Coarctation in teenagers: two new surgical modifications

Definitive surgical procedure for correction of aortic coarctation presenting initially in teenagers, remains an issue. Classic subclavian angioplasty as described by Waldhausen is not recommended after the age 1 or 2 years. Prosthetic patch angioplasty has been associated with an unacceptable incidence of aneurysm formation and resection with end to end anastomosis is not always easy, owing to the development of friable collaterals.

In the last 4 years, we have utilized two surgical modifications for the treatment of primary isolated coarctation in teenagers. The first is aortoplasty, which relies on minimal resection of the coarctation segment and a plastic procedure of creating four identical flaps from the proximal and distal aorta, the interlocking of which will restore aortic lumen. The second modification is the use of a classic subclavian flap aortoplasty with the addition of a Gore-Tex graft, anastomosed between the upper lateral opening in the suture line and the distal left subclavian artery. Additionally, for the treatment of recurrent coarctation associated with cardiac anomalies, we have utilized the use of adult sized extra-anatomical conduit interposed between the ascending and the descending aorta.

All three procedures have yielded gratifying results and we believe will increase the options available for the surgeon treating teenagers' coarctation.