Surgery of Coarctation of the Aorta: A Nine-year Review of 253 Patients

Abstract

From 1973 to 1982, 253 patients--164 males and 89 females--underwent an operation for coarctation of the aorta in our clinic. Of the patients 72.3% presented with a circumscribed lesion and 58.5% with associated congenital cardiovascular defects. Resection with end-to-end anastomosis was performed in 138 patients (54.5%). Seventy-four patients (29.3%) had vascular graft prosthesis, 1.2% underwent the Clagett's operation, 9.1%, the indirect isthmoplasty and the rest (5.9%), the subclavian flap plastic. Ventricular fibrillation led to the intraoperative death of 3 infants with associated intracardiac and multiple somatic defects. The operative mortality was high in children under 15 months (13.2%), 1% in all the others taken together and 0% in all cases without concomitant lesions. Paraplegia occurred in only one patients (0.4%). One hundred twenty-eight patients were followed-up over a mean period of 3.6 years. The systolic and diastolic pressures decreased by a mean of 30 mmHg and 15 mmHg respectively. Eighty-seven patients (68%) had normal blood pressure at the time of examination. The rest (41 patients) had persistent postoperative hypertension necessitating medical management. The surgical technique elected did not influence the level and incidence of persistent postoperative hypertension, rather the level of the preoperative systolic right arm-to-leg pressure gradient (SPG) related closely to the incidence of persistent hypertension. Thirty patients (23.4%), among whom were 24 children under 10 years--some of them with preductal hypoplasia--presented with an SPG above 20 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure Changes After Aortic Coarctation Surgery Performed in Adulthood

“…The risk factors for subsequent hypertension after repair include an older age at the time of repair and higher blood pressure before the time of repair 24,25 . The surgical technique selected did not influence the level and incidence of persistent postoperative hypertension 26 …”

Long-term outcomes after surgical repair of the coarctation of aorta beyond infancy period

“…All patients should be recommended for endocarditis prophylaxis. [20] Nonetheless, there are some limitations to this study. Although 110 patients underwent surgical repair for CoA, only 49 patients (44.5%) were contactable and underwent follow-up in the outpatient setting.…”

“…It has been shown that bicuspid aortic valve with coexisting CoA may be present in up to 80% of the cases. [20] The valve may function normally or may advance to stenosis or regurgitation with progressive calcification. In addition, patients with bicuspid aortic valves have a 9-18-fold higher incidence of developing an aortic aneurysm due to accelerated degeneration of the aortic media.…”