Review
Coarctation of the aorta: Review of 234 patients and clarification of management problems

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Abstract

Two hundred thirty-four patients with coarctation of the aorta who were managed between 1948 and 1978 were reviewed. Their ages ranged from 1 day to 72 years. Only 6 percent of the patients who had surgical correction between ages 1 and 5 years had residual hypertension. In contrast, 21 percent of those operated on before age 1 year (all with residual or recurrent coarctation), 30 percent of those operated on between ages 6 and 18 years, 47 percent of those operated on between ages 19 and 40 years and 50 percent of patients over 40 age years at the time of operation had residual postoperative hypertension. These data suggest that the optimal time for elective surgical correction of coarctation is between the ages of 1 and 5 years.

Preoperative congestive heart failure was present in 67 percent of patients under age 1 year, in 67 percent of those over age 40 years and in only 4 percent of those aged 1 to 40 years. Eight of the 29 infants with preoperative heart failure had residual postoperative failure related in most to associated congenital cardiac anomalies. Six of the 16 patients with preoperative heart failure who were over age 40 years at correction had residual failure, although even in these patients heart failure was improved. Bacterial endocarditis, cerebral vascular accident, myocardial infarction and aortic dissection were present in 2, 6, 3 and 2 percent of patients, respectively; these complications occurred more frequently with advancing age and occurred in 13 patients who had had prior coarctation repair.

Additional congenital heart lesions were present in 34 percent of the patients. Of those under age 1 year, 67 percent had a clinically significant patent ductus arteriosus with or without ventricular septal defect or aortic stenosis. After age 1 year, 27 percent of the patients had associated cardiac lesions, and no patient had a clinically significant patent ductus or ventricular septal defect. Aortic stenosis or insufficiency was present in 33 patients. When identified during infancy, aortic stenosis was often clinically significant. Thereafter, only eight patients had clinically significant aortic valve disease at the time of this review, and only two of these patients were younger than age 40 years.

References (54)

  • CP Bailey et al.

    Experiences with coarctation of the aorta

    Am J Cardiol

    (1959)
  • WE Ostermiller et al.

    Coarctation of the aorta in adult patients

    J Thorac Cardiovasc Surg

    (1971)
  • ME Abbott

    Coarctation of the aorta of the adult type. I. Complete obliteration of the descending arch at insertion of the ductus in a boy of fourteen; biscuspid aortic valve; impending rupture of the aorta; cerebral death

    Am Heart J

    (1928)
  • ME Abbott

    Coarctation of the aorta of the adult type. II. A statistical study and historical retrospect of 200 recorded cases with autopsy, of stenosis or obliteration of the descending arch in subjects above the age of two years

    Am Heart J

    (1928)
  • AF Hartmann et al.

    Recurrent coarctation of the aorta after successful repair in infancy

    Am J Cardiol

    (1970)
  • CG Parsons

    Recurrent coarctation of the aorta

    Am Heart J

    (1967)
  • C Ibarra-Pérez et al.

    Recoarctation of the aorta: nineteen year clinical experience

    Am J Cardiol

    (1969)
  • CB Morgani

    Desedibus et causis morboram

    (1760)
  • SN Sinha et al.

    Coarctation of the aorta in infancy

    Circulation

    (1969)
  • HT Lang et al.

    Coarctation of the aorta with congestive heart failure in infancy: medical treatment

    Pediatrics

    (1956)
  • AJ Moss et al.

    The growth of the normal aorta and of the anastomotic site in infants following resection of coarctation of the aorta

    Circulation

    (1959)
  • MH Frick

    Major hazards of coarctation of the aorta

    Cardiologia

    (1961)
  • J Sehested

    Evaluation of optimum time for surgical repair of coarctation of the aorta

    Surg Gynecol Obstet

    (1978)
  • AM Margileth et al.

    Coarctation of the aorta: diagnostic and surgical problems

    Arch Surg

    (1964)
  • FTI Oey et al.

    Coarctation of the aorta in older patients

    Thorax

    (1961)
  • WD O'Sullivan et al.

    Contraindications to the surgical therapy of coarctation of the aorta

    Ann Surg

    (1955)
  • BJ Maron et al.

    Prognosis of surgically corrected coarctation of the aorta: a 20-year postoperative appraisal

    Circulation

    (1973)
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