MEDIUM-TERM RESULTS OF SURGICAL-TREATMENT OF COARCTATION OF THE AORTAIN THE NEONATE

Between 1990 and 1997, 122 neonates aged 8.7 +/- 7.5 days, 75 boys (61 .4 %), were referred for coarctation of the aorta which was isolated ( 54 cases) or associated with one (52 cases) or more (20 cases) ventric ular septal defects. Hypoplasia of the aortic arch, diagnosed in 52 ca ses: was more common in children with ventricular septal defects (p < 0.05). The diagnosis was later in isolated coarctation (10.6 +/- 6.8 d ays) than in cases with shunts (7.8 +/- 7.7 days) and/or hypoplasia of the aortic arch (5.1 +/- 4.3 days). One hundred and nineteen patients were operated, including 112 of left thoracotomy (24 had pulmonary ar tery banding in addition) at the age of 1.1 +/- 2.7 months, and 7 by s ternotomy of first intention for aortic repair and closure of ventricu lar septal defect. After thoracotomy, closure of the ventricular septa l defect was undertaken at 11.3 +/- 10.8 months in children who had un dergone previous pulmonary banding and at 3.5 +/- 2.4 monts in the abs ence of banding. Early mortality after aortic repair was 2.5 % and lat e mortality 9.5 %, higher in cases of large ventricular septal defects and hypoplasia of the aortic arch (p < 0.001). Follow-up varied from 55 days to 7.8 years (3.99 +/- 2.24 years). Global survival was 97.5% at 1 month and 98.2% at 8 years. In coarctation with ventricular septa l defect survival was 95.6 % at 1 month and 74.7 % at 8 years with a w orse prognosis in cases with large single interventricular shunts. Res tenosis was observed in 28.5 % of cases, 2.25 +/- 3.8 months after aor tic surgery (88.5 % of cases before the 6th month) and was generally t reated by percutaneous aortic angioplasty (10 cases performed 13.5 +/- 12 months after surgery). In all, two factors seemed to increase the risk of death (hypoplasia of the aortic arch and large ventricular sep tal defects) and restenosis was observed in 1 out of 4 cases, usually before the 6th postoperative month.