A New Surgical Technique for Repair of Aortic Coarctation

Abstract

From June, 1987, to February, 1989, 7 patients underwent a new technique of coarctation repair. This technique consists of a complete mobilization of the left subclavian artery (LSA) so that it can be pulled down as much as possible. After all the proper clamping, the anterior wall of the aorta is incised longitudi nally, beginning on the anterior wall of the LSA and extending distally to the descending aorta 2 cm past the coarctation. The coarctation membrane is ex cised carefully. The LSA is pulled down so that the proximal end of the incision can come to the distal end. Then, this longitudinal incision is sutured trans versely with 5/0 polydiaxonone and continuous technique, widening the coarcta tion site and also preserving the blood flow to the left upper limb. If extreme tension occurs, the LSA is transected. After the aortoplasty is completed, a polytetrafluoroethylene (PTFE) graft in size of 6 or 8 mm is interposed between the proximal and the distal parts of the LSA, providing continuity.

The ages of the patients ranged from eighteen months to twenty years (mean: 11.5 years) and their weights ranged from 11 to 83 kg (mean: 37 kg). There were no hospital deaths. There were no significant pressure gradients through the isthmic area after the operation. Mean follow-up was eighteen months, and all patients but 1 were in class I effort capacity (NYHA). The authors have also noticed good blood flow to the left upper limb, including 2 patients who have a PTFE graft interposed in their LSA. The authors' experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of preservation of blood flow to the left upper limb.