Aortic coarctation repaired within the first year of life: an 11 year review

Summary
Introduction. Congenital heart diseases (CHD) affect 8-12 per 1000 live-born infants and it is one of the most common and serious
congenital anomalies, aortic coarctation (AoCo) accounts for 6-10% of all the congenital heart diseases, and if not diagnosed early
in life it can result in severe morbidity and mortality (3,9,13,11).
Aim of the study. The aim of the study was to analyze the epidemiology of AoCo in newborn in Latvia, to evaluate a single centre 11
year experience with children who underwent AoCo repair in our institution within the first year of life, to define morbidity, mortality,
risk factors, short and long term results.
Materials and methods. The study was approved by the committee of ethics of the university hospital for children. Retrospective
and prospective study/follow-up of all (74) patients younger than 12 months undergone native coarctation repair in our institution
between January1, 2000 and December 31, 2010.
Results. The prevalence of the coarctation of the aorta in Latvia was 3.43+/-1.2 per 10 000 life born infants. Seventy-four neonates
and infants were analyzed: 44 boys (59%) and 30 girls (41%). Median age at the time of primary surgical correction was 47.3+/-58
days, medium weight 4.2+/-1.6kg. Prostoglandin E1 was used in 62%, inotropic stimulation in 20% of cases, assisted ventilation in
18%. According to the anatomy of the congenital heart disease patients constituted group I- the patients with simple coarctation with
and without atrial septal defect (ASD) in 57%, group II –patients with coarctation and ventricular septal defect (VSD) 23%, group
III- complex coarctation 20%. The infantile juxtaductal AoCo with isthmus hypoplasia was detected in 83%(n=62), postductal AoCo
in 4%(n=3) and juxtaductal membrane in 12%(n=9), hypoplasia of the aortic arch in 16%(n=12). The techniques for primary repair
included the resection with simple anastomosis end-to-end (ETE) in 26% (n=19), subclvian flap aortoplasty(SFA) in 65%(n=48) and
extended anastomosis end-to-end (eETE) in 8%(n=6), primary balloon angioplasty in 1 case. There were 5 cases (6,8%) of early
postoperative death and 9 cases of later death. Recoarctation occurred in 14 patients (23%), all underwent balloon angioplasty with
no significant residual gradient, and there was no mortality or complications after reinterventions.
Conclusions. The surgical correction of the AoCo remains gold standard for neonates and small infants. There were no statistically
significant differences between the incidences of recoarctation dependent on the method of primary surgical correction. The
incidence of recoarctation in cases of primary surgical correction early in life remains comparatively high. Baloon angioplasty is
a method of choice in cases of recoarctation, it is safe and effective with low incidence of persistent coarctation. Mortality is most
importantly influenced by preoperative status, the severity of associated anomalies, surgical outcomes, perioperative intensive
treatment.
Key words: aortic coarctation, congenital heart disease.