Management of Coarctation of the Aorta in Infants and Children: Preferential Use of Subclavian Flap Aortoplasty

Abstract

INTRODUCTION: Patients with coarctation of the aorta present with absent or diminished lower extremity pulses, either early in infancy with severe congestive failure or later in life, usually with asymptomatic hypertension. Those patients presenting with failure in infancy have a significant associated cardiac lesion in 67% to 95% cases, most frequently a PDA, VSD, bicuspid aortic valve or mitral valvular disease. RESULTS: Six of the 25 infants died. The only intraoperative death was among the 8 patients who had simultaneous pulmonary artery banding (Table – IV). One patient with a small VSD and severe mitralstenosis, acidotic and seizing preoperatively, died in a low output state 36 hours after repair and pulmonary artery banding. Nine patients have undergone repeat catheterization and none demonstrated any gradient, with satisfactory growth of the subclavian flap segment of repair (Table - VIII and Figs. 5 8). DISCUSSION: Until a few years ago patients with coarctat ion of the aorta coming to surgery were older children and adults who were treated by the standard method of resection and endto-end. Based on our experience, therefore, we conclude that repair of coarctation of the aorta can be safely performed in any patient regardless of’ age or size. The mortality is that of any associated intracardiac anomalies. The subclavian flap technique offers reliably reproducible results and demonstrates satisfactory growth potential. This is especially useful in the infant and neonatal patients, while other procedures can be satisfactory utilized in older patients.