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Long-term follow-up of aortic coarctation in infants, children and adults

Published online by Cambridge University Press:  19 August 2008

Prasad Mathew ,
Douglas Moodie ,
Gary Blechman  and
Carl C. Gill
Prasad Mathew
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Douglas Moodie*
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Gary Blechman
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Carl C. Gill
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
*
Dr. Douglas Moodie, Chairman, Department of Pediatrics, A 120, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. Tel. (216)444-6717.
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Abstract

We have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.

Keywords

Coarctationaortasurvivalhypertensionfollow-up
Type
Original Articles
Information
Cardiology in the Young , Volume 3 , Issue 1 , January 1993 , pp. 20 - 26
Copyright
Copyright © Cambridge University Press 1993

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References

Fyler, DC, Buckley, LP, Hellenbrand, WE, Cohn, HE.Report of the New England Regional Infant Cardiac Program, Pediatrics 1980; 65(Suppl): ???–???.Google Scholar
Crafoord, C, Nylan, G.Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 1945; 14: 347–367.CrossRefGoogle Scholar
Liberthson, RR, Pennington, DG, Jacobs, ML, Dagget, WM.Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol 1979; 43: 835–840.CrossRefGoogle ScholarPubMed
Koller, M, Rothlin, M, Senning, A.Coarctation of the aorta: review of 362 operated patients. Long-term follow-up and assessment of prognostic variables. Eur Heart J 1987; 8: 670–679.CrossRefGoogle ScholarPubMed
Clarkson, PM, Nicholson, MR, Barrat-Boyes, BG, Neutze, JM, Whitlock, RM. Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481–1488.CrossRefGoogle ScholarPubMed
National Heart, Lung and Blood Institutes Task Force on blood pressure control in children. Standards for children's blood pressure. Pediatrics 1977; 59: 802–803.Google Scholar
Zar, J.Biostatistical Analysis. 2nd edition. Prentice-Hall, New York, 1984, pp 150–152.Google Scholar
Cox, DR.Regression models in life tables. J Royal Statistical Soc, Series B 1972; 34: 187–220.Google Scholar
Macmanus, Q, Star, A, Lambert, LE, Grunkemeier, G.Correction of aortic coarctation in neonates: mortality and late results. Ann Thorac Surg 1977; 24: 544–549.CrossRefGoogle ScholarPubMed
Tawes, RL Jr, Aberdeen, E, Waterston, DJ, Carter, REB.Coarctation of the aorta in infants and children: a review of 333 operative cases, including 179 infants. Circulation 1969; 39(Suppl I): I 173–I 184.CrossRefGoogle ScholarPubMed
Kopf, GS, Hellenbrand, W, Kleinman, C, Lister, G, Talner, N, Laks, H.Repair of aortic coarctation in the first three months of life: immediate and long-term results. Ann Thorac Surg 1986; 41: 425–430.CrossRefGoogle ScholarPubMed
Korfer, R, Meyer, H, Kleikamp, G, Bircks, W.Early and late results after resection and end-to-end anastomosis of coarctation of the thoracic aorta in early infancy. J Thorac Cardiovasc Surg 1985; 89: 616–622.CrossRefGoogle ScholarPubMed
Maron, BJ, Humphries, JO, Rowe, RD, Mellits, ED.Prognosis of surgically corrected coarctation of the aorta. A 20 year post-operative appraisal. Circulation 1972; 47: 119–126.CrossRefGoogle Scholar
Williams, WG, Shindo, G, Trusler, GA, Dische, MR, Olley, PM.Results of repair of coarctation of the aorta during infancy. J Thorac Cardiovasc Surg 1980; 79: 603–608.CrossRefGoogle ScholarPubMed
Shinebourne, EA, Tarn, ASY, Elseed, AM, Paneth, M, Lennox, SC, Cleland, WP, Lincoln, C, Joseph, MC, Anderson, RH.Coarctation of the aorta in infancy and childhood. Br Heart J 1976; 38: 375–380.CrossRefGoogle ScholarPubMed
Kish, GF, Tenekjian, VK, Tarney, TJ, Warden, HE, Zimmermann, B.Coarctation of the thoracic aorta: an 18 year experience. Am Surg 1981; 47: 26–47.Google ScholarPubMed
Sorland, SJ, Rostad, H, Forfang, K, Abyholm, G.Coarctation of the aorta. A follow-up study after surgical treatment in infancy and childhood. Acta Pediatr Scand 1980; 69: 113–118.CrossRefGoogle ScholarPubMed
Nanton, MA, Olley, PM.Residual hypertension after coarctectomy in children. Am J Cardiol 1976; 37: 769–772.CrossRefGoogle ScholarPubMed
Hermann, VM, Laks, H, Fagan, L, Terschluse, D, Willman, VL.Repair of aortic coarctation in the first year of life. Ann Thorac Surg 1978; 23: 57–63.CrossRefGoogle Scholar
Connors, JP, Hartmann, AF Jr, Weldon, CS.Considerations in the surgical management of infantile coarctation of the aorta. Am J Cardiol 1975; 36: 489–492.CrossRefGoogle Scholar
Waldhausen, JA, Nahrwrold, PL.Repair of the aorta with a subclavian flap. J Thorac Cardiovasc Surg 1966; 51: 532–533.CrossRefGoogle ScholarPubMed
Pennington, DG, Liberthson, RR, Jacobs, M, Scully, H, Goldblatt, A, Daggett, WM.Critical review of experience with surgical repair of coarctation of the aorta. J Thorac Cardiovasc Surg 1979; 77: 217–229.CrossRefGoogle ScholarPubMed
Presbitero, P, DeMarie, D, Villani, M, Perinetto, EA, Riva, G, Orzan, F, Bobbio, M, Morea, M, Brusca, A.Long-term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 1987; 57: 462–467.CrossRefGoogle ScholarPubMed
Bergdahl, L, Bjork, VO, Jonasson, R.Surgical correction of coarctation of the aorta. The influence of age on late results. J Thorac Cardiovasc Surg 1983; 85: 532–536.CrossRefGoogle ScholarPubMed
Laurie, GM, De Bakey, NE, Morris, GC, Crawford, ES, Wagner, WF, Glaeser, DH.Late repair of coarctation of the descending thoracic aorta in 190 patients. Results upto 30 years after operation. Arch Surg 1981; 116: 1557–1560.CrossRefGoogle Scholar
Bjork, VO, Bergdahl, L, Jonasson, R.Coarctation of the aorta. The world's longest follow-up. Adv Cardiol 1978; 22: 205–215.Google Scholar