[Symptomatic aortic coarctation in infants. Changes in the prognosis]

Between january 1971 and january 1988, the number of infants of less than 12 months diagnosed in our Hospital of symptomatic coarctation of aorta by cardiac catheterization and angiography was 101, 50 between 1971-1982, before the introduction of infusion of prostaglandin E, and 51 between 1983-1988. In the first period only 25 of the infants (50%) were treated surgically, the overall mortality was 74% and the surgical mortality was 60%. Between 1983 and 1988 the number of children who had surgical repair was 48 (94%), the overall mortality was 35.2% and the surgical mortality was 33.3%. In the two periods all the deaths took place in the first year. The high risk of mortality in this group, mark again the importance of the surgical correction in optimal conditions and as early as possible. The actuarial survival data support that improvements in the medical treatment before surgery are the main factors in the improvement of the prognosis after 1983. Four children survived after a second operation for repair of other cardiac associated anomalies. At 9.5 years mean follow-up the frequency of recurrence of the coarctation was low (5.1%), the repair was good in the majority of the survivors and the less satisfactory functional results was done in the cases with associated defects. None of the survivors has systemic hypertension. The results shows the important modification of the natural history of this malformation in the last decade.