[Choice of surgical method in the child or adult (excluding infants) suffering from coarctation of the aorta and severe cardiopathy]

Abstract

A study of a serie of 45 cases of coarctation of the aorta associated with a severe cardiac lesion or malformation, and treated at a single operative session (18 cases) or in two consecutive stages (27 cases) has produced the following conclusions: --Treatment at a single operation is possible, usually at the cost of two consecutive surgical approaches, thus making the operation rather long. This plan, which has given good results in the 18 cases studied (only one death and no serious complications) should be adopted only for young patients who are well-balanced psychologically, and whose cardiac defect is well-compensated. --Treatment in two stages is a more reasonable course for the remainder of the patients, but it must be decided which lesion to treat first: this could be the coarctation if it is a difficult or poorly tolerated one and if the cardiac defect (especially when an aortic valve lesion) is well compensated. It will be the cardiac lesion if, by contrast, the coarctation is simple and well-tolerated, and the cardiac lesion is severe and decompensated (especially a mitral malformation with shunts and major pulmonary hypertension). Current techniques of open heart surgery allow us to employ extracorporeal circulation easily and safely with the coarctation still in place; this will then be treated later. In every case in which a two-stage treatment plan has been chosen, it should be carried out as a planned procedure so that the second stage of the operation is not put off unduly.