Early and late results after resection and end-to-end anastomosis of coarctation of the thoracic aorta in early infancy.

Over a 9 year period, 55 infants underwent resection and end-to-end anastomosis for symptomatic coarctation of the thoracic aorta during their first 120 days of life (mean age 47 days; mean weight 3.7 kg). Forty-two had preductal coarctation and 13, postductal. Additional cardiac lesions were found in 48 patients. Ventricular septal defect, either isolated or associated with other malformations, was the most frequent finding (37 patients). Simultaneous banding of the pulmonary artery was performed in 14 infants because of nonrestrictive ventricular septal defects. The hospital mortality was 3.6% (two patients). There were no late deaths. All survivors have been reinvestigated, and 27 have been recatheterized. In the group as a whole, after an average follow-up of 4.5 years, the mean pressure gradient (arm/leg) was 7 mm Hg (range 0 to 45 mm Hg). In the recatheterized infants, the average systolic pressure gradient at the anastomotic site was 16 mm Hg (range 2 to 62 mm Hg), whereas the mean pressure gradient in this group was 7 mm Hg (range 0 to 33); only three of them had systolic pressure gradients of more than 20 mm Hg. One reoperation is scheduled. Our data suggest, that resection and end-to-end anastomosis for symptomatic coarctation in the first 3 months of life can be performed with very low operative mortality and excellent long-term results.