Coarctation of the Aorta in Children at Siriraj Hospital
DUANGMANEE LAOHAPRASITIPORN, M.D.*, APICHART NANA, M.D.*, KRITVIKROM DURONGPISITKUL, M.D.* SOMCHAI JARUCHAROENPORN, M.D.*, JARUPIM SOONGSWANG, M.D.*,
Affiliation : *Department of Pediatrics, Faculty ofMedicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
A retrospective analysis of 33 children who were diagnosed to have coarctation of aorta at Siriraj Hospital between January 1989 and December 1998 was undertaken. There were 21 males (64%) and 12 females (36%). Their ages ranged from one day to 11 years (median 2 months). The majority of the patients (78.8%) were presented early within the first year of life. The predominant clinical manifestations were congestive heart failure (69.6% ), systemic hypertension of the upper extremities (36.3%) and decreased femoral pulses. Chest roentgenogram revealed cardiomegaly (70%) and increased pulmonary blood flow (84%), reflecting congestive heart failure and asso- ciated left-to-right shunting. Electrocardiogram showed normal pattern (33.3% ), right ventricular hypertrophy (33.3% ), left ventricular hypertrophy (22.2%) and biventricular hypertrophy ( 11.2% ). The younger the patient is, the more right ventricular predominance is demonstrated. According to the echocardiogram and/or aortogram, juxtaductal type was found in 51.5 per cent, postductal type in 27.3 per cent and preductal type in 21.2 per cent. Medical management included prostaglandin E 1 infusion in a newborn baby presented with low-cardiac output state, anticongestion and anti- hypertension, if indicated, followed by surgical correction. The result of coarctectomy with end- to-end anastomosis with or without arch augmentation was good. The operative mortality rate was 5 per cent. The overall mortality in the present study was 9 per cent. The most common causes of death were multiorgan failure and pulmonary infection. Residual coarctation was found in 5 per cent.
Keywords : Coarctation of Aorta, Children
