Evaluation of Results of Surgical Correction for Coarctation of Aorta by Subclavian Flap Aortoplasty(SCFA) and other Methods in Rajaee Heart Center, 1994-2004

Coarctation accounts for about 5-9% of congenital heart diseases and is the fifth common congenital heart disorder in children. Approximately 90% of untreated patients die before the age of 50 and about half of deaths occur before the age of 10 due to heart failure. The main goal of this study is assessing the frequency of reccurent coarctation after repair and determining the results and complications after subclavian flap aortoplasty. Patients & In this retrospective study, the results of surgical repairs for coarctation of aorta in 188 patients under 14 who had been treated at the Rajaee Heart Center were evaluated. The average age of patients was 5.5 years. 72.3% of cases were male and 27.7% were female, including 61 pure coarctation patients. The frequency of associated heart malformations was PDA(Patent Ductus Arteriosus)(67.6%), VSD(Ventricular Septal Defect)(21.8%), AS(Aortic Stenosis)(20%), Bicuspid Aortic Valve(15.4%), MS(Mitral Stenosis)(6.4%), Shone Complex(4.8%), and ASD(Atrial Septal Defect)(3.2%). The proportion of stenosis was 78% for discrete and 22% for long segment. The most common methods of surgical treatment included patch-graft aortoplasty(59%), resection with end-to-end anastomosis(20.7%), and SCFA(16.5%). None of them experienced paraplegia. The patients were followed for 1-126 months with a mean of 41.6 months. In postoperative echocardiography, 29% of cases showed PG(Peak Gradian)≥25mmHg of whom 10% had undoubted recoarctation according to angiography. Later, these patients underwent Balloon Angioplasty. The highest incidence rate of recoarctation was found in patch-graft aortoplasty method(12.7%) and the lowest in SCFA(3.2%). The rate was 10.3% in end-to-end anastomosis. No case experienced acute ischemia, gangrene or left hand dysfunction in SCFA method during follow-up. The incidence of recoarctation in long segment stenosis was significantly more than discrete one(30% versus 4%, P=0.001). In patients younger than 1 year, the incidence of recoarctation was lower than those older than 1 year and those above 5 years(4% versus 15% and 10%). In conclusion, we believe that surgical repair for neonatal and infantile coarctation gives no rise to incidence of recoarctation and decreases postoperation complications such as HTN(Hypertension). Therefore, it should be done as soon as possible. Regarding fewer complications in SCFA method, it provides an excellent method of surgical repair especially in young age.