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Diagnosis, management and prognosis of patients with critical coarctation of the aorta

Petar Shivachev, Lachezar Marinov, Margarita Tzonsarova, Dobrinka Radoinova

Abstract

The aim of this study is to analyze the clinical presentation, diagnosis, operative results and prognosis of the patients with critical coarctation of the aorta (CoA). 

Methods and materials: A group of 43 newborns and infants up to 3 months of age with critical CoA out of 272 patients with critical congenital heart diseases (CCHD) from the region of North-East Bulgaria were retrospectively followed for a period of 25 years (1987-2011). Methods of investigation included: clinical examination, electrocardiography, conventional radiography, echocardiography and cardiac catheterization. Corrective procedures was done in 31 of the children. Time of postoperative follow-up was an average of 6 years. Operating results are evaluated on a scale developed by us. 

Results: The CoA is the second most frequent CCHD after the transposition of the great arteries (TGA) - 16%, most often in conjunction with other cardiac abnormalities. The clinical presentation and the time of diagnosis of the patients were significantly delayed (ð<0,001). One third of newborns with CCHD, discharged from hospital without being diagnosed with cardiac malformation, turned out to be with CoA. Only 9.5% of our patients were diagnosed in neonatology department, versus 32.7% in other critical cardiopathies (p<0.001) and in one fourth of the children the diagnosis was incorrect or incomplete. Corrective surgical procedures were performed in 31 (72.1%) of the children - 1.6 intervention on each patient average. In 64.5% one-stage correction was performed with spontaneously recovery of the concomitant heart malformation. The preferable surgical technique was Amato procedure - resection and plastic `end-to-end`. Early postoperative mortality was 9.7%. Reoperations were performed in 6 children - 19.4 percent. The late operating results are often good or very good in 65.4% of patients. 

Conclusion: CoA is a common CCHD and the time of the clinical manifestation and the diagnosis are significantly delayed. In spite of the common concomitant heart anomalies in most of the patients it is possible a one-stage corrective procedure to be performed with good postoperative result.


Keywords

critical coactation of the aorta; critical congenital heart disease; clinical manifestation; diagnosis; surgical results; prognosis

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DOI: http://dx.doi.org/10.14748/ssm.v45i1.994

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About The Authors

Petar Shivachev
Medical University of Varna
Bulgaria

Clinic of Pediatrics

Lachezar Marinov
Medical University of Varna
Bulgaria

Clinic of Pediatrics, MU - Varna, Bulgaria

Margarita Tzonsarova

Bulgaria

Department of Pediatrics and Pediatric Cardiology, National Hospital of Cardiology - Sofia, Bulgaria; 3 Department of Pathology and Forensic medicine, MU - Varna, Bulgaria

Dobrinka Radoinova

Bulgaria

Department of Pediatrics and Pediatric Cardiology, National Hospital of Cardiology - Sofia, Bulgaria; 3 Department of Pathology and Forensic medicine, MU - Varna, Bulgaria

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