Recurrent coarctation of the aorta after successful repair in infancy

Histo-anatomical Backgrounds of Subclavian Flap Aortoplasty in Coarctation of the Aorta

“…Follow-up studies on end-to-end anastomosis after resection of coarctation of the aorta show a recoarctat ion with an incidence varying from 8 % to 54 % (4,8,15,17,2 1). The mechanisms held responsible for recoarctation included scar formation with stricture at the anastomosis, lack of growth and incomplete resection with thickening of the residual aortic segments (4,7,19).…”

“…The mechanisms held responsible for recoarctation included scar formation with stricture at the anastomosis, lack of growth and incomplete resection with thickening of the residual aortic segments (4,7,19). In the present study we investigated the st ructure of the left subclavian artery in 16 children with co arctation of the ao rta by comparing it with that of the matehing descending aorta and aortic isthm us.…”

Coarctation of the aorta corrected during childhood. Clinical aspects during follow-up

“…More precisely, residual coarctation is defined by the presence of a gradient in the operated area in the early post-operative period when the patient is still in the hospital, but is defined by recurrent coarctation when it is detected after hospital discharge 16,31,32 . A peak gradient at rest greater than 20mmHg through the area of coarctation is the most used measurement for the detection of residual or recurrent coarctation 12,19,25,27,[32][33][34] . However, no consensus exists about that, and gradients ranging from 10 to 30mmHg have also been used as reference point 18,[35][36][37] .…”

“…However, no consensus exists about that, and gradients ranging from 10 to 30mmHg have also been used as reference point 18,[35][36][37] . Even if this parameter were accepted by all, some controversy would still exist, because the systolic gradient has been determined by different methods in several studies in the literature, such as: simultaneous measurement of the blood pressure in the superior and inferior limbs with a sphygmomanometer, instantaneous peak gradient by Doppler echocardiography or direct measurement by cardiac catheterization 12,[32][33][34]38 . In addition, the development of collateral circulation also remains after surgery and may decrease the validation of the systolic gradient when it is used in isolation.…”

“…31,32 . Taking all these factors into consideration, it is not surprising that such a variability in the prevalence of recurrent coarctation exists (5% to 60%); however, these figures have progressively decreased in more recent series 10,12,16,27,30,33,35 .…”