COARCTATION OF THE ABDOMINAL-AORTA

Four patients with suprarenal coarctation of the abdominal aorta were managed from 1978 to 1993 (mean follow-up 8.75 years). Ages at the tim e of diagnosis were 2 months, 8 months, 4.5 years, and 15 years, respe ctively. Three children presented with severe hypertension, two of who m were in congestive heart failure, and the fourth child presented wit h a cold, ischemic leg. The 8-month-old patient had Williams syndrome (supravalvular aortic and pulmonic stenosis, bilateral renal artery st enosis and celiac artery occlusion, ''elfin'' facies, and mental retar dation) and was treated nonoperatively. After 12 years of follow-up, h e was given five medications to control hypertension, cardiac arrhythm ias, and heart failure. Three patients with abdominal aortic coarctati on were treated operatively and none died. Two patients underwent bypa ss grafting from the supraceliac aorta to the infrarenal aorta, with b ilateral renal artery reconstruction in one. Postoperative arteriogram s obtained 1 year or more after operation were normal in both cases. T he 2-month-old patient underwent patch aortoplasty, with subsequent re operation 1.5 years later for recurrent hypertension and heart failure with a bypass graft to the left kidney and removal of an infarcted ri ght kidney. In all three patients, operative repair of the suprarenal aortic coarctation has resulted in long-term control of blood pressure and cardiac and renal function.