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Heart 88:113-114 doi:10.1136/heart.88.2.113
  • Editorial

Survivors of coarctation repair: fixed but not cured

  1. D S Celermajer,
  2. K Greaves
  1. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
  1. Correspondence to:
    Professor David S Celermajer, Department of Cardiology, Page Chest Pavilion Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia;
    david{at}card.rpa.cs.nsw.gov.au

    While often considered to be cured, patients with repaired coarctation of the aorta frequently have premature morbidity and even mortality

    Surgically repaired coarctation of the aorta (CoAo) is often regarded as a benign condition, in which the patient is essentially “cured”. Consistent with this belief, life insurance companies often provide standard policies for young adults with postoperative CoAo, yet for the vast majority of other types of corrected congenital heart disease, individuals are either insurable only at high rates or not insurable at all.1

    It has been recognised for many years, however, that patients with repaired CoAo frequently have premature morbidity and even mortality. Two long term studies of subjects who underwent repair in late childhood or young adult life reported that the mean age of death in such postoperative patients was only 38 years of age.2,3

    Late problems after CoAo repair are principally caused by recoarctation, late aneurysm formation, hypertension and/or premature coronary, and cerebrovascular disease. Many (but not all) of the complications responsible for this poor outcome are consequences of mechanical problems at the site of repair. A relatively frequent problem is recurrent coarctation. A recent analysis of 11 studies which recruited 718 asymptomatic subjects who had undergone patch aortoplasty documented a recurrence rate of haemodynamically significant CoAo in up to 50% of survivors of neonatal repair and an overall recurrence rate of over 5%.4 Accordingly, coarctation resection and end-to-end anastomosis (where possible) is now recommended as the repair of choice in the neonatal group.4

    Late aneurysm formation has also been reported after every type of CoAo repair (end-to-end, subclavian flap, and patch aortoplasty), with rupture of such aneurysms being responsible for approximately 7% of all deaths.2 Late aneurysm formation is particularly prevalent following Dacron patch repair, a technique commonly employed 10–20 …