Impact of Down's syndrome on presentation, hemodynamics and surgical outcome of complete atrio-ventricular canal defects

Abstract

Objective: A retrospective comparison of clinical, echocardiographic and radiologic outcome following surgical correction of coarctation of the aorta by subclavian flap aortoplasty or resection end to end anastomosis at less than 3 months of age.Methods: 62 patients under 3 months of age with isolated coarctation of the aorta who underwent surgical correction between 1997 and 2002 (34 resections and 28 subclavian flap aortoplasties) were studied. Age at time of repair was comparable (p=0.54). Weight at time of repair was lower in the resection group (p=0.008). Follow up included clinical evaluation, echocardiographic estimation of residula gradient and left ventricular mass index in all patients and CT Aortography if there was evidence of recoarctation. Measurements of mid-arm circumference, acromion to-olecranon distance along with brachial artery flow velocity and flow pattern in both upper limbs were carried out in the flap aortoplasty group.Results: Mean follow-up was 33.21±14.78 months (range 12-65 months) which was similar in both groups (p=0.26). 12 in the resection group (35%) and 4 in the flap group (15%) had recoarctation. Left ventricular mass index was higher in the resection group (mean 76.50±11g/m 2 ) than the flap group (mean 58±4.77 g/m 2 ) p=0.00. There were no obvious upper limb ischaemic complications in the flap group, but the left arm was significantly shorter than the right.Conclusions: Subclavian flap procedure is superior in terms of lesser recurrence, and also lower left ventricular mass index. Minor differences in limb length were noted though none of the patients were symptomatic. 5Post-operative evaluation of arterial switch by 3D helical computed tomographic angiography