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Asian Cardiovasc Thorac Ann 2002;10:310-313
© 2002 Asia Publishing EXchange Pte Ltd

ORIGINAL CONTRIBUTION

Coarctation of the Aorta in Neonates And Young Infants: Surgical Experience

Narasinga Rao Pantula, MCh, Raghavan Nair Suresh Kumar, DM1, Anil Kumar Dharmapuram, MCh, Mohmoud Hassan Mohamed, MCh, Sushil Chandran, MCh, Achal Kumar Dhir, FRCA2, Dileep Kumar Saxena, MD2, Sivan Pillay Azhagappan, MD2, Velayudhan Ramakrishna Pillai, MD1, Venkitachalam Chokkanathapuram Gopalakrishnan, MD1, Mohamed Amin Fikree, FRCP1, Yousuph Abdul Nazer, MCh, Timothy Boyd Cartmill, FRACS, Mrutyunjaya Rao Ivatury, MCh

Department of Cardiac Surgery
1 Department of Cardiology
2 Department of Cardiac Anaesthesia Al Mafraq Hospital Abu Dhabi UAE
For reprint information contact: Ivatury Mrutyunjaya Rao, MCh Tel: 971 2 582 3100 Fax: 971 2 582 1549 email: imrao{at}emirates.net.ae Department of Cardiac Surgery, Al Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE.
A retrospective analysis of repair of aortic coarctation in young infants was conducted. Between April 1997 and December 2000, 21 patients under 4 months of age underwent repair of coarctation. Their mean age and weight were 41 ± 42 days (range, 2 to 120 days) and 3.6 ± 0.7 kg (range, 2.6 to 4.9 kg). The indications for surgery were congestive heart failure and/or shock. Diagnosis was made by 2-dimensional echocardiography with Doppler color flow imaging. Preoperative gradients ranged from 25 to 100 mm Hg. Aortic arch hypoplasia was present in 8 patients; 7 patients also had ventricular septal defect. Wide excision of the coarctation segment with extended end-to-end anastomosis was performed in 20 patients, while 1 required a Gore-Tex interposition graft between the left common carotid artery and the descending aorta. Subclavian angioplasty was performed to augment the anastomosis in 1 patient. There was no early mortality. One patient died 2 months after surgery. Follow-up examination revealed recoarctation in 5 patients (23.8%), all of whom underwent successful balloon dilatation. In conclusion, wider excision of the coarctation with extended end-to-end anastomosis reduces the chances of recoarctation. Percutaneous balloon angioplasty for treating recoarctation is effective in immediately reducing pressure gradients.






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