosis (RETE) and subclavian flap angioplasty (SFA) had similar results for simpler cases.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Thoracic Surgery
Context:
- Coarctation of the aorta is a critical congenital heart defect requiring surgical intervention in infants.
- Infants undergoing coarctation repair present with diverse pathologies, including simple coarctation, ventricular septal defects, and complex cardiac anomalies.
- A patent ductus arteriosus is frequently observed in conjunction with coarctation of the aorta.
Purpose:
- To evaluate the outcomes of surgical repair for coarctation of the aorta in infants.
- To compare the efficacy of different surgical techniques, specifically resection and end-to-end anastomosis (RETE) versus subclavian flap angioplasty (SFA).
- To analyze the impact of associated cardiac anomalies on operative mortality and recurrent coarctation rates.
Summary:
- This study reviewed 46 infants (<1 year) undergoing coarctation of the aorta repair between 1972 and 1991.
- Patients were categorized into simple coarctation (Group 1), coarctation with ventricular septal defects (Group 2), and complex cardiac anomalies (Group 3).
- Operative mortality was 0% in Group 1, 9.1% in Group 2, and 82.3% in Group 3, with no significant differences in outcomes between RETE and SFA for Groups 1 and 2.
Impact:
- Surgical technique (RETE vs. SFA) did not significantly affect outcomes for simple coarctation or coarctation with VSD.
- Complex cardiac anomalies significantly increase operative mortality in infants undergoing coarctation repair.
- Palliative procedures combined with coarctectomy showed poor results in complex cases, suggesting primary repair of anomalies may be beneficial.
Abstract:
Fourty-six infants less than 1 year of age underwent repair of coarctation of the aorta in our institution between 1972 and 1991. Pathologic types and numbers of patients were simple coarctation (Group 1) in 7 patients, with ventricular septal defects (Group 2) in 22 patients and with complex cardiac anomalies (Group 3) with 17 patients. A patent ductus arteriosus was present in 43 of these patients. Operative technique used were resection and end-to-end anastomosis (RETE) in 30 patients, subclavian flap angioplasty (SFA) in 15 and Blalock-Park operation in one patient. RETE procedures were employed from 1972 until 1980 and SFA procedures were employed between 1981 and 1985. After 1986 RETE procedures were employed again. The operative mortality rates were 0% (0/7) in Group 1, 9.1% (2/22) in Group 2 and 82.3% (14/17) in Group 3. The high mortality rate in Group 3 are thought to be related to severe associated cardiac anomalies. There were no significant differences in the operative mortality and recurrent coarctation rates between RETE and SFA procedures in Group 1 and 2. In patient with a large associated intracardiac shunt (Group 2 and 3) banding of the main pulmonary artery (PAB) was performed with coarctectomy simultaneously. In Group 2 VSD closure and debanding could be done a few months later with excellent results, but in Group 3 primary repair of cardiac anomalies may be worth to try since results of coarctectomy with palliative procedures in these group of patients were poor.(ABSTRACT TRUNCATED AT 250 WORDS)