Immediate and medium term results of surgery of coarctation of the aorta in children under 6 months of age.

The aim of this study was to assess the impact of medical and surgical advances on the results of surgery of coarctation of the aorta without major associated cardiac malformations in children aged under 6 months, operated by the surgical team of Tours over a period of 17 years. A retrospective analysis of patients' files allowed inclusion of 75 children : 34 in group 1 (1980-1988) and 41 in group ii (1989-1996). The age at diagnosis, mode of presentation, clinical and echocardiographic parameters, initially and at surgery, were comparable in the two groups. In group II, the surgical procedure of choice changed to the Crafoord procedure (p = 0.0001), the peroperative haemodynamic complications were less common (p = 0.04), patients were operated sooner after diagnosis (p = 0.002) with a higher number of neonates (p = 0.04). There were two early deaths in group I and two late deaths in group II. Six children (8.2%) had recurrence of coarctation. This was more common in children operated before 1 month of age (p = 0.0001) and in cases of hypoplasia of the aortic arch (p< 0.01). The risk of recoarctation in neonates was lower in group II than in group 1 (p< 0.02). At medium term, the coarctation was considered well repaired in 93.7% and 92.6% of patients in group I and II respectively. However, hyper-tension on exercise was observed in 8 of the 19 children studied. Finally secondary surgical or instrumental procedures were required in 9 children to treat associated cardiovascular abnormalities. The authors conclude that in recent years, aortic coarctation was repaired earlier, mainly by a modified Crafoord procedure, with fewer haemodynamic complications, without early mortality The risk of recoarctation remains low but persistent in neonates. At medium term, hypertension on exercise is a common problem even in children with excellent repairs.