Between February 1984 and March 1992, 10 patients with aortic coarctation undetwent surgical correction with the technique of subclavian aortoplasty with preservation of arterial flow to the left upper limb. Eight of the patients were male and 2 were female. Their ages ranged from 2 months to 25 years (mean 6.3 years) and the weight ranged from 3.1 to 60 kg (mean 21.2 kg). Surgical technique basically consisted of detachment of the left subclavian artery with subsequent reimplant as a ceiling over the constricted aortic area, thus preserving the arterial flow to the left arm. In this procedure two steps are fundamental: a) wide dissection of aorta and the left subclavian artery in order to allow full mobilization of those vessels, and b) anterior aortic incision should be large to allow reimplant of the subclavian proximal flap well beyond the constricted area. This will produce a wide anatomic reconstruction without tension on the suture lines. Two modifications of the original technique have been utilized: a) resection of a segment of anterior aortic wall the base of the subclavian artery. This will allow a good aortoplasty for patients with well formed isthmus with less dislodgement of the original subclavian insertion, and b) resection of the coarcted segment, end to end anastomosis of the posterior wall and anterior widening with the previously detached and posteriorly incised subclavian artery. This modification is best indicated for small children since it will remove the adjacent ductal tissue. The original technique was utilized for three patients; the modification with and anterior aortic flap was employed in 2 patients and the technique with simultaneous resection of the coarcted area was utilized in the other 5 patients. There was a single operative death, not related to the technique. Nine patients were followed for 1 to 8 years post-operatively (mean 3.9 years). All patients remained asymptomatic, with normal arterial blood pressure and normal pulses in the second day and six years (mean 1.6 years), and demonstrated an excellent aortic widening with preservation of arterial flow to the left arm in 8 patients. One patient had a small circular constriction which produced a 20 mmHg gradient. In conclusion, the subclavian-aortoplasty with preservation of arterial flow to the left arm (basic or combined technique) allows an adequate anatomic correction, permits the subsequent aortic growth and can be utilized in the vast majority of cases of aortic coarctation treated during the pediatric age.
aortoplasty, subclavian; aortic coarctation