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Asian Cardiovasc Thorac Ann 1999;7:115-120
© 1999 Asia Publishing EXchange Pte Ltd

ORIGINAL CONTRIBUTION

Influence of Associated Defects and Type of Surgery in Neonatal Aortic Coarctation

Ali Jelly, CABP, Mohammed Omar Galal, MD, PhD, Fadel Al Fadley, MD, Michael de Moor, MD, Zohair Al Halees, MD

Department of Cardiovascular Diseases
King Faisal Specialist Hospital & Research Centre
Riyadh, Saudi Arabia
For reprint information contact: Mohammed Omar Galal, MD, PhD Tel: 966 1 464 7272 Ext 32056 Fax: 966 1 442 5717 email: galal{at}kfshrc.edu.sa Department of Cardiovascular Diseases (MBC 16), King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia.

   Abstract
TOP
 Abstract
Introduction
 Patients and Methods
 Results
 Discussion
 References
 
We reviewed our 12-year experience of surgical treatment for aortic coarctation in 86 neonates. Twenty-three patients had simple coarctation, 38 had an associated large ventricular septal defect, and 25 had complex intracardiac defects. The surgical techniques included subclavian flap angioplasty in 54 (63%), combined resection with end-to-end anastomosis augmented by a subclavian flap in 22 (26%), resection with extended end-to-end anastomosis in 7 (8%), and patch aortoplasty in 3 (3%). Five patients required additional transverse aortic arch augmentation. Hospital mortality was 14% (12/86) and was not related to the type of repair but associated pathology increased the operative risk. Late mortality was 11% (8/74) within one year of repair. Recoarctation developed in 5 patients (7%) within one year. No recoarctation was observed in the group repaired by end-to-end anastomosis augmented by a subclavian flap (p = 0.04).


   Introduction
TOP
 Abstract
 Introduction
Patients and Methods
 Results
 Discussion
 References
 
Coarctation of the aorta is a relatively common congenital heart defect.1,2 In neonates, coarctation of the aorta is associated with high mortality from severe congestive heart failure and progressive metabolic acidosis when the ductus arteriosus closes. The use of prostaglandin to maintain ductal patency has led to improvement in the preoperative condition in many patients.3 Since the first successful repair of neonatal coarctation by Mustard and colleagues4 in 1953, several refinements in the surgical technique have been described. The most widely reported techniques are resection with end-to-end anastomosis, subclavian patch angioplasty, and prosthetic patch angioplasty. Although the outcome of neonatal coarctation judged by mortality, morbidity, and recoarctation, has improved recently, optimal surgical management is still debated. One of the associated findings that makes repair difficult is diffuse tubular hypoplasia of the transverse arch and isthmus proximal to the coarctation, which is particularly associated with complex intracardiac pathology or ventricular septal defect.5,6 We report our 12-year experience of surgical treatment for aortic coarctation in neonates and assess the influence of the type of repair and associated cardiac lesions on the surgical outcome.


   Patients and Methods
TOP
 Abstract
 Introduction
 Patients and Methods
Results
 Discussion
 References
 
The records of 86 consecutive neonates (less than one month old) who underwent repair of aortic coarctation at King Faisal Specialist Hospital & Research Centre between December 1983 and December 1995 were reviewed retrospectively. There were 38 girls (44%) and 48 boys (56%) with a mean age of 21 ± 7 days (range, 1 to 28 days) and mean weight of 3 ± 0.5 kg (range, 2.1 to 4.2 kg). Details of the patient's clinical status, including the use of mechanical ventilation, inotropic support, and prostaglandin, were recorded. Operative notes, postoperative course, and follow-up reports were assessed. The patients were divided into 3 groups according to their additional cardiovascular defects. Group 1 patients (n = 23) had simple coarctation without associated cardiac defects other than a small ventricular septal defect (VSD), hemodynamically insignificant bicuspid aortic valve, subaortic stenosis, or mild mitral valve disease. Group 2 (n = 38) had coarctation with a large ventricular septal defect. Group 3 (n = 25) had coarctation with complex intracardiac pathology. Patent ductus arteriosus (PDA) occurred in all three groups. Patients with interrupted aortic arch were not included in this analysis.

Recoarctation was said to be present if there was systemic hypertension (defined as systolic and diastolic blood pressure higher than the 90th centile for age) with diminished femoral pulses or blood pressure gradients between the right arm and legs of 20 mm Hg or more. Additionally, on Doppler echocardiography a gradient of more than 25 mm Hg across the isthmus and surgical area with continuous flow in diastole was regarded as recoarctation. Early death was defined as death within 30 days of operation or before discharge from the hospital. The size of a VSD was defined according to the size of the aortic annulus, a small to moderate VSD being less than 1/2 the size of the aortic annulus, a large VSD being more than 1/2 the size of the aortic annulus.

Patients were followed up initially at 4 to 6 weeks after coarctation repair, then at 6 months and 1 year. Thereafter, they were seen at least once every year. Five patients were lost to follow-up, the others were seen at least twice. Information regarding some infants not recently assessed at our institution was obtained via telephone by the first author. Follow-up was 94% complete.

Surgical Techniques
Surgical approach was through a lateral thoracotomy in 82 patients and via a midline sternotomy in 4. The ductus arteriosus, left subclavian artery, left common carotid artery, aortic arch, and descending thoracic aorta were dissected. The ductus arteriosus was either ligated or divided. The subclavian artery was ligated just proximal to the vertebral artery when the subclavian flap or resection flap procedures were used. Subclavian flap angioplasty was performed with a running 7/0 polydioxanone suture. In the resection flap procedure, the ductus was divided and the stenosed segment was excised. End-to-end anastomosis with 7/0 polydioxanone suture was started posteriorly and the anastomosis was augmented anteriorly with the subclavian flap. For resection with end-to-end anastomosis, the proximal aorta was clamped at the level of the aortic arch to allow cerebral flow through the innominate artery. The distal aorta was usually mobilized extensively to allow tension-free anastomosis. The coarcted segment and the ductal tissue were excised. The undersurface of the aortic arch was opened to the level of the mid-arch and the anastomosis was performed with running 7/0 polydioxanone suture. Occasionally a combination of techniques and some additional alternations were needed to obtain a satisfactory result. Use of patch material was avoided as much as possible, however, patches were required in 3 patients. Concomitant pulmonary artery banding was performed in children with unrestrictive pulmonary blood flow with systemic pulmonary artery pressure, where the risk of postoperative congestive heart failure was felt to be high. The distal pulmonary artery pressure was used as a guide to the degree of banding.

Data are presented as mean ± standard deviation. Categorical data were compared using the chi-squared test or Fisher's exact test. A p value of less than 0.05 was considered significant.


   Results
TOP
 Abstract
 Introduction
 Patients and Methods
 Results
Discussion
 References
 
Initial clinical findings included symptoms of congestive heart failure in 38 (44%) patients, weak femoral pulses in 69 (80%), upper extremity hypertension in 29, cyanosis in 10, and 18 (21%) were septic at presentation. Medical management was instituted with the aim of improving cardiac function, increasing urine output, and correcting acidosis to stabilize the patient's condition before surgery. Preoperatively, prostaglandin infusion was used in 46 patients (53%), inotropic support (dopamine) in 14 (16%), and 27 (31%) were intubated and placed on mechanical ventilation. Forty patients (47%) were referred for surgery after cardiac catheterization, whereas 46 (53%) were referred on the basis of echocardiography only. Between 1983 and 1990, 18 of 28 patients (64%) required cardiac catheterization to establish the diagnosis but after 1990, only 38% (22/58) had cardiac catheterization.

Associated defects included bicuspid aortic valve in 10 patients (12%) and subaortic stenosis in 8 (9%), requiring surgical intervention during coarctation repair in one case. There were 9 patients in group 1 with a large PDA, 5 with a small VSD, and one with Shone's anomaly and mild mitral stenosis. Group 2 included 6 patients with a secundum atrial septal defect and one with moderate mitral stenosis. The patients in group 3 had coarctation and complex cardiac pathology as shown in Table 1Go.


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  		Table 1. Associated Complex Intracardiac Anomalies in 25 Patients (Group 3)
 
Operative Data
Surgical repair of aortic coarctation was performed by subclavian flap angioplasty in 54 (63%) patients, resection with end-to-end anastomosis in 7 (8%), a combined resection and subclavian flap procedure in 22 (26%), and patch angioplasty in 3 (3%). In two patients, the ductus arteriosus tissue was used in the repair. The distal aortic arch needed augmentation by various techniques in 6% of patients distributed among the 3 groups. A comparison of the operative techniques among the groups is given in Table 2Go.


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  		Table 2. Distribution of Surgical Techniques Among Groups
 
Ligation of a PDA was carried out in 75 patients (87%). Concomitant pulmonary artery banding was performed in 46 (53%); this was required in 31 of the 38 patients with an associated VSD and in 15 of the 25 patients with associated complex cardiac defects. Of the 7 patients with VSD who were not banded, 3 underwent one-stage repair of coarctation and associated VSD, 2 had later VSD closure (2 weeks and 5 months later), one died of sepsis before VSD closure, and another was lost to follow-up. In 12 cases, the VSD was of the large muscular type, in 2 it was a Swiss-cheese type. Debanding of the pulmonary artery and repair of the VSD in group 2 patients was performed at a mean of 12 months (range, 2 to 23 months) after the initial repair. Reconstruction of the pulmonary artery was required in 3 patients and one had resection of a subaortic membrane. One patient with mitral atresia, transposed great arteries, and double-outlet right ventricle underwent a Damus-Kaye-Stancel operation to relieve subaortic stenosis in addition to coarctation repair. The mean aortic cross-clamp time was 27 ± 20 minutes (range, 11 to 95 minutes) and the mean bypass time was 119 ± 23 minutes (range, 103 to 151 minutes).

Postoperative Data
The mean duration of ventilation postoperatively was 3 ± 4.8 days (range, 1 to 21 days) and the mean stay in the intensive care unit was 7 days (range, 1 to 22 days). The most commonly encountered postoperative complications were respiratory in 16 patients (19%), septicemia in 11 (13%), and paradoxical hypertension in 9 (10%). There were no instances of postoperative hemorrhage or paraplegia in any patient.

The hospital mortality was 14% (12/86). The early mortality comprised 2 (9%) of the 23 patients in group 1 with simple coarctation, 5 of 38 (13%) in group 2 with coarctation and VSD, and 5 of 25 (20%) in group 3 with complex intracardiac pathology, which was significantly higher than groups 1 and 2 (p = 0.002). The 2 early deaths in group 1 were related to very poor preoperative left ventricular function and sepsis. These patients were admitted at the ages of 10 days and 21 days, the first patient developed necrotizing enterocolitis postoperatively and the second had poor left ventricular function with extensive pericardial effusion preoperatively. Hospital mortality in group 2 included 3 patients who had one-stage repair of coarctation and VSD. Two had large mid-muscular and subpulmonary VSDs and one had multiple small apical VSDs that had been missed at the preoperative assessment. One patient died with septicemia and one had severe biventricular hypertrophy with no gradient detectable across the pulmonary artery band by echocardiography, probably secondary to pulmonary hypertension and pulmonary vascular disease. In group 3, there was one operative death (Damus-Kaye-Stancel procedure), 2 died from septicemia, one from low cardiac output postoperatively (diagnosed with hypoplastic left heart syndrome), and one patient died in a local hospital 2 days after discharge from our institution; the cause of death was not clear. The causes of early deaths are listed in Table 3Go. The type of repair was not found to influence the early mortality (p = 0.4).


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  		Table 3. Causes of 12 Early Postoperative Deaths
 
Follow-Up
The mean follow-up period was 25 months (range, 6 months to 11 years). There were 8 late deaths (11%) among the 74 patients followed up. All late deaths occurred within the first year after coarctation repair. Six of the late deaths were cardiac related, 3 after VSD and ASD closure, 2 after arterial switch repair (in 1987), and one after a Glenn anastomosis. In group 1, 2 late deaths occurred at home, apparently related to infection. Considering all deaths in the analysis, coarctation with complex intracardiac anomaly was associated with a higher risk of mortality (p < 0.05).

Five patients (7%) experienced recurrent coarctation that was detected within one year of operation in 4 cases (mean, 9.4 months; range, 1 to 22 months). Recoarctation occurred in 4 of the 49 patients (8%) who had subclavian flap angioplasty, in one of the 5 patients (20%) who had resection with extended end-to-end anastomosis, and in none of those who had the combined resection and flap procedure or patch angioplasty (p = 0.04). Recoarctation in the 3 groups was 3/21 (14%) in group 1, 1/33 (3%) in group 2, and 1/20 (5%) in group 3 (p > 0.05). Two of the 3 patients with recoarctation in group 1 had hypoplasia of the distal arch and isthmus and one also had a large PDA. Probably the repair was not sufficiently extended to augment the arch, accounting for the relatively high recoarctation rate. The recoarctation rate can be compared with mortality among the groups in Table 4Go.


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  		Table 4. Summary of Mortality and Recoarctation
 
Reintervention was undertaken in one patient who had successful transcatheter balloon angioplasty and in 2 who had recoarctation with gradients of 25 and 27 mm Hg determined by cardiac catheterization; the first had long-segment coarctation for a possible stent and in the second, the gradient was related to hypoplastic aortic arch. One patient had an echocardiography gradient of 25 mm Hg and was scheduled for balloon dilatation, and one patient died before scheduled catheterization.


   Discussion
TOP
 Abstract
 Introduction
 Patients and Methods
 Results
 Discussion
References
 
Neonatal repair of the aorta remains a surgical challenge associated with higher mortality and more late restenosis than the same operation in older children. Early experience with resection and end-to-end anastomosis was associated with recurrence rates ranging from 36% to 75% when the operation was performed in neonates.7,8 In such patients, restenosis was attributed to lack of growth of the anastomosis suture line or active narrowing resulting from fibrosis.9,10 Subsequently, new surgical techniques were introduced. The subclavian flap repair described by Waldhausen and Nahrwold11 gained wide acceptance. In more recent studies, the risk of recurrent coarctation varied from 7% to 43% when subclavian flap repair was performed during the first month of life.12,13 However, many authors have emphasized that with this type of repair, the most important factor responsible for recurrence is the residual ductal tissue that may gradually develop into a prominent shelf, obstructing the aortic lumen.14,15 Two of our patients in whom the PDA was used in the repair, suffered a recurrence.

Another type of repair is the synthetic patch aortoplasty described by Vossschulte16. The published recoarctation rates after this procedure vary from 0% to 100%.17,18 In more recent studies, the prevalence of recoarctation after patch aortoplasty in infants ranged from 11% to 42%.19,20 Recoarctation after this type of repair may result from the small size of the patch material frequently used in neonates or it may be due to abnormal growth of the posterior shelf that may remain in situ.20 Another major complication of the prosthetic patch technique is late aneurysm formation.21

Recent publications advocating a return to resection with extended end-to-end anastomosis report a prevalence of recoarctation ranging from 15% to 25% in neonates.15,22,23 Recurrence has been attributed to the small size of the anastomosis with uncertain growth potential, since the suture line is circumferential. Dietl and colleagues24 introduced a new surgical technique in 1985 consisting of resection and end-to-end anastomosis enlarged with a subclavian flap. They compared their results with patch aortoplasty and subclavian flap angioplasty and concluded that the new technique was more effective in avoiding residual or recurrent gradients and in preventing recoarctation, especially in neonates. The advantages of this procedure are: complete excision of the coarctation segment with no residual ductal tissue or posterior shelf; the final anastomotic diameter is 1.5 to 2 times larger than that usually obtained with a simple end-to-end anastomosis; the suture line is non-circumferential; and the viable flap of subclavian artery has growth potential.

In spite of these refinements in surgical technique and improved survival rates, the long-term results have not been as good as expected because recurrent coarctation is still a problem, especially when surgical treatment is indicated during the first month of life. Our results of subclavian flap angioplasty in the first month of life, with an 8% restenosis rate, compares favorably with the reported incidence of restenosis after this technique.12,13 We could not demonstrate a significant difference in the incidence of restenosis between subclavian flap angioplasty versus resection with extended end-to-end anastomosis (20%). The incidence of restenosis after subclavian flap angioplasty and resection with extended end-to-end anastomosis in recent times has frequently been reported as comparable in neonates.15,25–27 Although there is a distinct trend towards improved outcome in terms of recurrence of coarctation in recent surgical series, another study has shown that evaluation of those patients for a minimum 5 years of follow-up revealed a statistically significant higher rate of recurrence after extended end-to-end anastomosis compared to subclavian flap angioplasty.28 In our series, the prevalence of recoarctation was significantly reduced when the combined resection-flap procedure was used; the risk of recoarctation was 0% in a mean follow-up period of 21 months but a higher incidence was found in patients repaired with extended end-to-end anastomosis. A longer follow-up of this group of patients may prove the effectiveness of the combined resection-flap procedure in preventing recoarctation in neonates. The risk for development of recoarctation is highest during the first year after operation.29 Vigilant follow-up in the first year after coarctation repair is necessary. Balloon dilatation has been reported as a successful treatment modality in the management of restenosis after coarctation repair.19,26,30 In our series, 1 of 5 patients with recoarctation was managed successfully with balloon dilatation.

Hospital mortality of 14% (12/86) in our series included 5 patients with complex intracardiac lesions as well as 2 patients with simple coarctation who were quite sick neonates needing emergency intervention. It is known that complex intracardiac lesions and the patient's preoperative condition are the main risk factors for perioperative death.15,27,31,32 Reviewing recent reports of hospital mortality with neonatal coarctation repair, the rates vary between 7.2% and 14%.13,28,29,31 It is probably important to consider whether alternative management strategies might have produced more satisfactory results. Our late mortality of 11% was in the range of late mortality in recently published series of 10.7% to 15.5%.28,29,31 Most of the deaths occurred within one year of coarctation repair.

Controversy still exists regarding concomitant pulmonary artery banding.33,34 The indication in our series was intractable congestive heart failure with a VSD not suitable for repair in the first month of life. Forty-six of the 63 patients (73%) with VSD or complex cardiac defects underwent pulmonary artery banding. In small critically ill newborns with associated intracardiac defects, pulmonary artery banding with coarctation repair can be a lifesaving procedure.26,33 We are aware of reports proposing one-stage repair of neonatal coarctation.35 When feasible, we now aim to adopt this and our preliminary results are encouraging.

We concluded that the surgical outcome of aortic coarctation repair in neonates is influenced by associated intracardiac defects. The technique of combined resection-flap appears to promise a better outcome in the repair of coarctation in neonates. We recommend careful follow-up of patients with a repaired coarctation during the first postoperative year.


   References
TOP
 Abstract
 Introduction
 Patients and Methods
 Results
 Discussion
 References
 

  1. Fyler DC, Buckley LP, Hellenbrand WE. Report of the New England regional infant cardiac program. Pediatrics 1980;65:432–6.

  2. Martin ML, Adams MM, Mortensen ML. Descriptive epidemiology of selected malformations of the aorta. Atlanta, 1970–1983. Teratology 1990;42:273–83.[Medline]

  3. Olley PM, Coceani F, Bodach E. E-type prostaglandins: a new emergency therapy for certain cyanotic congenital heart malformations. Circulation 1976;53:728–31.[Abstract/Free Full Text]

  4. Mustard WT, Rower RD, Keith JD, Sirek A. Coarctation of the aorta with special reference to the first year of life. Ann Surg 1995;141:249–52.

  5. Ho SY, Anderson RH. Coarctation, tubular hypoplasia, and the ductus arteriosus: histological study of 35 specimens. Br Heart J 1979;41:268–74.[Abstract/Free Full Text]

  6. Baharati S, Lev M. The surgical anatomy of the heart in tubular hypoplasia of the transverse aorta (preductal coarctation). J Thorac Cardiovasc Surg 1986;91:79–85.[Abstract]

  7. Kirklin JW, Barratt-Boyes BG. Coarctation of the aorta and aortic arch interruption. In: Kirklin JW, Barratt-Boyes, editors. Cardiac surgery. 1st ed. New York: Churchill Livingstone, 1988:1035–80.

  8. Williams WG, Shindo G, Trusler GA, Dische MR, Olley PM. Results of repair of coarctation of the aorta during infancy. J Thorac Cardiovasc Surg 1980;79:603–8.[Abstract]

  9. Khoury GH, Hawes CR. Recurrent coarctation of the aorta in infancy and childhood. J Pediatr 1968;72:801–6.[Medline]

  10. Eshaghpour E, Olley PM. Recoarctation of the aorta following coarctectomy in the first year of life: a follow-up study. J Pediatr 1972;80:809–14.[Medline]

  11. Waldhausen JA, Nahrwold DL. Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg 1966;51:532–3.[Medline]

  12. Sciolaro C, Copeland J, Cork R, Barkenbush M, Donnerstein R, Goldberg S. Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-end anastomosis. J Thorac Cardiovasc Surg 1991;101:1–13.[Abstract]

  13. Shrivastava CP, Monro JL, Shore DF, Lamb RK, Sutherland GR, Fong LV, et al. The early and long-term results of surgery for coarctation of the aorta in the first year of life. Eur J Cardio-thorac Surg 1991;5:61–6.[Abstract]

  14. Beekman RH, Rocchini AP, Behrendt DM, Bove EL, Dick M II, Crowley DC, et al. Long-term outcome after repair of coarctation in infancy: subclavian angioplasty does not reduce the need for reoperation. J Am Coll Cardiol 1986;8:1406–11.[Abstract]

  15. Ziemer G, Jonas RA, Perry SB, Freed MD, Castaneda AR. Surgery for coarctation of the aorta in the neonate. Circulation 1986;74(Suppl I):125–31.

  16. Vossschulte K. Surgical correction of the aorta by an isthmus-plastic operation. Thorax 1961;16:338–45.

  17. Sade RM, Taylor AB, Chariker EP. Aortoplasty compared with resection for coarctation of the aorta in young children. Ann Thorac Surg 1979;28:346–53.[Abstract]

  18. Fleming WH, Sarafian LB, Clark EB, Dooley KJ, Hofschire PJ, Hopeman AR, et al. Critical aortic coarctation: patch aortoplasty in infants less than age 3 months. Am J Cardiol 1979;44:687–90.[Medline]

  19. Yee ES, Soifer SJ, Turley K, Verrier ED, Fishman NH, Ebert PA. Infant coarctation: a spectrum in clinical presentation and treatment. Ann Thorac Surg 1986;42:488–93.[Abstract]

  20. Hesslein PS, McNamara DG, Morriss MJH, Hallman GL, Cooley DA. Comparison of resection versus patch aortoplasty for repair of coarctation in infants and children. Circulation 1981;64:164–8.[Abstract/Free Full Text]

  21. Kron IL, Flanagan TL, Rheuban KS, Carpenter MA, Gutgesell HP Jr, Blackbourne LH, et al. Incidence and risk of reintervention after coarctation repair. Ann Thorac Surg 1990;49:920–6.[Abstract]

  22. Waldman JD, Lamberti JJ, Goodman AH, Mathewson JW, Kirkpatrick SE, George L. Coarctation in the first year of life: patterns of postoperative effect. J Thorac Cardiovasc Surg 1983;86:9–17.[Abstract]

  23. Cobanoglu A, Teply JF, Grunkemeier GL, Sunderland CO, Starr A. Coarctation of the aorta in patients younger than three months: a critique of the subclavian flap operation. J Thorac Cardiovasc Surg 1985;89:128–35.[Abstract]

  24. Dietl CA, Torres AR, Favaloro RG, Fessler CL, Grunkemeier GL. Risk of recoarctation in neonates and infants after repair with patch aortoplasty, subclavian flap, and combined resection-flap procedure. J Thorac Cardiovasc Surg 1992;103:724–32.[Abstract]

  25. Hopkins RA, Kostic I, Klages U, Armiru U, de Leval M, Sullivan I, et al. Correction of coarctation of the aorta in neonates and young infants: an individualised surgical approach. Eur J Cardio-thorac Surg 1988;2:296–304.[Abstract]

  26. Kopf GS, Hellenbrand W, Kleinman C, Lister G, Talner N, Laks H. Repair of aortic coarctation in the first three months of life: immediate and long-term results. Ann Thorac Surg 1986;41:425–30.[Abstract]

  27. Trinquet F, Vouhe PR, Vernant F, Touati G, Roux PM, Pome G, et al. Coarctation of the aorta in infants: which operation? Ann Thorac Surg 1988;45:186–91.[Abstract]

  28. Merrill WH, Hoff SJ, Stewart JR, Elkins CC, Graham TP Jr, Bender HW Jr. Operative risk factors and durability of repair of coarctation of the aorta in the neonate. Ann Thorac Surg 1994;58:399–403.[Abstract]

  29. Knott-Craig CJ, Elkins RC, Ward KE, Overholt ED, Razook JD, Lane MM. Neonatal coarctation repair: influence of technique on late result. Circulation 1993;88:198–204.[Abstract/Free Full Text]

  30. Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD. Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 1991;102:596–601.[Abstract]

  31. Van Herun LWE, Wong CM, Spiegelhalter DI, Sorensen K, de Leval MR, Stark J, et al. Surgical outcome of aortic coarctation in infants younger than three months: 1985 to 1990. Success of extended end-to-end arch aortoplasty. J Thorac Cardiovasc Surg 1994;107:74–86.[Abstract/Free Full Text]

  32. Conte S, Lacour-Gayet F, Serraf A, Sousa-Uva M, Bruniaux J, Touchot A, et al. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg 1995;109:663–75.[Abstract/Free Full Text]

  33. Park JK, Dell RB, Ellis K, Gersomy WM. Surgical management of the infant with coarctation of the aorta and ventricular septal defect. J Am Coll Cardiol 1992;20:176–80.[Abstract]

  34. Metzdroff MT, Cobanglu A, Grunkemeier GL, Sunderland CO, Starr M. Influence of age at operation on late results with subclavian flap aortoplasty. J Thorac Cardiovasc Surg 1985;89:235–41.[Abstract]

  35. Hirooka K, Fraser CD Jr. One-stage neonatal repair of complex aortic arch obstruction or interruption. Texas Heart Inst J 1997;24:317–21.[Medline]




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