Staged surgical treatment of complex form of coarctation of the aorta in neonates and infants
Kishimoto, H.; Yagihara, T.; Sawa, Y.; Nakada, T.; Hirose, O.; Shigi, K.; Oka, N.; Ootake, S.; Matsuda, H.
Nihon Kyobu Geka Gakkai 33(2): 229-236
1985
ISSN/ISBN: 0369-4739 PMID: 3998544 Document Number: 245795
The surgical treatment of coarctation of the aorta was performed in 5 neonates (< 1 mo.) and 1 infant < 2 mo. of age. The onset of congestive heart failure was 3-33 days of age (mean 15 days) and the age of admission was 9-46 days (mean 21 days). Two-dimensional echocardiography and aortography by brachial or radial artery injection were used for diagnosis of coarctation of the aorta. All of them had ventricular septal defect (VSD) and patent ductus arteriosus (PDA). One patient had a tricuspid atresia (TA) and the other one had aortic overriding and aortic valve stenosis. Left ventricular outflow tract obstruction (LVOTO) was observed in 4 of 6 patients. The patients ranged in weight from 1.8-4.1 kg (mean 3.2 kg). All presented in severe congestive heart failure, and 1 was ventilator dependent preoperatively. All were treated with prostaglandin E1 infusion prior to the operation. The subclavian flap aortic reconstruction and ligation of the PDA were performed at 2-7 days (mean 4 days) after admission. Pulmonary artery banding was performed at the time of initial coarctation repair for 2 patients with diagnosis of associated TA or double-outlet right ventricle. One premature infant died from digitalis intoxication. Out of remaining 5 patients, three required VSD closure at age of 4 mo., 38 days and 54 days, respectively. Sternal splintage was used for 2 infants under 8 wk who could not tolerate primary stenal closure. Administration of noradrenaline increased arterial blood pressure and reduced the pressure gradient between left ventricle and aorta. These experiences confirmed the advantage of the staged surgical treatment of this complex form of coarctation of the aorta in infancy.