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The Journal of Cardiovascular Surgery 2002 February;43(1):1-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Repair of critical aortic coarctation in neonatal age

Korbmacher B., Krogmann O. N., Rammos S., Godehardt E., Volk T., Schulte H. D., Gams E.

From the Clinic of Thoracic and Cardiovascular Surgery *Pediatric Cardiology Unit, Heinrich-Heine-University Medical Center, Düsseldorf, Germany


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Back­ground. The ­data of 111 (­male: 64; ­female: 47) in the ­period of 1967 ­until 12/93 con­sec­u­tive oper­ated neo­na­tals (<1 ­month) ­were ­studied ret­ro­spec­tively (­mean ­weight 3270 g, ­mean age at oper­a­tion 14 ­days).
­Methods. Pre­ductal ­anatomy was ­present in 96 ­patients. The coarc­ta­tion was iso­lated in 30 ­patients (­group I), 34 ­patients had addi­tional ­large ven­tric­ular ­septal ­defects (­group II) and 47 had com­plex ­heart dis­ease (group III). The pre­op­er­a­tive ­heart cath­et­er­iza­tion ­revealed a gra­dient of <20 ­mmHg in 35%, >20 ­mmHg in 51.4% and >50 ­mmHg in 12.9%. The indi­ca­tion for ­repair was con­ser­va­tively untreat­able ­heart insuf­fi­ciency. In the ­vast ­majority (n=97) of ­patients resec­tion and end-to-end anas­tom­osis ­were per­formed, in 31 ­cases ­using an absorb­able ­suture, in 18 of ­these ­using a con­tin­uous ­suture ­line. In 4 ­patients a sub­cla­vian ­flap angio­plasty (SFA) was ­done, in 4 a ­patch enlarge­ment, 4 ­times a ­repair was ­described as not pos­sible and in 2 ­patients ­there was no gra­dient ­after divi­sion of the ­ductus.
­Results. ­Early ­lethality was 3.3% (n=1) in ­group I, 24.2% (n=8) ­died in ­group II and 39.1% (n=18) in ­group III; ­after intro­ducing Pros­ta­glandin E1 0% in ­group I, 15% in II and 25% in III. Rel­e­vant reco­arc­ta­tion (Gra­dient >20 ­mmHg) devel­oped in 9 (­among ­them 4 ­with hypo­plastic ­arch, 2 ­after SFA) of the 77 ­long-­term sur­vi­vors; 6 of ­these ­were reop­er­ated on, 5 ­without ­residual gra­dient, 1 ­with a gra­dient of 25 ­mmHg ­without clin­ical symp­toms (­after 4 ­years). In the ­last 3 ­patients a bal­loon dila­tion was car­ried out ­without ­residual gra­dient. ­Mean ­follow-up ­time was 6 (0-24) ­years. No ­patient ­needs anti­hy­per­ten­sive treat­ment. The cumu­la­tive sur­vival ­rate is 96.7% (+6.6%) for ­group I, 77.4% (+15.0%) for II and 51.9% (+16.6%) for III.
Con­clu­sions. Resec­tion and end-to-end anas­tom­osis ­using a con­tin­uous absorb­able ­suture is the ­method of ­choice at theo­ret­ical con­sid­er­a­tions and in our expe­ri­ences. The ­number of reco­arc­ta­tions in neo­natal age is rel­a­tively ­high; reinter­ven­tions (oper­a­tion respec­tively dila­tion) can be ­done ­safely and suc­cess­fully.

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