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J Thorac Cardiovasc Surg 2004;127:712-720
© 2004 The American Association for Thoracic Surgery
Surgery for congenital heart disease |
a Faculty of Medicine from Federal University of Minas Gerais, Department of Internal Medicine, Belo Horizonte, Minas GeraisBrazil
b Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
Received for publication March 13, 2003; revisions received April 8, 2003; revisions received May 12, 2003; accepted for publication June 25, 2003.
* Address for reprints: Margarida M. C. Smith Maia, Faculdade de Medicina da UFMG/Departamento de Clínica Médica, Av Alfredo Balena 190/4070, CEP: 30130-100 Belo Horizonte, Minas Gerais, Brazil
margamaia{at}bol.com.br
OBJECTIVE: The goals of this study were to determine the prevalence of hypertension and recoarctation in operated children and teenagers and to integrate clinical and imaging technique data.
METHODS: One hundred thirteen infants and children (ages 14 years or less) were retrospectively divided into 3 groups according to the age at operation and the surgical technique: 79 underwent resection with end-to-end anastomosis; 14 had patch enlargement; 13 had subclavian flap aortoplasty; and 7 had other techniques performed. The mean age at operation was 3.95 ± 4.17 years and the mean follow-up period was 4.62 ± 4.90 years. Each patient was clinically examined and Doppler echocardiography was performed in 112 patients. Sixty-six patients underwent magnetic resonance imaging. Diameters of aortic arch were measured at 4 levels; the ratios between each one and descendent aorta diameters were calculated. Qualitative variables and associations were studied by Fisher exact test or chi-squared test. Comparisons of measurements in different groups were performed using variance analysis, with tests of selective contrasts (nonparametric tests). The level of statistical significance was <.05.
RESULTS: The prevalence of hypertension and recoarctation was 38% and 14%, respectively. No statistical difference was found among the age groups. In 65 patients who underwent magnetic resonance imaging, the transverse aortic arch was hypoplastic in 31 (47%) patients; 41 (63%) had stenosis at the site of anastomosis (ratio < 0.9).
CONCLUSION: Hypoplasia of transverse aortic arch was highly prevalent. These data suggest that hypoplastic aortic arch should be corrected concomitantly with coarctation.
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