Patch graft aortoplasty for repair of coarctation of the aorta in infants under 1 year of age.
Patch graft angioplasty for symptomatic coarctation of the aorta was carried out in 34 infants aged from 6 days to 9,5 months (mean 49,4 days). Congestive cardiac failure was present in 32 and severe hypertension alone in 2 patients. Of the 34 children, 21 (61,8%) had significant associated cardiac lesions and 25 (73,5%) were less than 6 weeks of age. Systolic blood pressures were recorded by the Doppler technique before and after the operation. There were 6 hospital deaths (17,6%) and 3 late deaths, giving a total mortality of 26,5%. Pre-operative systolic pressure gradients between upper and lower limbs ranged from 20 to 92 mmHg (mean 54,5 mmHg). Of the 28 early survivors, 1 was lost to follow-up. Duration of follow-up ranged from 3,5 to 62 months (mean 24,5 months). Postoperative residual gradients of less than 20 mmHg were found in 19 of the 27 cases followed up (70,4%), while 8 patients had significant residual gradients (40 - 90 mmHg). Of these 8, 7 had undergone surgery when less than 6 weeks old, and 6 of them have subsequently undergone a second corrective operation. It is concluded that while patch graft angioplasty is a life-saving procedure for the correction of symptomatic coarctation of the aorta in early infancy, a significant proportion of the patients develop a recurrence of coarctation necessitating further surgery later.