Critical aortic coarctation: patch aortoplasty in infants less than age 3 months

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Thoracic Surgery

Background:

• Coarctation of the aorta is a severe congenital heart defect often presenting with intractable congestive heart failure in infants.
• Infants with coarctation frequently have associated cardiac anomalies, complicating management and increasing surgical risk.

Purpose of the Study:

• To evaluate the safety and efficacy of patch aortoplasty for critical coarctation of the aorta in infants.
• To assess outcomes in infants with coarctation and concurrent cardiac anomalies.

Main Methods:

• Twenty-three infants under 3 months with critical coarctation underwent patch aortoplasty.
• Procedures included ductus arteriosus closure, aortic angioplasty (target diameter ≥16 mm), and pulmonary artery banding in select cases.
• Postoperative catheterization was performed to assess repair success.

Main Results:

• One hospital death occurred due to sepsis; prolonged hospitalization was linked to unrepaired lesions.
• Three late deaths were associated with additional major anomalies.
• Postoperative catheterization showed no significant gradient at the coarctation repair site in most patients.

Conclusions:

• Surgical repair of critical coarctation of the aorta using patch aortoplasty is safe and effective in infants.
• The presence of other cardiac anomalies does not preclude successful surgical intervention.
• Careful patient selection and management of associated defects are crucial for optimal outcomes.