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J Thorac Cardiovasc Surg 1999;117:844-845
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Invited letter concerning surgical repair of recurrent aortic coarctation

Department of Cardiology
The Children's Hospital
Harvard Medical School
300 Longwood Ave
Boston, MA 02115

To the Editor:

Sakopoulos and colleagues ¹ have provided a very useful service to physicians caring for children and adults with coarctation of the aorta by reviewing a recent series of patients with recurrent aortic coarctation who were managed surgically. Their results demonstrate that improvements in surgical technique and modern preoperative, intraoperative, and postoperative management approaches have further reduced the early morbidity and mortality associated with the surgical management of recurrent aortic arch obstructions. The absence of mortality and the minimal morbidity continue to challenge those physicians who would recommend transcatheter-based or medical therapy for patients with arch obstructions that persist after surgical repair.

Although their argument is perhaps less convincing than they wish it were because of the inevitable comparison with reports that are almost entirely from the experience with transcatheter-based therapies, the primary weakness in this article relates entirely to the precision and completeness with which late follow-up was obtained. For such an article to prompt cardiologists to change recommendation and management practices, certain basics of follow-up would be necessary: the measurement of blood pressures; the definition of what constituted a normal versus an abnormal blood pressure; the techniques used to assess gradients, their presence or absence; the techniques used to assess the presence or absence of recurrent aneurysms; and increasingly more sophisticated studies of left ventricular compliance and wall mass as an alternate and perhaps more sensitive way to measure the pressure load on these left ventricles. In the absence of more rigorous and quantitative follow-up data, this study is much less persuasive than it could have been. Nonetheless, the absence of mortality and the very low levels of acute morbidity are real and indicate that surgical management is safer than prior reports might have suggested. Interventional cardiologists, blood pressure pharmacologists, and cardiovascular surgeons continue to improve the results of their respective techniques in managing this patient population, and all of us serve our patients better.

12/8/96529

References

1. Sakopoulos AG, Hahn TL, Turrentine M, Brown JW. Recurrent aortic coarctation: Is surgical repair still the gold standard? J Thorac Cardiovasc Surg 1998;116:560-5.[Abstract/Free Full Text]
   

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				R. J. Walhout, J. C. Lekkerkerker, G. H. Oron, G. B.W.E. Bennink, and E. J. Meijboom Comparison of surgical repair with balloon angioplasty for native coarctation in patients from 3 months to 16 years of age Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 722 - 727. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lock, J. E. Search for Related Content PubMed PubMed Citation Articles by Lock, J. E.