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J Am Coll Cardiol, 2004; 44:188-191, doi:10.1016/j.jacc.2004.01.052
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Follow-up of aortic coarctation repair in neonates

Michael D. Puchalski, MD*,*, Richard V. Williams, MD*, John A. Hawkins, MD*, L. LuAnn Minich, MD* and Lloyd Y. Tani, MD*

* Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, USA

Manuscript received October 13, 2003; revised manuscript received December 17, 2003, accepted January 19, 2004.

* Reprint requests and correspondence: Dr. Michael D. Puchalski, University of Utah, Primary Children's Medical Center, 100 North Medical Drive, Salt Lake City, Utah 84113, USA.
pcmpucha{at}ihc.com

OBJECTIVES: The purposes of this study were to assess the growth of left heart (LH) structures, to evaluate midterm outcomes, and to define echocardiographic parameters predictive of increased risk of re-intervention in patients born with aortic coarctation and hypoplasia of LH structures that underwent neonatal coarctation repair.

BACKGROUND: Neonatal coarctation is often associated with hypoplasia of LH structures. Although previous studies have shown that coarctation repair can be performed with good results in these neonates, there are little data regarding growth of the LH structures or outcomes in these patients.

METHODS: Patients with isolated coarctation and at least one hypoplastic LH valve (mitral or aortic Z-score <–2) who underwent a neonatal coarctation repair were identified. Clinic charts and the latest echocardiograms were reviewed.

RESULTS: All 55 patients were alive and well, and no patient had clinical evidence of mitral stenosis. Three patients (5%) required re-intervention. Thirty-eight patients had echocardiograms that demonstrated normal left ventricular (LV) size and function with a follow-up duration of 73 ± 19 months (range 3 to 9 years). Both mitral and aortic annulus Z-scores increased significantly: –3.1 ± 1.5 to –0.5 ± 1.6 (p < 0.001) and –3.5 ± 1.9 to 0.7 ± 1.6 (p < 0.001), respectively. Nine patients (24%) developed LV outflow tract obstruction by echocardiographic criteria.

CONCLUSIONS: After neonatal coarctation repair with associated LH hypoplasia, LH structures increase substantially in size, and clinical outcomes are excellent at midterm follow-up. Despite initial annular hypoplasia, the need for intervention for mitral or aortic/subaortic stenosis is uncommon.

Abbreviations and Acronyms
  LH = left heart
  LV = left ventricle/ventricular




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