Aortic coarctation is a congenital narrowing of the descend ing thoracic aorta at or near the connection of the ductus arteriosus. It is the sixth most common congenital heart disease in the pediatric age group and constitutes 8% of congenital heart anomalies. Delivering anesthesia care to children undergoing coarctation repair is challenging be cause the anesthetist and the surgeon do not have the immediate safety net provided by cardiopulmonary bypass. Once the aorta is cross-clamped and the repair begins, the anesthesiologist is at the mercy of the surgeon's technical skill and speed and the child's ability to tolerate aortic cross- clamping. This article addresses the etiology and morphol ogy of this lesion. In addition, the perioperative anesthetic management principles relating to coarctation repair are discussed.
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References
1.
Rudolph AM, Heymann MA, Spitznas U.: Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol30:514-524, 1972
2.
Backer CL, Mavroudis C.: Coarctation of the aorta and interrupted aortic arch, in Baue AE, Geha AS, Hammond GL, et al (eds): Glenn's Thoracic and Cardiovascular Surgery, vol 2 (ed 6). Stamford, CT, Appleton & Lange, 1996, pp 1243-1269
3.
Castaneda AR, Jonas RA, Mayer JE, Jr, et al: Aortic coarctation, in Castaneda AR, Jonas RA, Mayer JE, Jr, et al (eds): Cardiac Surgery of the Neonate and Infant. Philadelphia, PA, Saunders , 1994, pp 333-352
4.
Russell GA, Berry PJ, Watterson K.: Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg102:596-601, 1991
Miller MJ, Geffner ME, Lippe BM: Echocardiography reveals a high incidence of bicuspid aortic valve in Turner syndrome. Pediatrics102:47-50, 1983
7.
Hughes HE, Davies SJ: Coarctation of the aorta in Kabuki syndrome. Arch Dis Child70:512-514, 1994
8.
Wilson DI, Cross IE, Goodship JA: DiGeorge syndrome with isolated aortic coarctation and isolated ventricular septal defect in three sibs with a 22q11 deletion of maternal origin. Br Heart J66:308-312, 1991
9.
Kirklin JW, Barratt-Boyes BG: Coarctation of the aorta and interrupted aortic arch, in Kirklin JW, Barratt-Boyes BG (eds): Cardiac Surgery, vol 2 (ed 2). New York, NY, Churchill Livingstone, 1993, pp 1263-1325
10.
Mathew R., Simon G., Joseph M.: Collateral circulation in coarctation of aorta in infancy and childhood. Arch Dis Child47:950-953, 1972
11.
Gersony WM: Coarctation of the aorta and ventricular septal defect in infancy: Left ventricular volume and management issues. J Am Coll Cardiol14:1553-1554, 1989
12.
Neches WH, Park SC, Lenox CC: Coarctation of the aorta with ventricular septal defect. Circulation55:189-194, 1977
13.
Park JK, Dell RB, Ellis K.: Surgical management of the infant with coarctation of the aorta and ventricular septal defect. JACC20:176-180, 1992
14.
Quaegebeur JM, Jonas RA, Weinberg AD: Outcomes in seriously ill neonates with coarctation of the aorta. J Thorac Cardiovasc Surg108:841-854, 1994
15.
Heymann MA, Berman W, Jr, Rudolph AM: Dilatation of the ductus arteriosus by prostaglandin E1 in aortic arch abnormalities. Circulation59:169-173, 1979
16.
Jonas RA, Lang P., MayerJE: The importance of prostaglandin E1 in resuscitation of the neonate with critical aortic stenosis. J Thorac Cardiovasc Surg89:314-315, 1985
17.
Zehr KJ, Gillinov AM, Redmond JM: Repair of coarctation of the aorta in neonates and infants: A thirty-year experience. Ann Thorac Surg59:33-41, 1995
18.
Ing FF, Starc TJ, Griffiths SP: Early diagnosis of coarctation of the aorta in children: A continuing dilemma . Pediatrics98: 378-382, 1996
19.
Rosen DA, Rosen KR: Anomalies of the aortic arch and valve, in Lake C (ed): Pediatric Cardiac Anesthesia (ed 3). Stamford, CT, Appleton & Lange, 1998, pp 431-469
20.
Parker FB, Farrell B., Streeten Dhp: Hypertensive mechanisms in coarctation of the aorta. J Thorac Cardiovasc Surg80:568-573, 1980
21.
Sehested J. , Baandrup U., Mikkelsen E.: Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Circulation65:1060-1065, 1982
22.
Matsuyama K. , Sonoda E., Nakao K.: Baroreceptor reflex in a patient with coarctation of the aorta. Clin Cardiol10:535-536, 1987
23.
Morriss Mjh, McNamara DG: Coarctation of the aorta and interrupted aortic arch, in Garson A, Bricker JT, McNamara DG (eds): The Science and Practice of Pediatric Cardiology. Philadelphia, PA, Lea & Febiger, 1990, pp 1353-1381
24.
Mullen JC, Bentley MJ, Talwar MK: Coarctation of the aorta: Tailoring the surgical approach. Can J Cardiol13:931-935, 1997
25.
Pfammatter JP, Ziemer G., Kaulitz R.: Isolated aortic coarctation in neonates and infants: Results of resection and end-to-end anastomosis. Ann Thorac Surg62:778-783, 1996
26.
Hovaguimian H., Senthilnathan V., Iguidbashian JP: Coarctation repair: modification of end-to-end anastomosis with subclavian flap angioplasty. Ann Thorac Surg65:1751-1754, 1998
27.
Cobanoglu A. , Thiagarajan GK, Dobbs JL: Surgery for coarctation of the aorta in infants younger than 3 months: End-to-end repair versus subclavian flap angioplasty: Is either operation better?Eur J Cardiothorac Surg14:19-26, 1998
28.
Dietal CATorres AR, Favaloro RG, et al: Risk of recoarctation in neonates and infants after repair with patch aortoplasty, subclavian flap, and the combined resection-flap procedure . J Thorac Cardiovasc Surg103:724-732, 1992
29.
Rao PS: Long-term follow-up results after balloon dilatation of pulmonic stenosis, aortic stenosis, and coarctation of the aorta: A review. Prog Cardiovasc Dis42:59-74, 1999
30.
Caspi J., Ilbawi MN, Milo S.: Alternative techniques for surgical management of recoarctation. Eur J Cardiothorac Surg12: 116-119, 1997
31.
Hijazi ZM, Fahey JT, Kleinman CS: Balloon angioplasty for recurrent coarctation of aorta. Circulation84:1150-1156, 1991
32.
Crawford FA , Jr, Sade RM: Spinal cord injury associated with hyperthermia during aortic coarctation repair. J Thorac Cardiovasc Surg87:616-618, 1984
33.
Bennett Mwr , Cheema Sps, Entress AH: The use of thoracic epidural anesthesia in repair of an aortic coarctation. J Cardiothor Anesth9:174-176, 1995
34.
Lerberg DB, Hardesty RL, Siewers RD: Coarctation of the aorta in infants and children: 25 years of experience. Ann Thorac Surg33:159-170, 1982
35.
Park SC, Neches WH: The neurologic complications of congenital heart disease. Neurol Clin11:441-462, 1993
36.
Krieger KH, Spencer FC: Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross-clamping?Surgery97:2-7, 1985
37.
Pollock JC, Jamieson MP, McWilliam R.: Somatosensory evoked potentials in the detection of spinal cord ischemia in aortic coarctation repair. Ann Thorac Surg41:251-254, 1986
38.
Brewer LA, Fosburg RG, Mulder GA: Spinal cord complications following surgery for coarctation of the aorta. J Thorac Cardiovasc Surg64:368-381, 1972
39.
Dasmahapatra HK, Coles JG, Taylor MJ: Identification of risk factors for spinal cord ischemia by the use of monitoring of somatosensory evoked potentials during coarctation repair. Circulation76:14-18, 1987 (suppl)
40.
Watterson KG , Dhasmana JP, O'Higgins JW: Distal aortic pressure during coarctation operation. Ann Thorac Surg49: 987-990, 1990
41.
Marini CP, Grubbs PE, Toporoff B.: Effect of sodium nitroprusside on spinal cord perfusion and paraplegia during aortic cross-clamping. Ann Thorac Surg47:379-383, 1989
42.
Sealy WC: Coarctation of the aorta and hypertension. Ann Thorac Surg3:15-28, 1967
43.
Sealy WC: Paradoxical hypertension after repair of coarctation of the aorta: A review of its causes. Ann Thorac Surg50:323-329, 1990
44.
Rocchini AP , Rosenthal A., Barger AC: Pathogenesis of paradoxical hypertension after coarctation resection. Circulation54:382-387, 1976
45.
Benedict CR , Grahame-Smith DG, Fisher A.: Changes in plasma catecholamines and dopamine beta-hydroxylase after corrective surgery for coarctation of the aorta. Circulation57:598-602, 1978
46.
Fox S., Pierce WS, Waldhausen JA: Pathogenesis of paradoxical hypertension after coarctation repair. Ann Thorac Surg29:135-141, 1980
47.
Parker FB, Jr, Streeten DH, Farrell B., et al: Preoperative and postoperative renin levels in coarctation of the aorta. Circulation66:513-514, 1982
48.
Casta A., Conti VR, Talabi A.: Effective use of captopril in postoperative paradoxical hypertension of coarctation of the aorta. Clin Cardiol5:551-553, 1982
49.
Gidding SS, Rocchini AP, Beekman R.: Therapeutic effect of propranolol on paradoxical hypertension after repair of coarctation of the aorta. N Engl J Med312:1224-1228, 1985
50.
Leenen Fhh, Balfe JA, Pelech AN: Postoperative hypertension after repair of coarctation of aorta in children: Protective effect of propranolol. Am Heart J113:1164-1173, 1987
51.
Smerling A. , Gersony WM: Esmolol for severe hypertension following repair of aortic coarctation. Crit Care Med18:1288-1290, 1990
52.
Simsolo R., Grunfeld B., Gimenez M.: Long-term systemic hypertension in children after successful repair of coarctation of the aorta. Am Heart J115:1268-1273, 1988
53.
Swan L., Wilson N., Houston AB: The long-term management of the patient with an aortic coarctation repair . Eur Heart J19:382-386, 1998
54.
Johnson D., Perrault H., Vobecky SJ: Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta. Eur Heart J19:638-646, 1998
