Postoperative growth of the left subclavian artery in a case after a modified Blalock-Park procedure.

Abstract

Various kinds of operations for coarcation of the aorta in infancy are life saving, but they still carry a high operative mortality rate and are followed frequently by residual or recurrent coarctation. Fifteen years ago we performed a modified Blalock-Park procedure on a 12 month old male infant with preductal coarctation, a large VSD and PDA. Recently a follow-up study was performed on this patient. Aortography revealed a normally developed aortic arch without any sign of stenosis. The intraaortic pressure tracings revealed no pressure gradient through the aortic arch and thoracic aorta. These findings suggest that this procedure is recommendable for the treatment of infants with severely hypoplastic aortic isthmus.modified Blalock-Park operation ; side-to-side anastomosis ; growth of subclavian artery ; preductal coarctation Today, the outcome of surgical treatment of coarctation of the aorta in children and young adults is gratifying. However, infants with varying degrees of hypoplastic aortic arch and isthmus can not be treated by resection of the coarctation and direct end-to-end anastomosis of the aorta. In general, the Blalock-Park procedure is used in such cases (Blalock and Park 1944). The coarctation is resected and the subclavian artery is used to restore continuity of the aortic arch. However, it has become less popular because of unsatisfactory operative results. The main cause of failure is attributed to bending or kinking of the subclavian artery at the site of anastomosis (Shumacker et al. 1968). This prohibits maintenance of a functionally adequate pathway.In order to overcome this problem, we modified the conventional technique and carried out a follow-up study for more than 10 years. As a result, no stenosis due to bending or kinking was found at the site of the anastomosis. The left subclavian artery grew as large as the normal portion of the descending aorta to allow normal circulation.This report is concerned with the details of the operative procedure and the clinical course of this case.