A new method for the plastic repair of the aorta in coarctation

Thirty-six patients underwent operation in the Samara Cardiosurgical Centre in the period from 1987 to 1991. Their ages ranged from 18 months to 28 years, 32 of them were under 16 years of age. The operation was carried out through a lateral approach in third or fourth intercostal space. After mobilization of the aorta the constricted part was resected together with the orifice of the ductus arteriosus at a distance of 2-3 mm from the constricting membrane without removal of areas of conic constrictions of the remaining ends of the vessels. Longitudinal incisions were made in the aortic walls perpendicular to one another and the edges of the flaps were shaped to form triangles. An anastomosis was then formed with continuous sutures. The average time of compression of the aorta was 27 +/- 2.5 min. There were no fatal outcomes. Among the complications were bleeding which called for rethoracotomy in 2 patients, and suppuration of the wound in 3 patients. Thirty-two persons were discharged from the clinic with normal arterial pressure, in 4 patients the pressure reduced as compared to the preoperative level. The long-term results were studied in 29 patients in follow-up periods of 6 months to 4 years. Twenty-five of them had no complaints, residual hypertension was encountered in 4 patients but without signs of recoarctation. Thus, with the use of the described method the possibility for forming a direct anastomosis in cases in which a prosthesis had to be formed applied is greater, and in operations on children it became possible to increase the lumen of the anastomosis with growth of a child.