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Coarctation of the aorta in infants under 1 year of age
Insights
Surgical repair of coarctation of the aorta in infants significantly reduces mortality. This study details 26 infant repairs, highlighting associated anomalies and surgical techniques, with a 30.7% overall hospital mortality.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Untreated coarctation of the aorta (CoA) in infants carries a mortality rate as high as 90%.
- Surgical intervention is critical for managing this severe congenital heart defect.
- Associated cardiac anomalies are common in infants with CoA.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for coarctation of the aorta in infants.
- To analyze the types of associated anomalies and surgical techniques employed.
- To determine the hospital mortality associated with infant CoA repair.
Main Methods:
- A retrospective review of 26 infant surgical repairs for coarctation of the aorta over 7 years.
- Documentation of patient demographics, associated anomalies, surgical procedures (coarctectomy with end-to-end anastomosis, subclavian flap aortoplasty, Dacron patch aortoplasty), and additional interventions.
- Analysis of overall hospital mortality rates.
Main Results:
- 26 infants underwent surgical repair, with ages ranging from 6 days to 11 months.
- 85% of patients had associated anomalies, including ventricular septal defect (VSD) and patent ductus arteriosus (PDA).
- The overall hospital mortality was 30.7%, with no deaths in patients with uncomplicated coarctation.
Conclusions:
- Surgical repair of coarctation of the aorta in infants is associated with significant, but reduced, mortality compared to untreated cases.
- The presence of associated anomalies impacts surgical outcomes.
- Effective surgical strategies can improve survival rates for infants with coarctation of the aorta.
Abstract:
Untreated coarctation of the aorta in infants is associated with a high mortality, reaching up to 90%. During a period of 7 years 26 infants underwent surgical repair of this condition, the youngest being 6 days old and the oldest 11 months. Two underwent emergency surgery after catheterization, while the rest had an elective or semi-elective operation. Associated anomalies were present in 85% of the whole group; of the 22 patients with anomalies, a ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were present in 11 patients, a PDA in 7, a VSD in 6, transposition of the great arteries in 3, an atrial septal defect in 3, a single ventricle in 1, a hypoplastic aortic arch in 1, a hypoplastic left ventricle in 1 and a partial anomalous pulmonary venous defect in 1. Four patients (15%) had no other associated anomaly. The surgical techniques used were coarctectomy and end-to-end anastomosis in 61,5%, subclavian flap aortoplasty in 27%, and Dacron patch aortoplasty in 11,5%. Additional pulmonary artery banding was performed in 6 patients; in 2 patients lung biopsies were also carried out in order to establish the severity of pulmonary hypertension. The overall hospital mortality was 30,7%. No patients with uncomplicated coarctation died.