Early and mid term results of surgical repair of coarctation of the aorta: experience of Benha in 19 patients with simple coarctation of the aorta

ABSTRACT

To evaluate early and mid-term results of surgical repair of coarctation of the aorta in patients with isolated [simple] coarctation of the aorta. Between March 2000 and February 2005, nineteen patients diagnosed as cases of isolated coarctation of the aorta [with or without PDA] using Echocardiography .They underwent resection of the coarctated segment with end-to-end anastomosis. The patients were followed up for a mean period 23.8 +/- 7.4 months. In each visit, the patient was clinically evaluated for blood pressure, gradient [by echocardiography], neurological and recoarctation symptoms. The age ranged from 6 months to 9 years [mean of 4.4 +/- 2.8 gears] and 12 patients of them [63%] were males. The patients presented with different symptoms in the form of claudications in 12 patients [63%], headache in 10 patients [54%], chest pain in 3 patients [16%], and repeated chest infections in 7 patients [36%]. On examination, 14 patients [73%] had weak femoral pulse, and 11 patients [58%] had systolic continuous murmur conducted to the back. All the patients had hypertension which was defined as blood pressure greater than that of the 90th percentile for age, On measuring blood pressure, the mean upper limb blood pressure was 129/83 +/- 6.7/5.7 mm Hg, and the mean gradient was 35.4 +/- 6.8mm Hg. Operatively, the mean operative time was 149.2 +/- 14.6 minutes, the mean cross clamp time was 25.7 +/- 2.4 minutes, the mean intercostal tube [ICT] period was 2.7 +/- 0.8 days, the mean ICU stay was 1.6 + 0.6 days and the mean hospital stay was 9.9 +/- 1.6 days. There was no operative or hospital mortality. There was immediate postoperative increase in mean blood pressure which was 131/82 +/- 6/3 mm Hg, this increase was controlled with infusion of antihypertensive drugs. However, all the patients had dramatic improvement in blood pressure before discharge as the mean blood pressure on discharge was 114/67 +/- 6/4 mm Hg and the mean gradient on discharge was 13.3 +/- 5.1mm Hg. On follow up, the signs of hypertension occurred in total of 4 patients [21%], unfortunately, 2 of them died due to heart failure [11 and 15 months postoperatively]. The other 2 patients with postoperative hypertension were on one antihypertensive medication to control blood pressure. There was significance difference [P Value less than 0.05] between both mean blood pressure as well as mean gradient on admission and both on discharge, also, there was significant difference between both mean blood pressure and mean gradient on admission and both on 30 months after surgery. Surgical repair of isolated coarctation of the aorta by the technique of excision of the coarctated part with end-to-end anastomosis is essential in young patients to avoid subsequent morbidity and premature mortality. The short-term and mid-term results were satisfactory and encouraging