Treatment of Critical Aorta Coarctation in Newborns and Infants

Treatment of critical heart defects is one of the most difficult problems in cardiovascular surgery. The purpose of our work was to study the features of the course, diagnostics and tactics of surgical treatment of infants with Critical Aorta Coarcation (hereinafter – CoA). Material and methods. 59 patients with CoA were operated on in the State Institution "Amosov National Institute of Cardiovascular Surgery of National Academy of Medical Sciences of Ukraine ". Among the operated children there were 43 are boys (72.9%), and 16 girls (27.1%) with a ratio of 2.69. The 1st group (n=41) had surgical treatment, the 2nd group (18 patients) had endovascular balloon dilatation of aortic coarctation (CoA), 13 of them had surgical treatment performed after balloon dilation at different times after endovascular treatment (hereinafter – EL). The average age of patients was 97.9±10.8 days (from 1 to 360 days); their average weight was 4.5±1.3 kg (2.0 to 9.5 kg). 34 (57.6%) patients were diagnosed with the defect prenatally and confirmed by the Echo-KG immediately after birth, which allowed the child to be delivered urgently to the State Institution "Amosov National Institute of Cardiovascular Surgery of National Academy of Medical Sciences of Ukraine " to provide highly skilled surgical help. If taken in groups, the average age on the day of surgery was 98.8±13.8 in the 1st group, and 37.2 ±18.3 and 118±17.8 in the 2nd group and subgroup 1a, respectively. Results and discussion. After treatment, the value of the preoperative gradient of pressure in the 1st group decreased from 59.3 ±18.7 to 17.5±7.4 mm Hg after surgery (p <0.05); in the 2nd group it decreased from 57.4±16.5 to 14.2±6.3 mm Hg (p <0.05). The average number of days in the hospital was 6.4±3.6 with BA and 21.5±8.7 days in the surgical group with a significant difference (p <0.05). Both direct and long-term results showed the absence of mortality. However, reCoA was conducted in 13 (72.2%) patients of the 2nd group and was localized as a site of a former cortal ring or membrane. After 3 months of conservative treatment, all patients underwent surgical treatment. In the 1st group, reCoA was detected in 1 case (2.4%) and was limited by the size of anastomosis. Hypoplasty of the aesthetic and/or arterial asthma did not occur. The next balloon dilatation was successful in all patients. Formation of aneurysms was not marked in these series. Conclusions. The obtained results showed that surgical recovery and balloon angioplasty for local CoA in newborns are effective and useful methods. In this case, balloon angioplasty can be a successful alternative to surgical treatment, but the high level of recoarctation of this method can be considered in critically ill newborns with congestive heart failure as the first palliative procedure. The limitation of this method had retrospective (retroactive), non-randomized character with a small number of cases.