SHA24/042005

Coarctation of Aorta in Infants Surgery Vs. Catheter Intervention Ahmed Abdullah Jamjoom

Surgery Vs. Catheterization Simple Aortic Coarctation Aortic Coarctation without associated intracardiac lesions, with or without posterior arch hypoplasia

Vs.

Dr. Omar Galal

KFSH & RC Jeddah 2002-2007

Literature Review

Surgery Results

• • • • •

29 papers 2789 patients Age 33 d ( 1-275 ) Weight 3.2 Kg ( .75-5.4 ) Follow up 1-20 y

Surgery Results - Mortality

0-26%

- Morbidity • • • • •

Re-coarctation 2-44% - 96% successful Cath.

- 4% required surgery Paraplegia 0-5% Nerve injury 0-4% Aneurysm formation 0-11% Chylothrax 0-7%

Catheterization results

• • • •

18 papers 194 patients Age 68 d ( 13-320 ) Weight 4.8 Kg ( .8-7.1 ) Follow up 1-15 y

Catheterization results - Mortality

0-10%

- Morbidity • Re-coarctation 7-83% - 30% successful Cath.

- 70% required surgery •Paraplegia ----•Nerve injury ----•Aneurysm formation 3-45% •Femoral artery occlusion 6-35%

Radiation exposer Air Embolism Catheter Malfunction

Summery Table

Results Justification

• Ductal tissue • Hypoplasia of the arch 40-60%

INDICATIONS FOR CORRECTIVE surgery

(Grade 1B)  Neonates and Infants younger than four months of age surgical correction is recommended

(Grade 2B) Older than four months – The decision regarding balloon angioplasty versus surgical repair is determined on a caseby-case basis by the clinical team

It is reasonable after a case-by-case review to consider balloon angioplasty of native coarctation •As a palliative measure to stabilize a patient irrespective of age when extenuating circumstances are present such as severely depressed ventricular function, severe mitral regurgitation, low cardiac output, or systemic disease affected by the cardiac condition Class IIa /C •In patients beyond 4 to 6 months of age when associated with a transcatheter systolic coarctation gradient >20 mm Hg and suitable anatomy Class IIb /C

KFSH & RC J Surgery

July 2000 – December 2012 1. No. of Patients : 2. Age : 3. Sex : 4. Weight

   

:

Mortality Recurrent coarctation Chylothorax Phrenic nerve injury

86 (6 days – 1 years) Female - 41 (48%) Male - 45 (52%) 1.2 – 5.2 kg

:

: 3(3.4%) : 2(2.3%) 5(5.8%) : 2(2.3%)

KFSH & RC J Cath In the last 6 years 129 cases 22 / Year

Conclusion • Management strategy ( Immediate & Long term ) - Growth potential should be incorporated - Synthetic material should be avoided - Repair should be performed early • Results presented • Guide lines

SURGERY IS THE RIGHT WAY

Thank you