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Left arm structure and function late after subclavian flap repair of aortic coarctation in childhood

Published online by Cambridge University Press:  20 June 2019

Mark R. Dennis Open the ORCID record for Mark R. Dennis [Opens in a new window] ,
Anne Cusick ,
Jacinta Borilovic ,
Calum Nicholson ,
Tanya Derwin ,
Rajesh Puranik  and
David S. Celermajer
Mark R. Dennis
Affiliation:
The University of Sydney, Sydney Medical School, NSW 2006, Australia Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia Specialist MRI, Newtown, Sydney 2050, Australia
Anne Cusick
Affiliation:
The University of Sydney, Discipline of Occupational Therapy, NSW 2006, Australia
Jacinta Borilovic
Affiliation:
The University of Sydney, Discipline of Occupational Therapy, NSW 2006, Australia
Calum Nicholson
Affiliation:
Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia Heart Research Institute, Sydney, 2006, Australia
Tanya Derwin
Affiliation:
Specialist MRI, Newtown, Sydney 2050, Australia
Rajesh Puranik
Affiliation:
The University of Sydney, Sydney Medical School, NSW 2006, Australia Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia Specialist MRI, Newtown, Sydney 2050, Australia
David S. Celermajer*
Affiliation:
The University of Sydney, Sydney Medical School, NSW 2006, Australia Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Australia Heart Research Institute, Sydney, 2006, Australia
*
Author for correspondence: Professor David Celermajer, Cardiology Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia. Tel: 61-2-9515 6111; Fax: 61-2-9519 4938; E-mail: david.celermajer@health.nsw.gov.au
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Abstract

Objectives:

Concerns exist over the long-term consequences of subclavian artery ligation in subclavian flap repair for coarctation of the aorta. We sought to analyse upper limb structural and functional performance in adults who have had surgery in childhood for coarctation of the aorta, using either subclavian flap repair or end to end aortic anastomosis.

Methods:

Two-group observational design using anatomical and upper limb functional performance measures. Purposive sampling from our specialist adult congenital heart disease database of patients who received subclavian flap repair or end to end anastomosis for coarctation of the aorta as children. Upper limb measurements were completed using MRI and blood flow velocity with ultrasound imaging. Bilateral standardised upper limb functional testing of assessment of strength, dexterity and a standardised self-report of upper limb disability was completed.

Results:

Eighteen right-handed patients, 9 with subclavian repair, (38 ± 12 years, 78% males) were studied. Age at repair was 4.7 ± 5.9 years; mean time from initial repair 32 ± 9 years. The subclavian group had a larger difference between right and left when compared the end to end anastomosis group in: lower arm muscle mass (94.5 ± 42.3 mls versus 37.8 ± 94.5 mls, p = 0.008), lower arm maximal cross-sectional area, (5.9 ± 2.8 cm2 versus 2.9 ± 2.6 cm2, p = 0.038) and grip strength (14.7 ± 8.3 lbs versus 5.9 ± 5.3 lbs, p = 0.016) There were no significant functional differences between groups.

Conclusions:

In adults with repaired coarctation of the aorta, those with subclavian flap repair had a greater right to left arm muscle mass and grip strength differential when compared to those with end to end anastomosis repair.

Keywords

CHDmuscle massgrip strengthfunction
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 856 - 861
Copyright
© Cambridge University Press 2019 

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