Perioperative management of neonatal aortic isthmic coarctation

Aortic isthmic coarctation is a common cardiovascular cause of neonatal mortality. This study reviews retrospectively sixty-one consecutive neonates operated on for this condition at the Royal Children's Hospital, Melbourne, in the years 1978-1983 inclusive. In this series, the overall mortality has fallen from 50% and 67% in 1978 and 1979 respectively, to 11% in 1983. In the last three years of this review, there have been no early hospital deaths and the late deaths relate to associated congenital anomalies. The decrease in mortality is ascribed to methods of perioperative support, non-invasive cardiac investigation, and surgical repair with subclavian aortoplasty. Prior to surgery, all infants are paralysed, mechanically ventilated and infused with prostaglandin E1 to reopen the ductus arteriosus, and dopamine to support the failing myocardium. The physical status of all infants improved with these maneuvres. This paper reviews the pathophysiology of neonatal aortic coarctation, the current modes of management, results and complications.