Repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants

ABSTRACT

The surgical repair of aortic coarctation with hypoplastic distal aortic arch has evolved over time. Some changes came from technique refinements and anatomical variations while other changes came from high rate of residual, recurrence or other complications. We report our experience with performing repair of aortic coarctation with hypoplastic distal aortic arch without prosthetic material to enlarge all areas of distal aortic arch in neonates and infanty. From March 2003 to March 2005, 17 patients ranging in age from 10 days to 8 months with aortic coarctation and hypoplastic distal aortic arch underwent repair.8 paticnts underwent extended end-to-end anastomosis with reversed subclairan flap.5 patients underwent extended end-to-end anastumosis.2 patients underwent extended end-to-end anastomosis with subclavian augmentation.2 patients underwent extended end to-end anastomosis with combined carotid- subclavian arch augmentation. There was no operative mortality. Residual gradients were as follows 7 patients had no residual gradient, 8 patients had low residual gradient [< 20 mmHg] and 2 patients had gradients between 20 and 35 mmHg. There was no paraplegia, recurrent laryngeal nerve injury, Horner's syndrome, phrenic nerve injury or stroke. There was no left arm ischemia, hemorrhage, aneurysm, chylothorax, recoarctation or paradoxical hypertension. Performing repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants is safe, effective, and reproducible and avoids use of prosthetic materials. It has low residual gradient and complication rate