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A Journal on Cardiac, Vascular and Thoracic Surgery

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

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


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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