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Coarctation of the aorta in children. Late results after surgery
Insights
Early surgery for coarctation of the aorta in infants under six months significantly increases mortality. Long-term survivors face risks of recoarctation and hypertension, necessitating ongoing follow-up.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Outcomes Research
Background:
- Coarctation of the aorta is a critical congenital heart defect.
- Surgical outcomes for coarctation of the aorta have historically varied.
- Long-term sequelae after repair require thorough investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical repair for coarctation of the aorta.
- To assess mortality rates based on age at operation.
- To identify the incidence of recoarctation and systemic hypertension in survivors.
Main Methods:
- Retrospective analysis of 110 patients operated on between 1960-1970.
- Comparison of mortality rates in infants (<6 months) versus older children (>6 months).
- Late follow-up (5-15 years) for 87 survivors, assessing recoarctation and hypertension.
Main Results:
- Overall mortality was 23%.
- Infants operated on before 6 months had a 63% mortality versus 4% for older children.
- Late follow-up revealed 14% recoarctation and 23% systemic hypertension in survivors.
Conclusions:
- Age at operation is a critical determinant of mortality in coarctation of the aorta repair.
- Significant rates of recoarctation and postcoarctectomy hypertension occur even without clinical evidence of recoarctation.
- Continuous long-term monitoring is essential for patients following coarctation of the aorta repair.
Abstract:
From 1960 to 1970, 110 patients underwent operation for coarctation of the aorta. The overall mortality was 23%. However, in infants operated on at less than 6 months of age, the mortality was 63%, whereas there was only a 4% mortality in those operated on after 6 months of age. Late follow-up was available in 87 patients from five to 15 years postoperatively. There was a 14% frequency of recoarctation in the group of long-term survivors. Systemic hypertension, defined as an upper extremity blood pressure greater than 140/90 mm Hg, was found in 23% of the survivors. This study has demonstrated a significant frequency of postcoarctectomy hypertension and residual hemodynamic and angiographic abnormalities in patients without clinical evidence of recoarctation. This indicates the need for continued long-term follow-up of these patients.