Repair of coarctation of the aorta in children: postoperative morphology

To determine the morphologic sequelae after surgical repair of coarctation of the aorta, the authors retrospectively reviewed angiograms and hemodynamic and clinical data on 215 patients who underwent cardiac catheterization after surgical repair of coarctation of the aorta during a 13-year period. Ninety-seven patients (45%) underwent coarctation resection with end-to-end anastomosis; 92 (43%), subclavian-flap angioplasties; and 26 (12%), synthetic-patch repairs. Sixty-four patients (30%) had an "aneurysm," defined as a measurement ratio of repair site to diaphragmatic aorta greater than 1.5. Transverse-arch or isthmic hypoplasia or recoarctation was detected in 86 patients (40%) and was most commonly associated with septal defects or obstruction of the left ventricular outflow tract. Pullback systolic pressure gradients at catheterization were significantly higher (P = .0001) in the patients with transverse-arch hypoplasia and recoarctation than in those with ratios of transverse arch to diaphragmatic aorta greater than 0.9. Significant postoperative arch obstructions can be predicted with measurement ratios on the basis of the diameter of the abdominal aorta.