Related Experiment Videos
[Aortic coarctation in the first 3 months of life. Surgical results]
S Estébanez1, A Cabrera, M A Izquierdo
1Servicio de Cardiología Pediátrica, Hospital Infantil de Cruces, Bilbao.
Insights
Surgery for coarctation of the aorta in infants under 3 months is associated with high mortality, especially with aortic arch hypoplasia or pulmonary hypertension. Avoiding pre-operative catheterization may improve outcomes and reduce recoarctation rates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Aortic Coarctation Repair
Context:
- Coarctation of the aorta is a critical congenital heart defect requiring early surgical intervention.
- Infants under 3 months present unique challenges due to their small size and physiological immaturity.
- Surgical outcomes are influenced by associated anomalies and pre-operative procedures.
Purpose:
- To analyze the surgical outcomes and identify risk factors for mortality and recoarctation in infants younger than 3 months undergoing coarctation of the aorta repair.
- To evaluate the impact of pre-operative catheterization and specific surgical techniques on patient survival and re-intervention rates.
Summary:
- This study reviewed 51 infants (<3 months) with coarctation of the aorta who underwent surgical correction between 1973 and 1989.
- Mortality was 23.5%, with higher rates in neonates, those with aortic arch hypoplasia, pulmonary hypertension, or undergoing surgery within the first two weeks.
- Recoarctation occurred in 10 patients, more frequently after end-to-end anastomosis, and was often managed with balloon angioplasty.
Impact:
- Findings suggest that avoiding pre-operative catheterization and delaying surgery beyond the first two weeks may reduce morbimortality.
- The study highlights the importance of considering associated anomalies and specific surgical techniques in managing complex coarctation of the aorta.
- Recommendations include performing surgery without prior catheterization to potentially improve outcomes in this vulnerable infant population.
Abstract:
Between January 1973 and September 1989, 51 patients younger than 3 months with coarctation of the aorta underwent surgery. All of them had atrio-ventricular and ventriculo-arterial concordance with well developed ventricular cavities. Thirty-four were male and 17 female. Thirty five had associated anomalies and catheterism was done in 36 before surgical correction. The surgical procedures we used were 19 subclavian plasty (Waldhausen), 13 end-to-end anastomosis, 13 Alvarez technique and three goterex parch. Twelve died (23.5%), three during surgery and the others in a period of 3 to 20 days after surgery. Eight were younger than 17 days, seven had aortic arch hypoplasia associated and six had ventricular septal defect (five with pulmonary hypertension). Other ten developed recoarctation (gradient greater than 20 mmHg) between 10 days and 8 months after first intervention (media = 3 months). Five had previously end-to-end correction (41.6%), two angioplasty with parch (66%), two Alvarez (20%) and one Waldhausen (7%). The correction of the recoarctation required surgery in 4 patients (three with angioplasty with parch and one with end to end correction), and the other six underwent angioplasty with catheter-balloon. None of the 15 patients without previous catheterism died, and neither did those who underwent surgery during the last 4 years. The associated anomalies required a second time surgery. We conclude that morbimortality is related to the aortic arch hypoplasia, pulmonary hypertension and surgery during the first 2 weeks. We recommend surgery without previous catheterism. The recoarctation is more frequent in patients with end to end correction, without an increase of the mortality.