Prognosis of infants with coarctation of aorta

Noninvasive diagnosis of neonatal coarctation and associated anomalies using two-dimensional echocardiography

Two-dimensional echocardiography (2DE) was used to study 51 neonates in whom coarctation of the aorta had been diagnosed clinically. In 40 patients, studies showed coarctation or arch interruption that was later confirmed at angiography, surgery, or autopsy. Of the remaining 11 studies, one gave a false positive result, one was technically poor, three had echocardiographic evidence of only mild arch narrowing and are being followed clinically, and six were negative. There were two false negative studies. Four studies were apparently true negatives. Many additional lesions were correctly identified by echocardiography although some, such as patent ductus arteriosus and small ventricular septal defect, were frequently missed. Twelve patients underwent surgery without preoperative catheterization. 2DE has proven extremely useful in confirming the diagnosis of neonatal coarctation of the aorta and sometimes obviates the need for invasive catheterization.

Prognosis of symptomatic coarctation of the aorta in infancy

Medical and surgical advances have improved the outlook for infants with symptomatic coarctation of the aorta. To help predict the clinical course of individual patients and to aid in individualizing their treatment, a 10-year experience with this condition was reviewed. Of 97 infants with symptomatic coarctation, 10 had isolated defects. In these patients, medical treatment was successful and surgical intervention could be postponed to allow for growth. The 87 other patients with associated cardiac defects were generally sicker at presentation and required earlier operation. Eleven of these died before surgical correction, 10 died at the time of repair, and 13 died later. The overall survival rate after 8 years was 62%, with most deaths occurring in the first 6 months of life. Late surgical results are flawed by a 32% rate of residual coarctation. Late postoperative hypertension is uncommon, and is usually attributable to a residual coarctation.

Surgical management of coarctation of aorta with ventricular septal defect. Multivariate analysis

Optimal management of coarctation with ventricular septal defect is difficult. Should one treat the coarctation, the ventricular septal defect, or both? This dilemma was investigated by reviewing 39 successive patients, aged less than 4 months, undergoing coarctation repair without pulmonary artery banding. Twelve hospital deaths occurred. Ventricular septal defect size was graded "blind" according to preoperative angiocardiographic and haemodynamic findings. Of 14 patients classified as having a large ventricular septal defect, necropsy and operative findings in eight showed defects 7 to 12 mm in diameter. Factors associated univariately with significantly increased mortality were young age, raised atrial and ventricular end-diastolic pressures, low weight, high admission blood urea, preoperative ventilation, and a large ventricular septal defect. All but the last two were also closely associated with each other. A jack-knifed discriminant function based upon ventricular septal defect size, blood urea, pulmonary venous oxygen content, and inferior caval oxygen saturation correctly predicted outcome in 78.9% of patients. Combinations of these four giving a probability greater than 0.9 of survival were rare with blood ureas above 8 mmol/litre. Raised blood urea was associated with low descending aortic pressure and subsequent dialysis. Only patients with a large ventricular septal defect stand to benefit from pulmonary artery banding at initial operation. Preoperative treatment to increase renal blood flow (prostaglandins, dopamine) may improve overall survival.