Aortoplasty with the left subclavian flap in older children

Ten patients between 8 months and 9 years of age (average 4.3 years) underwent surgical relief of coarctation of the aorta by the technique of left subclavian flap aortoplasty. Before operation, nine patients had systolic hypertension in the upper extremity (average 145 mm Hg) and all had a significant pressure gradient across the coarctated aortic segment (average 45 mm Hg). The hospital and late mortality were zero. The follow-up over 7 years has shown complete relief of the coarctation and no ischemic impairment or functional limitation of the left upper extremity. The blood pressure returned to normal in all patients. Hemodynamic and angiographic studies, performed in one case, demonstrated adequate growth of the repaired segment and absence of a pressure gradient across the previously narrowed area. The time interval between the peak of the femoral pulse and the dicrotic notch of the carotid pulse, recorded postoperatively, was normal. We consider the left subclavian flap technique to be the operation of choice in infancy and also in older children, whenever the anatomic configuration of the coarctation suggests that subsequent growth would be severely restricted if other techniques were used.