Late Results of Operation in Children with Coarctation of the Aorta

The first nineteen consecutive Swedish children operated upon for coarctation of the aorta by Crafoord during the years 1944 to 1952 were followed-up in this study. Seven of them had no symptoms pre-operatively. A blood pressure above 130/80 mmHg was found in all the patients. At operation resection of the coarctation with end-to-end anastomosis was performed in all cases. One patient died postoperatively in necrosis of the small bowel. Five others had died during the follow-up period, three of them probably due to valvular lesions. One patient was successfully re-operated on for an aneurysm of the anastomosis. Another patient with residual coarctation was re-operated on after 7 years with a diamond-shaped Dacron patch graft. He later developed an aneurysm and was re-operated on a second time with a tubular Dacron graft and has thereafter been without complications for 6 years. Two patients, who were in good health, would not consent to a hospital investigation. Follow-up examinations were performed in 11 patients with a mean follow-up period of 28 years. All were in good health (N.Y.H.A. class I) and their physical growth had been satisfactory. Hypertension (above 160/90 mmHg) was found in only one patient (9%). A slight aortic insufficiency was found in 2 patients, one of whom also had a slight mitral stenosis. The physical working capacity was normal in all patients. ECG showed sinus rhythm at rest and during exercise in all patients except one, who had an ectopic atrial rhythm at rest. No patient had signs of left ventricular hypertrophy. Heart volume was normal in all the patients. Cardiac output in relation to oxygen uptake was normal in all the 8 patients who underwent heart catheterization. No pressure difference over the anastomosis was found in 3 patients and a peak systolic pressure difference of 7-20 mmHg at rest in 5 patients, increasing to 25-60 mmHg during exercise. The long-term results in children operated upon for coarctation of the aorta are far better than for older patients.