Background: Coarctation of the aorta (COA) is a congenital disorder characterized by narrowing the aorta; the most common site is an aortic isthmus. While Interrupted aortic arch (IAA) is the most severe form of CoA. This disorder results in a decrease in the amount of perfusion and an increased afterload on the left ventricle. The most common clinical sign of aortic coarctation is a difference in pulse strength, oxygen saturation, and blood pressure between the upper and lower extremities. In addition, narrowing the aorta can cause many other abnormalities, such as ventricular dysfunction and systemic hypertension. By the third or fourth decade of life, unrepaired coarctation leads to ventricular dysfunction, aortic aneurysm/dissection, and cerebral vascular disease. Therefore, early treatments are important. This study aims to demonstrate treatment outcomes and possible complications in patients with COA and IAA.
Objective: To describe the patient demographic data and treatment outcomes of the patient diagnosed with CoA/IAA between 2011-2020 at Chiang Mai University Hospital.
Methods: A Retrospective review of pediatric patients diagnosed with COA/IAA and intracardiac defects at Chiang Mai University Hospital between 2011-2020. Descriptive statistics were used in demographic data. K-M survival analysis was used for analyzed long-term survival and recoarctation.
Results: Total 101 aortic coarctation and interrupted aortic arch cases, there are 19 cases of IAA and 82 cases of coarctation of the aorta. All IAA cases received surgical repair, 3 cases dead immediately post-operation (15.8%), 3 cases have had recoarctation (18.8%).median age of recoarctation is 3 years 7 months. For 82 COA, 4 cases died before surgery, 17 cases had mild CoA, 61 were treated 59 by surgery and 2 by balloon native CoA. There were immediate post operative 3 cases were dead (5.1%). Long term mortality rate is 8.5%. Re-COA was observed in 6 surgical cases (10.2%) and 1 case (50%) from balloon native COA. The Median Age at Surgery for CoA and IAA group is 60 days and 22 days, body weight 3.94 kg and 3.1kg and duration for admission 23.5 day and 27 days. Sensitivity of critical congenital heart screening is 89.5% for IAA and up to 86.9% for COA. Our study shows pneumonia is the most common complication (18.64%), whereas systemic hypertension is the second complication in COA patients (16.94%).The re-coarctation-free rate was 88.9% in COA and 81% in IAA patients.
Conclusion: Immediate and late Post-operative mortality of coarctation repair in CMUH for IAA is 5.3% and 15.8% respectively and 5.1% and 8.5% in the IAA group. Re-coarctation-free rate is 88.9% in COA group and 81.3% in IAA patients. The common complications are pneumonia and hypertension.
