Surgical correction of coarctation of the aorta with distal aortic arch hypoplasia in infants
Published 2016-08-17
Keywords
- coarctation of the aorta,
- arterial hypertension,
- recoarctation of the aorta,
- aortic aneurysms.
How to Cite
Copyright (c) 2016 Soynov I.A., Sinelnikov Yu.S., Kornilov I.A., Nichay N.R., Gasanov E.N., Kulyabin Yu.Yu., Omelchenko A.Yu., Gorbatykh Yu.N.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Aim: The paper focuses on assessment of the late results and causes of complications when repairing coarctation with distal aortic arch hypoplasia.
Methods: This prospective randomized study included 54 patients who underwent repair of coarctation of the aorta. All patients were divided in 2 groups depending on the correction type: reconstruction using the modified reverse left subclavian artery flap plasty (Group I, 27 pts) or extended end-to-end anastomosis (Group II, 27 pts).
Results: A postoperative follow-up period was 26 (21;31) months. Recoarctation of the aorta during long-term follow-up was found in 1 patient (3.84%) in Group I and in 2 patients (7.7%) in Group II (p=0.5). Two patients in the Group I (7.7%) and 8 patients in the Group II (30.8%) had arterial hypertension (p=0.03).
Conclusion: With modern types of surgical correction used, the anastomotic area tended to proportionally grow in different segments of the aortic arch and did not influence the postoperative complications rate. Endocardial fibroelastosis and ascending aortic wall rigidity could be considered as predictors of arterial hypertension in the late period after coarctation repair in infants. Low body weight before surgery is a factor of aortic recoarctation development in the late postoperative period. Arterial hypertension persistence depends on the correction type. One-stage reconstruction of the distal aortic arch allows for reducing the rate of arterial hypertension from 30.8% to 7.7%. Despite a range of complications in the late postoperative period, the infants’ quality of life was not affected and was high in both groups.
References
- Soynov IA, Sinelnikov YuS, Gorbatykh AV, Nichay NR, Ivantsov SM, Kornilov IA, Kshanovskaya MS, Gorbatykh YuN. Arterial hypertension in patients with repaired coarctation and hypoplastic aortic arch. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(2):102-13. (In Russ.).
- Soinov IA, Sinelnikov YuS, Kliver EE, Kornilov IA, Nichai NR, Gorbatykh AV, Kulyabin YuYu, Gorbatykh YuN. Morphological features of brachiocephalic arteries in patients with aortic arch hypoplasia. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(4):14-8. (In Russ.).
- Jenkins NP, Ward C. Coarctation of the aorta: natural history and outcome after surgical treatment. QJ Med. 1999;92:365-371.
- Luijendijk P, Bouma BJ, Vriend JW, Vliegen HW, Groenink M, Mulder BJ. Usefulness of exercise-induced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood. Am J Cardiol. 2011;108(3):435-9.
- Gorbatykh IuN, Sinelnikov IuS, Soinov IA, Kornilov IA, Kshanovskaya MS, Gorbatykh AV, Ivantsov SM, Omelchenko AYu. Surgical treatment of aortic arch malformations in infants under cardiopulmonary bypass. Khirurgiya. Zhurnal imeni N.I. Pirogova = Surgery named after N.I. Pirogov. 2015;8:18-21. (In Russ.).
- Pandey R, Jackson M, Ajab S, Gladman G, Pozzi M. Subclavian flap repair: review of 399 patients at median follow-up of fourteen years. Ann Thorac Surg. 2006;81:1420-8.
- Sciolaro C, Copeland J, Cork R, Barkenbush M, Donnerstein R, Goldberg S. Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-to-end anastomosis. J Thorac Cardiovasc Surg. 1991;101:1-13.
- Backer C, Mavroudis C, Zias EA. Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg. 1998;66:1365-71.
- Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008;21(8):922-34. http://dx.doi.org/10.1016/j.echo.2008.02.006
- Kuhn A, Baumgartner C, Horer J, Schreiber C, Hess J, Vogt M. Impaired elastic properties of the ascending aorta persist within the first three years of neonatal coarctation repair. Pediatr Cardiol. 2009;30:46-51. http://dx.doi.org/10.1007/s00246-008-9280-6
- Ou P, Celermajer D, Mousseaux E, Giron A, Aggoun Y, Szezepanski I, Sidi D, Bonnet D. Vascular remodelling after successful repair of coarctation. J Am Coll Cardiol. 2007;49:883-90.
- The fourth on the diagnosis and treatment of the high blood pressure in children and adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114(2):555-76.
- Uzark K, Jones K, Slusher J, Limbers CA, Burwinkle TM, Varni JW. Quality of life in children with heart disease as perceived by children and parents. Pediatrics. 2008;121(5):1060-7. http://dx.doi.org/10.1542/peds.2006-3778
- Sinelnikov YS, Gorbatyh AV, Ivantsov SM, Strelnikova MS, Kornilov IA, Gorbatyh YN. Reverse subclavian flap repair and maintenance of antegrade blood flow within the left subclavian artery in neonates with aortic coarctation and distal arch hypoplasia. Heart Surg Forum. 2013;16(1):52-6. http://dx.doi.org/10.1532/HSF98.20121044
- O'Sullivan JJ, Derrick G, Darnell R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart. 2002;88:163-6.
- Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J. Coarctation long term follow up: significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical resection of isolated coarctationevenin the absence of recordation and prosthetic material. J Thorac Cardiovasc Surg. 2007;134:738-45. http://dx.doi.org/10.1016/j.jtcvs.2007.04.027
- Sinelnikov YuS, Kshanovskaya MS, Prokhorova DS, Nartsissova GP, Gorbatych AV, Ivanzov SM, Soinov IA, Kornilov IA. Surgical correction of aortic coarctation: does it always satisfy expectations? The Siberian Medical Journal. 2013;28(4):55-8. (In Russ.).
- Kenny D, Polson J, Martin R, Caputo M, Wilson D, Cockcroft J, Paton J, Wolf A. Relationship of aortic pulse wave velocity and baroreceptor reflex sensitivity to blood pressure control in patients with repaired coarctation of the aorta. Am Heart J. 2011;162:398-404. http://dx.doi.org/10.1016/j.ahj.2011.03.029
- Brili S, Antonopoulos AS, Oikonomou E, Kalampogias A, Papamikroulis G-A, Chrysochoou C, Mourouzis K, Nihoyanopoulos P, Tousoulis D. Impairment of arterial elastic properties and elevated circulation levels of transforming growth factor-beta in subjects with repaired coarctation of aorta. International Journal of Cardiology. 2016;207:282-3. http://dx.doi.org/10.1016/j.ijcard.2016.01.168
- Cobanoglu A, Teply JF, Grunkemeier GL, Sunderland CO, Starr A. Coarctation of the aorta in patients younger than three months: a critique of the subclavian flap operation. J Thorac Cardiovasc Surg. 1985;89:128-35.
- Zehr K, Gillinov M, Redmond M, Greene PS, Kan JS, Gardner TJ, Reitz BA, Cameron DE. Repair of coarctation of the aorta in neonates and infants: a thirty year experience. Ann Thorac Surg. 1995;59:33-41.
- Poirier NC, Van Arsdell GS, Brindle M, Thyagarajan GK, Coles JG, Black MD, Freedom RM, Williams WG. Surgical treatment of aortic hypoplasia in infants and children with biventricular hearts. Ann Thorac Surg. 1999;68:2293-7.
- Fiore AC, Fischer LK, Schwartz T, Jureidini S, Balfour I, Carpenter D, Demello D, Virgo KS, Pennington DG, Johnson RG. Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg. 2005;80:1659-65.
- Unnikrishnana M, Theodorea S, Peter AM. Late thoracic aortic dissecting aneurysm following balloon angioplasty for recoarctation after subclavian flap aortoplasty in childhood—successful surgical repair under circulatory arrest. European Journal of Cardio-thoracic Surgery. 2005;27:520-2.
- Theodore S, Varma PK, Neema PK, Neelakandhan KS. Late aneurysm formation with destruction of the left lung after subclavian flap angioplasty for coarctation of aorta. J Thorac Cardiovasc Surg. 2005;129:468-9. http://dx.doi.org/10.1016/j.jtcvs.2004.07.026