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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 226-230, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
FW Hehrlein, J Mulch, HW Rautenburg, M Schlepper and HH Scheld
From 1957 to 1984 direct and indirect isthmoplasty as described by
Vossschulte has been the method of choice for surgical therapy of
coarctation of the aorta in our hospital. A total of 317 patients have been
so treated, 54 of whom were less than 12 months old at operation. The
hospital mortality in this group was 15% and the mortality in patients
older than 1 year was 3%. The early results were encouraging, but during
follow-up an increasing number of postoperative aneurysms have been
detected. During reinvestigation an aneurysm was diagnosed in 18 cases.
Therefore, we have studied the cause of these aneurysms. To this point
reoperation has been performed in 15 patients having late aneurysms.
Extensive resection of a fibrous membrane of the aortic isthmus at the
first intervention seems to be an essential predisposing factor for
development of aneurysms. Microscopic examination of the aneurysmal wall
revealed degeneration of the media in more than half of the patients. From
our experience we conclude that the posterior fibrous ridge should no
longer be excised and the Vossschulte operative technique should be viewed
more critically.
ARTICLES
Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation
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