Surgery of Coarctation of the Aorta: A Nine-year Review of 253 Patients

Summary

From 1973 to 1982, 253 patients - 164 males and 89 females - underwent an Operation for coarctation of the aorta in our clinic. Of the patients 72.3% presented with a circumscribed lesion and 58.5% with associated congenita! cardiovascular defects. Resection with end-to-end anastomosis was performed in 138 patients (54.5%). Seventy-four patients (29.3%) had vascular graft prosthesis, 1.2% underwent the Clagett's Operation, 9.1 %, the indirect isthmoplasty and the rest (5.9%), the subclavian flap plastic. Ventricular fibrillation led to the intraoperative death of 3 infants with associated intracardiac and multiple somatic defects. The operative mortality was high in children under 15 months (13.2%), 1 % in all the others taken together and 0 % in all cases without concomitant lesions. Paraplegia occurred in only one patient (0.4%).

One hundred twenty-eight patients were followed-up over a mean period of 3.6 years. The systolic and diastolic pressures decreased by a mean of 30 mmHg and 15 mmHg respectively. Eighty-seven patients (68%) had normal blood pressure at the time of examination. The rest (41 patients) had persistent postoperative hypertension necessitating medical management. The surgical technique elected did not influence the level and incidence of persistent postoperative hypertension, rather the level of the preoperative systolic right arm-to-leg pressure gradient (SPG) related closely to the incidence of persistent hypertension.

Thirty patients (23.4%), among whom were 24 children under 10 years - some of them with preductal hypoplasia -presented with an SPG above 20 mmHg. Only 3 such patients had a reoperation because of new clinical Symptoms suggestive of recoarctation. Postoperatively, only 32 % of the followed-up patients had minor complaints which, however, did not restrict their day-to-day activities. - This compared favorably with the 95% of the patients symptomatic preoperatively, partly showing disabling complaints. The best clinical results were observed in the age group between 6 and 10 years.

Key words

Aorta - Coarctation - Surgery