Aortic coarctation repaired within the first year of life: an 11 year review

Abstract

Introduction. Congenital heart diseases (CHD) affect 8-12 per 1000 live-born infants and it is one of the most common and serious congenital anomalies, aortic coarctation (AoCo) accounts for 6-10% of all the congenital heart diseases, and if not diagnosed early in life it can result in severe morbidity and mortality (3,9,13,11). Aim of the study. The aim of the study was to analyze the epidemiology of AoCo in newborn in Latvia, to evaluate a single centre 11 year experience with children who underwent AoCo repair in our institution within the first year of life, to define morbidity, mortality, risk factors, short and long term results. Materials and methods. The study was approved by the committee of ethics of the university hospital for children. Retrospective and prospective study/follow-up of all (74) patients younger than 12 months undergone native coarctation repair in our institution between January1, 2000 and December 31, 2010.Results. The prevalence of the coarctation of the aorta in Latvia was 3.43+/-1.2 per 10 000 life born infants. Seventy-four neonates and infants were analyzed: 44 boys (59%) and 30 girls (41%). Median age at the time of primary surgical correction was 47.3+/-58 days, medium weight 4.2+/-1.6kg. Prostoglandin E1 was used in 62%, inotropic stimulation in 20% of cases, assisted ventilation in 18%. According to the anatomy of the congenital heart disease patients constituted group I-the patients with simple coarctation with and without atrial septal defect (ASD) in 57%, group II -patients with coarctation and ventricular septal defect (VSD) 23%, group III-complex coarctation 20%. The infantile juxtaductal AoCo with isthmus hypoplasia was detected in 83%(n=62), postductal AoCo in 4%(n=3) and juxtaductal membrane in 12%(n=9), hypoplasia of the aortic arch in 16%(n=12). The techniques for primary repair included the resection with simple anastomosis end-to-end (ETE) in 26% (n=19), subclvian flap aortoplasty(SFA) in 65%(n=48) and extended anastomosis end-to-end (eETE) in 8%(n=6), primary balloon angioplasty in 1 case. There were 5 cases (6,8%) of early postoperative death and 9 cases of later death. Recoarctation occurred in 14 patients (23%), all underwent balloon angioplasty with no significant residual gradient, and there was no mortality or complications after reinterventions. Conclusions. The surgical correction of the AoCo remains gold standard for neonates and small infants. There were no statistically significant differences between the incidences of recoarctation dependent on the method of primary surgical correction. The incidence of recoarctation in cases of primary surgical correction early in life remains comparatively high. Baloon angioplasty is a method of choice in cases of recoarctation, it is safe and effective with low incidence of persistent coarctation. Mortality is most importantly influenced by preoperative status, the severity of associated anomalies, surgical outcomes, perioperative intensive treatment.

Echocardiographic Follow up After Surgical Correction of Aortic Coarctation During The First Year of Life

“…Our study included a relatively small number of patients, as the birth rate in Latvia within the years 2000-2010 was only 21 197 ± 1212 live born infants per year (Anonymous, 2011a). The prevalence of AoCo in Latvia during those years was 3.4 ± 1.2 per 10 000 live born infants per year (Ligere et al, 2011). There was a relatively high incidence of Ao recoarctation.…”