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Long-term follow-up of aortic coarctation in infants, children and adults

Published online by Cambridge University Press:  19 August 2008

Prasad Mathew ,
Douglas Moodie ,
Gary Blechman  and
Carl C. Gill
Prasad Mathew
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Douglas Moodie*
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Gary Blechman
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
Carl C. Gill
Affiliation:
From the Department of Pediatrics and Pediatric Cardiology, The Cleveland Clinic Foundation, Cleveland
*
Dr. Douglas Moodie, Chairman, Department of Pediatrics, A 120, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. Tel. (216)444-6717.
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Abstract

We have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.

Keywords

Coarctationaortasurvivalhypertensionfollow-up
Type
Original Articles
Information
Cardiology in the Young , Volume 3 , Issue 1 , January 1993 , pp. 20 - 26
Copyright
Copyright © Cambridge University Press 1993

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