Aortic obstructions in infants and children
Identifieur interne : 002E13 ( Main/Exploration ); précédent : 002E12; suivant : 002E14Aortic obstructions in infants and children
Auteurs : John W. Hammon Jr. [États-Unis]Source :
- Progress in Pediatric Cardiology [ 1058-9813 ] ; 1994.
Abstract
Persistent or recurrent coarctation of the aorta is caused by technical factors at the time of first operation and lack of growth at the area of the anastomosis combined with biochemical alterations in the aortic wall. The most important factor related to recoarctation is the age of the child at the time of first operation, with younger children having a much higher recoarctation rate. Previous subclavian flap aortoplasty predicts a lower recoarctation rate. Indications for operation include upper extremity hypertension or measured gradients between the upper and lower extremities combined with >50% reduction in the size of the aorta at the site of previous operation by an imaging study. Operation should consist of a left thoracotomy in almost every case, with resection of coarctate segment and end-to-end anastomosis when technically feasible. If extensive scarring or aortic wall damage is present, other options include synthetic patch angioplasty or synthetic graft bypass from the ascending aorta or one of its branches. The mortality rate is low and incidence of serious complications including paraplegia are present but appear to be decreasing.Although surgical repair of coarctation of the aorta is a common and safe procedure, persistence of the coarctation or restenosis is not uncommon. Several long-term follow-up studies have documented an incidence of 5% to 11% of persistent or recurrent pressure gradients after primary repair in childhood.1–3 This article addresses the causes of persistent or recurrent coarctation, the indications for operation, and the various surgical options available for the treatment of these conditions.
Url:
DOI: 10.1016/1058-9813(94)90027-2
Affiliations:
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