الفهرس 
Historical NoteOnly 14 pages are availabe for public view
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Abstract
Coarctation of the aorta is the congenital narrowing of the upper descending thoracic aorta adjacent to the site of the ductus arteriosus. Coarctation can be presented isolated, with or without patent ductus arteriosus, or coexisting with other major cardiac anomalies. Coarctation of the aorta can be presented at any age from neonatal age up to old age. This study is a prospective study which included thirty patients with coarctation of the aorta. Mean age was 8.9 years (range 11 days to 32 years). Male to female ratio was 2:1. The patients have been divided into four groups according to their age. • Group A included neonates and they were four patients with mean age 15.7 days (11-22 days) and mean body weight was 2.95 kg. • Group B included infants, they were four patients with mean age 89.7 days (37-300 days) and the mean body weight was 4.7 kg. • Group C included fourteen children, their mean age was 6.2 years (16 months to 13 years). • Group D included eight adults with mean age 20.5 years (15-32 years). In our study half of the patients (50%) were asymptomatic and discovered accidentally during routine examination for other non-related or related conditions. One fourth of the patients (26.7%) had palpitation and 23% presented with epistaxis. ECHO as a non invasive investigatory tool was the definitive study to visualize coarctation, and associated intracardiac defects in detail. Also the severity of coarctation was often assessed by characterizing intracardiac and great artery blood patterns using color Doppler signaling. Different investigatory tools including X-ray of the chest, electrocardiography, catheterization, CTA, and MRA were of importance to confirm the diagnosis. All can be done for sure anatomical features of the coarctation, associated cardiac anomalies, exclude abnormal left subclavian artery origin, and intercostals arteries aneurismal dilatation. Almost all patients with coarctation of the aorta should be operated upon at an appropriate time unless there were significant contraindications. Six surgical techniques have been used in our patients. The most commonly used technique was extended end to end anastomosis where it has been used in half of our patients (15 patients out of 30, 50%). The second one used was the subclavian aortoplasty which was used in 6 patients (20%). Interposition tube graft has been used in 4 patients (13.3%). Some other techniques have been used infrequently such as PPA in two patients (6.7%), combined EEA with SFA in 2 patients (6.7%) and finally, RSFA in only one patient (3.3%). However, in our study we have found that the age of the patient had a direct influence on the choice of the technique of surgery. Subclavian flap aortoplasty or reversed subclavian flap aortoplasty was only used in younger ages and never used in any one of our adult patients, and neither the PPA, or Interposition tube graft used for the young patients. Cardiopulmonary bypass was not used for any patient in our study. All patients passed the stages of surgery safely without Intra-operative death or complications and transferred to the ICU in a stable condition. In our study the early post operative mortality was one patient (3.33%), and represented 12.5% of adult patients. Sixty percent of the patients (18 patients) had no significant morbidity or mortality in the early postoperative stage and during the follow-up period of 3 months. All of them had uneventful postoperative recovery and smooth postoperative course, short ICU and hospital stay. However, 12 patients (40%) developed some other complications which required longer ICU and hospital stay for management of these complications. Two patients (6.7%) developed postoperative empyema, two patients (6.7%) developed postoperative bleeding, one neonate patient (3.33%) developed post operative chylothorax and was re-operated for thoracic duct ligation, three patients (10%) had wound infection. The mean ICU stay in our patients was related to their age. The longest ICU stay was found in the neonatal period 106±37.4 hours followed by infancy 82±26.4 hours, childhood 49±12.1 hours and finally adulthood 45±5.5 hours. This was related mainly to prolonged ventilation, care of the IV fluids, vasodilators and inotropes in the younger ages rather than in the older ones. The mean follow up period was 15.3±7.1 months, no patients had been lost during follow up period. ECHO pressure gradient was measured at one week, one month and three months. Persistent coarctation in our study was noticed in 2 patients from total 30 patients (6.7%). Persistent hypertension during follow up period was documented in seven patients of thirty (23.33%) [Three children (21.4%), and in four (50%) of adults]. No any of neonates or infants had postoperative persistent hypertension. Post operative persistent hypertension, or re-coarctation are not closely related to a specific type of operation. But persistent hypertension is closely related to the age of the patient at the time of operation. CONCLUSION: • Coarctation of the aorta may present according to the age of the patient by different symptoms and signs, the most important of which are hypertension of the upper body and collateral arterial anastomosis. • Echocardiography is the non invasive tool of choice for diagnosis of the lesion. • Surgical treatment should be started promptly before the development of cardiac de-compensation or other concomitant affections. • Different surgical techniques are used for repair of coarctation depending on patient’s age. • Post-operative residual hypertension or re-coarctation are related to the age of the patient at time of operation.