The Journal of Thoracic and Cardiovascular Surgery, Vol 82, 103-106, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Aortoplasty with the left subclavian flap in older children
DI Hamilton, D Medici, M Oyonarte and DF Dickinson
Ten patients between 8 months and 9 years of age (average 4.3 years)
underwent surgical relief of coarctation of the aorta by the technique of
left subclavian flap aortoplasty. Before operation, nine patients had
systolic hypertension in the upper extremity (average 145 mm Hg) and all
had a significant pressure gradient across the coarctated aortic segment
(average 45 mm Hg). The hospital and late mortality were zero. The
follow-up over 7 years has shown complete relief of the coarctation and no
ischemic impairment or functional limitation of the left upper extremity.
The blood pressure returned to normal in all patients. Hemodynamic and
angiographic studies, performed in one case, demonstrated adequate growth
of the repaired segment and absence of a pressure gradient across the
previously narrowed area. The time interval between the peak of the femoral
pulse and the dicrotic notch of the carotid pulse, recorded
postoperatively, was normal. We consider the left subclavian flap technique
to be the operation of choice in infancy and also in older children,
whenever the anatomic configuration of the coarctation suggests that
subsequent growth would be severely restricted if other techniques were
used.
