Methods of management and results following surgery for coarctation of the aorta in infancy.

There were 30 infants, under 1 yr of age, in refractory congestive heart failure, who underwent surgical correction for coarctation of the aorta. The series was divided into two groups, depending on the type of surgical procedure performed: Group 1, 17 patients end-to-end anastomosis; Group 2, 13 patients aortic angioplasty. Aortic angioplasty was carried out by three methods. Ten patients had a subclavian flap angioplasty as described by Waldhausen in 1966. In two patients a carotid artery flap angioplasty was used to enlarge a severely hypoplastic aortic arch distal to the left carotid artery. In one patient an onlay patch of pericardium was used to relieve obstruction across a coarcted segment. Mortality rates in this series and other series from the literature are primarily dependent upon associated cardiac anomalies. Mortality rates approach zero in infants operated on for coarctation who have no associated intracardiac anomalies. While the mortality rate was slightly lower in those patients treated by some type of angioplasty, the figures are too small to be significant. In this series and other series recoarctation is far less likely to occur after subclavian flap angioplasty in comparison to those patients undergoing end-to-end anastomosis. We would advise that in infants 1 yr of age, a subclavian or carotid flap angioplasty be used as a primary method of repair.