HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pellegrino, A. Articles by Tynan, M. Search for Related Content PubMed PubMed Citation Articles by Pellegrino, A. Articles by Tynan, M.

The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 121-127, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Aortic coarctation in the first three months of life. An anatomopathological study with respect to treatment

A Pellegrino, PB Deverall, RH Anderson, A Smith, JL Wilkinson, P Russo, DA Girod and M Tynan

Operation for coarctation in infancy is a lifesaving procedure, but it still carries a high mortality and is followed frequently by recurrence of stenosis. This is especially true when the procedure is performed in the first 3 months of life. To determine a correlation, if any, between anatomy of coarctation and surgical procedures, we have studied a series of 42 autopsy specimens from patients younger than 3 months who had aortic coarctation. We found that concepts of coarctation based solely on a discrete lesion or isthmic hypoplasia were simplistic. The anatomy was much more complex, the findings being relevant to surgical techniques currently in use (resection and end-to-end anastomosis, subclavian flap aortoplasty). Of equal significance in the cases we studied to the presence of a shelf of ductal tissue within the aortic lumen or hypoplasia of a segment of the arch was the finding of "waist" lesions. In these cases the wall of the aorta was constricted to form the obstruction. Such "waists" coexisted with discrete shelves or with shelves and isthmic narrowing. While we recognize the danger of extrapolating from autopsy findings to predict clinical results, our observations suggest that surgical procedures might best be tailored to the precise anatomy present. It seemed that in may cases a subclavian flap procedure offered the best chance of success. Cases with anatomy suitable for resection and end-to-end anastomosis were less frequent. Percutaneous angioplasty seemed at best to offer only palliative options in limited cases.

This article has been cited by other articles:

				B. S. Allen, A. O. Halldorsson, M. J. Barth, and M. N. Ilbawi Modification of the subclavian patch aortoplasty for repair of aortic coarctation in neonates and infants Ann. Thorac. Surg., March 1, 2000; 69(3): 877 - 880. [Abstract] [Full Text] [PDF]

				N. C. Poirier, G. S. Van Arsdell, M. Brindle, G. K. Thyagarajan, J. G. Coles, M. D. Black, R. M. Freedom, and W. G. Williams Surgical treatment of aortic arch hypoplasia in infants and children with biventricular hearts Ann. Thorac. Surg., December 1, 1999; 68(6): 2293 - 2297. [Abstract] [Full Text] [PDF]

				H. Hovaguimian, V. Senthilnathan, J. P. Iguidbashian, D. M. McIrvin, and A. Starr Coarctation Repair: Modification of End-to-End Anastomosis With Subclavian Flap Angioplasty Ann. Thorac. Surg., June 1, 1998; 65(6): 1751 - 1754. [Abstract] [Full Text] [PDF]

				R. M. H. J. Brouwer, A. H. Cromme-Dijkhuis, M. E. Erasmus, C. Contant, A. J. J. C. Bogers, N. J. Elzenga, T. Ebels, and A. Eijgelaar DECISION MAKING FOR THE SURGICAL MANAGEMENT OF AORTIC COARCTATION ASSOCIATED WITH VENTRICULAR SEPTAL DEFECT J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 168 - 175. [Abstract] [Full Text]

				L. W. E. van Heurn, C. M. Wong, D. J. Spiegelhalter, K. Sorensen, M. R. de Leval, J. Stark, and M. J. Elliott Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990Success of extended end-to-end arch aortoplasty J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 74 - 86. [Abstract] [Full Text]

				A. P. Kappetein, A. H. Zwinderman, A. J. J. C. Bogers, J. Rohmer, and H. A. Huysmans More than thirty-five years of coarctation repairAn unexpected high relapse rate J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 87 - 95. [Abstract] [Full Text]