Late results of the subclavian flap procedure in infants with coarctation of the thoracic aorta.

Persistent stenosis or recoarctation occurs in 16 to 33% of infants who undergo repair of coarctation of the thoracic aorta by use of end-to-end anastomosis. This report describes the results in 12 infants of repair of coarctation of the aorta using a left subclavian artery flap procedure. Cardiac catheterization and cineangiography performed in four patients from 4 to 66 months following repair showed a 10 mm systolic gradient in one patient and no evidence of significant stenosis in any patient. The eight other patients have had recent sphygmomanometer pressures recorded from 1 to 29 months after repair. Four patients had no gradient while three patients had a systolic pressure gradient of 8, 10, and 12 mm Hg. Results suggest a smaller incidence of persistent stenosis or recoarctation following subclavian flap procedure than following end-to-end anastomosis. The subclavian flap operation provides an adequate aortic lumen with good growth potential. It is recommended as the operation of choice for infants with the most common form of coarctation of the aorta.