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Considerations in the surgical management of infantile coarctation of aorta

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      Abstract

      The results of a recent 5 year experience with resection of coarctation of the aorta in infants less than 1 year of age are compared with those of an earlier series from the same institution. The significant improvement in mortality and morbidity statistics is attributed to modifications in operative and postoperative care. Operative mortality has decreased from 38 to 17 percent and the incidence rate of significant restenosis has diminished from 60 to 33 percent. It is suggested that in patients with a large associated intracardiac shunt banding of the main pulmonary artery should be performed before resection of the coarctation. Three of five patients have survived procedures performed in this sequence. Microsurgical techniques and careful approximation of the aortic lumen with interrupted sutures are the major factors responsible for the reduced incidence of recoarctation. Prolonged ventilatory support postoperatively with the occasional addition of controlled positive airway pressure and continued aggressive medical therapy for heart failure are recommended.
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      References

        • Glass IH
        • Mustard WT
        • Keith JS
        Coarctation of the aorta in infants.
        Pediatrics. 1960; 26: 109-121
        • Campbell M
        • Bayles JH
        The course and prognosis of coarctation of the aorta.
        Br Heart J. 1956; 18: 475-495
        • Burford TH
        • Ferguson TB
        • Goldring D
        • et al.
        Coarctation of the aorta in infants: a clinical and experimental study.
        J Thorac Cardiovasc Surg. 1960; 39: 47-59
        • Waldhausen JA
        • King H
        • Nahrwold DL
        • et al.
        Management of coarctation in infancy.
        JAMA. 1964; 187: 116-121
        • Mortensen JD
        • Cutler PR
        • Rumel WR
        • et al.
        Management of coarctation of the aorta in infancy.
        J Thorac Cardiovasc Surg. 1959; 37: 502-509
        • Cooley DA
        • Hallman GL
        Surgery during the first year of life for cardiovascular anomalies.
        in: A review of 500 consecutive operations. Am J Surg. 107. 1964: 584-590
        • Hartmann AF
        • Goldring D
        • Staple TW
        Coarctation of the aorta in infancy.
        in: Hemodynamic studies. J Pediatr. 70. 1967: 95-104
        • Freundlch E
        • Engle MA
        • Goldberg HP
        Coarctation of the aorta in infancy.
        Pediatrics. 1961; 27: 427-439
        • Becker AE
        • Mies BJ
        • Edwards JE
        Anomalies associated with coarctation of the aorta, particular reference to infancy.
        Circulation. 1970; 41: 1067-1075
        • Litwin SB
        • Bernhard WF
        • Rosenthal A
        • et al.
        Surgical resection of coarctation of the aorta in infancy.
        J Pediatr Surg. 1971; 6: 307-313
        • Weldon CS
        • Hartmann AF
        • Steinhoff NG
        • et al.
        A simple, safe and rapid technique for the management of recurrent coarctation of the aorta.
        Ann Thorac Surg. 1973; 15: 510-519
        • Parsons CG
        • Astley R
        Recurrence of aortic coarctation after operation in childhood.
        Br Med J. 1966; 1: 573-577
        • Mulder DG
        • Linde LM
        Recurrent coarctation of the aorta in infancy.
        Am Surg. 1959; 25: 908-911
        • Khoury GH
        • Hawes CK
        Recurrent coarctation of the aorta in infancy and childhood.
        J Pediatr. 1968; 72: 801-806
        • Tawes RL
        • Aberdeen E
        • Waterston DJ
        • et al.
        Coarctation of the aorta in infants and children.
        Circulation 39. 1969; 40: I-173-I-184
        • Anderson DH
        • Kelly J
        Endocardial fibroelastosis: I. Endocardial fibroelastosis associated with congenital malformation of the heart. II. A clinical and pathologic investigation of those cases without associated cardiac malformations, including report of two familial instances.
        Pediatrics. 1956; 18: 513-555
        • Hartmann AF
        • Goldring D
        • Hernandez A
        • et al.
        Recurrent coarctation of the aorta after successful repair in infancy.
        Am J Cardiol. 1970; 25: 405-410
        • Gross RE
        Surgery for coarctation of the aorta in infants.
        Am J Cardiol. 1970; 25: 507-508
        • Malm JR
        • Blumenthal S
        • Jameson AG
        • et al.
        Observations on coarctation of the aorta in infants.
        Arch Surg. 1962; 86: 110-117