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ORIGINAL ARTICLE

Coarctation of the aorta and associated intracardiac lesions: concomitant repair with an anterior midline approach

Marcelo B JateneI; David OstoaI; Carlos A DiasI; Arlindo A RisoI; Miguel Barbero-MarcialII; Munir EbaidI; Adib D JateneI

DOI: 10.1590/S0102-76381993000200008

ABSTRACT

The association of intracardiac lesions with coarctation of the aorta (CoAo) is a situation that could be repaired in only one surgery by anterior midline approach, despite of sugestión of increased risk if compared with two stage repair. Our experience with this approach is a group of 22 children, with ages ranging from 12d to 18y (48.9m), being 12 male, from Jun 88 to Dec 92. All children had CoAo associated whith different intracardiac lesions like VSD in 12 (isolated in 6; with mitral and subaortic stenosis in 3; with subaortic stenosis in 2 and 1 with mitral regurgitation); aortic and subaortic stenosis in 5, mitral stenosis in 2. All children were operated on by anterior midline approach using cardiopulmonary bypass and profound hypothermia to repair first the CoAo and after the intracardiac lesion. In 17 children the CoAo zone was excised with end to end anastomosis; in 4 the left subclavian flap was used and in 1 a Dacron graft was used. No deaths were observed and the main immediate complications were low cardiac output syndrome in 3 and pneumonia in 2 children. In a follow up period from 1 to 50m (17.7%), 16 children are well and assymptomatic and 4 have incaracteristic chest pain. In the same period, the CoAo repair was evaluated by ECHO with no residual stenosis. In conclusion, the concomitant repair showed good results with low morbidity and no mortality in children with different ages and diagnosis.

RESUMO

A associação de lesões intracardíacas com coarctação de aorta (CoAo) pode ser tratada cirurgicamente em dois tempos, ou em um único procedimento por toracotomia medioesternal, sem que haja, necessariamente, aumento do risco operatório. No período de junho de 1988 a dezembro de 1992, 22 crianças (cças) foram operadas através deste acesso cirúgico. A idade variou de 12 dias a 18 anos (48,9m), sendo 12 do sexo masculino. Todas apresentavam CoAo de importante repercussão, associada a diferentes lesões intracardíacas, a saber: CIV em 12 cças (6 isoladas; 3 com estenose mitral e sub-aórtica; 2 com estenose sub-aórtica e 1 com insuficiência mitral);estenose aórtica e sub-aórtica em 5 cças; estenose mitral em 2 cças. Todas as cças foram operadas por toracotomia medioesternal com suporte de circulação extracorpórea e hipotermia profunda, reparaando-se, em primeiro lugar, a CoAo e, em seguida, a lesão intracardíaca. Em 17 cças, a zona coarctada foi ressecada e realizada anastomose término-terminal; em 4, utilizou-se flap de artéria subclávia esquerda e, em 1 cça, a CoAo foi corrigida com interposição de tubo de Dacron. Não foram observados óbitos nesse grupo e as principais complicações imediatas foram síndrome de baixo débito em 3 cças; pneumonia em 2 cças. Em um período de evolução de 1 a 50m (17,7 m), 16 cças estão bem e assintomáticas; 4 apresentaram sintomas dolorosos incaracterísticos e 2 cças tiveram seu seguimento perdido. No mesmo período, após avaliação por ecocardiograma, não se observou CoAo residual. Em conclusão, o tratamento cirúrgico concomitante se mostrou eficiente em cças de diferentes idades e com diferentes lesões, com baixa morbidade e sem mortalidade no grupo estudado.
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