RECOARCTATION OF AORTA - 19 YEAR CLINICAL EXPERIENCE

Recoarctation of the aorta has occurred in 20 (8.5 per cent) of 235 patients with adequate follow-up study after repair of coarctation of the aorta. All 20 patients were reoperated upon (4 had the first procedure performed elsewhere). Twelve were boys. The subjects ranged in age from 2 weeks to 15 years at the time of the first operation; significantly, however, 15 were 3 years or less. In 9 cases signs of recoarctation developed within five months of the procedure and were rapidly progressive in 6 cases. Sixteen patients had a technically satisfactory second procedure; I did not have repair because of anatomic limitations; 3 patients died during reoperation. One additional death occurred 40 days postoperatively because of rupture of a false aneurysm at the suture line. Of the 16 survivors, only 3 had evidence of recurrent obstruction, which was of significant degree in 2 patients. Recoarctation was attributed to insufficient resection of the coarcted segment in 1 patient, residual ductal tissue in 1, kinking of a left subclavian artery in 1 and thrombosis of a graft in another; fibrosis at the suture line was a significant factor in 8 cases. In the remaining cases the cause was not readily identifiable, but may possibly have been a result of failure of adequate growth at an anastomosis performed with a continuous suture. In 6 patients, obstruction proximal to the anastomosis may have played an important role in the development of the recoarctation. Indications for reoperation are progressive signs and symptoms of obstruction, with a difference in blood pressure between the upper and lower limbs of at least 40 mm. Hg. Aortography should confirm a significant narrowing, and a gradient of 40 mm. Hg or more should be substantiated by catheterization. If recoarctation is associated with reappearance of refractory heart failure, reoperation should be prompt. If recoarctation is slowly progressive, reoperation can wait until a fair-sized anastomosis can be achieved; however, procrastination until adult age should be avoided, thus minimizing the need for a prosthesis. © 1969.