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Coarctation of the aorta. Postoperative haemodynamic and angiographic findings in 52 patients
Insights
Surgical repair of coarctation of the aorta using tube prostheses showed no significant pressure gradients post-operation. End-to-end anastomosis had a higher rate of re-coarctation, necessitating further long-term study.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Vascular Surgery
Background:
- Coarctation of the aorta is a congenital narrowing of the aortic arch.
- Surgical repair techniques have evolved over time, impacting long-term outcomes.
- Postoperative assessment is crucial for evaluating the success of surgical interventions.
Purpose of the Study:
- To evaluate the long-term hemodynamic and angiographic outcomes of different surgical techniques for coarctation of the aorta.
- To compare the efficacy of tube prostheses versus end-to-end anastomosis in preventing re-coarctation.
- To assess the incidence of complications and the need for re-operation.
Main Methods:
- Retrospective analysis of 52 patients operated on for coarctation of the aorta between 1955 and 1978.
- Postoperative hemodynamic and angiographic examinations conducted between 1969 and 1979.
- Surgical techniques included tube prosthesis, end-to-end anastomosis, and patch repair (pericardial and dacron velour).
- Diagnostic methods included femoral artery catheterization, pulmonary artery injection, and transseptal left ventricular injection.
Main Results:
- Patients with tube prostheses exhibited no significant pressure gradients and minimal anastomotic indentations.
- Four patients (21%) with end-to-end anastomosis developed re-coarctation and required re-operation.
- The remaining 18 patients with end-to-end anastomosis showed comparable results to those with tube prostheses.
- No recoarctation has been observed to date in the tube prosthesis group.
Conclusions:
- Tube prostheses appear to be a safe and effective method for coarctation of the aorta repair, with no observed re-coarctation in this cohort.
- End-to-end anastomosis carries a risk of re-coarctation, necessitating careful follow-up and potential re-intervention.
- Long-term surveillance is essential to fully ascertain the durability and success of all surgical techniques for coarctation of the aorta.
Abstract:
52 patients operated on for coarctation of the aorta from 1955 to 1978 were subjected to postoperative haemodynamic and angiographic examinations during the period 1969 to 1979. Age at operation ranged from 11 days to 54 years (mean 21 years). Thirty patients, all above the age of 10, had a tube prosthesis inserted and an end-to-end anastomosis was performed in 19 patients. Two patients aged 4 and 13 years, respectively, had a pericardial patch inserted and the last patient aged 31 years a dacron velour patch. In 43 of the 52 patients, the haemodynamic and angiographic examinations were performed via the femoral artery. In 8 of the remaining patients, the contrast medium was injected into the pulmonary artery with filming after its passage through the lungs. Transseptal puncture with injection into the left ventricle was used in one patient. Patients with a tube prosthesis presented no significant pressure gradient and angiography showed slight indentations only at both the cranial and the distal anastomoses. Four of the patients with an end-to-end anastomosis developed re-coarctation and were re-operated. The remaining 18 patients showed haemodynamic and angiographic findings comparable to those found in patients where a tube prosthesis was inserted. Although none of the patients with a tube prosthesis have developed recoarctation so far, continued examination is necessary in order to clarify the long-term results.
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