Abstract
Introduction: Symptomatic coarctation of the aorta in neonatal age is a critical heart defect requiring urgent surgery, since inadequate blood flow to the lower half of the body results in splanchnic organ ischemia, oliguria up to anuria, which, when associated with left ventricular failure, may lead to death of the child. Patients and results: A total of 281 neonates with coarctation of the aorta underwent surgery at the Pediatric Heart Center of Motol University Hospital in the 1978-2002 period.
In 192 (68.3%) cases, coarctation of the aorta was associated with another intracardiac defect, most often with ventricular septal defect, transposition of the great arteries, or aortic stenosis. Aortic isthmus hypoplasia was diagnosed in 249 (88.6%) patients undergoing surgery while transverse aortic arch hypoplasia was present in 93 (33%) neonates.
Overall, 242 patients had resection of the coarctation with direct aortic anastomosis, with coarctation of the aorta managed by Waldhausen aortic isthmoplasty using the left subclavian artery in 35 patients, while aortic arch plastic surgery using the homograft wall and aortic isthmoplasty using a vascular prosthesis patch or conduit were performed in two cases each. In 40 patients, the hypoplastic transverse aortic arch was enlarged by reverse Waldhausen procedure using the left subclavian artery.
Among patients with heart defects with high pulmonary flow rates, coarctation surgery was combined with pulmonary artery bandage in 95 patients (33.8%) whereas coarctation was associated with another intracardiac defect in 10 cases and managed by on-pump radical correction. Recoarctation of the aorta, diagnosed in 51 patients (18.1%), was managed by balloon angioplasty in 29 cases while 15 patients required reoperation.
The operative mortality of 22.1% reported in the 1978-1990 period, dropped to 7.8% in the 1991-2002 period. Conclusion: Currently, over 50% of patients with coarctation of the aorta have surgery in neonate age.
The original technique of aortic isthmoplasty using the subclavian artery was fully replaced by coarctation resection with direct aortic anastomosis. This resulted in decreases in mortality and morbidity associated with a reduction in the incidence of recoarctation of the aorta.
Some congenital intracardiac defects associated with coarctation of the aorta can be currently managed with success by radical surgery already in neonatal age. Long-term postoperative follow-up of patients is imperative because of the potential for recoarctation at the site of anastomosis or aortic stenosis in the presence of a bicuspid aortic valve.