J Thorac Cardiovasc Surg 2004;128:489
© 2004 The American Association for Thoracic Surgery
Reply to Elsayed
Margarida Maria da Costa Smith Maia, MD, PhDa,
Vera Demarchi Aiello, MD, PhDb,
Miguel Barbero-Marcial, MD, PhDb
a Faculty of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
b Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
Reply to the Editor:
In response to Dr Elsayed's questions, we would like to clarify that 111 patients had chest radiography postoperatively. In 57 (51.4%) patients the cardiothoracic ratio was 0.53 or less, and in 54 patients it was greater than 0.53. The left ventricular silhouette studied by the method was increased in 55 (49.6%) patients. The systolic ejection fraction (EF%) on echocardiography was available postoperatively for 111 patients (mean, 79% ± 6%; median, 79%; minimum, 45%; maximum, 92%). The left ventricular mass was also available for 111 patients (mean, 104.32 ± 28.24 g/m2; median, 100.00 g/m2; minimum, 50.00 g/m2; maximum, 220.00 g/m2). The mean left ventricular diastolic diameter available for 110 patients was 39.7 ± 9.1 mm (median, 38.0 mm; minimum, 20.0 mm; maximum, 63.0 mm). We decided to not include these variables because 78.8% of the patients had associated cardiac lesions that could interfere in the results. Furthermore, age and sex also interfere in the left ventricular mass, and the sample was not large enough to include all these variables. In relation to EF, we observed that in 24 patients with a mean age at the time of the operation of 14.9 ± 16.4 months (median, 6.8 months; minimum, 25 days; maximum, 4.6 years), EF before the operation (mean, 48% ± 10%; median, 48%; minimum, 29%; maximum, 65%) had a favorable evolution postoperatively (mean, 79% ± 5%; minimum, 67%; maximum, 90%).
The aortic ratio median behaved the same way independently of age at correction, meaning that it decreased progressively up to the isthmus in each group. This pattern of behavior was also observed in normal adult patients1 studied by means of computed tomography, but the relationship was always greater than 1.
The recoarctation percentages relative to surgical techniques were revised and are correct.
About the surgical indications, 79% of the patients were symptomatic. The main symptoms were heart failure with or without cyanosis in small babies (3 of them were in shock), fatigue, ache in legs, and headache in older children. In 92 (81.4%) patients aortic coarctation was considered severe (gradient at coarctation site 
50 mm Hg), in 12 (10.6%) patients it was moderate, and it could be not classified in 9 (8.0%) patients. Only 1 patient had infective endocarditis caused by Staphylococcus aureus after the operation.
The method used for spinal protection was to decrease the nasoesophageal temperature down to 33°C by means of topical pleural hypothermia. The upper limit of aortic clamping was no more than 25 minutes.
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References
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- Lucarelli CL. Avaliação dos diâmetros normais da aorta torácica e abdominal pela tomografia computadorizada. [thesis]São Paulo, Brazil: University of São Paulo Medical School; 1995. pp. 94.
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