Author + information
- Received September 23, 1998
- Revision received April 9, 1999
- Accepted May 16, 1999
- Published online September 1, 1999.
- Damien Bonnet, MDa,* (, )
- Juliana Patkaï, MDa,
- Daniel Tamisier, MDa,
- Jean Kachaner, MDa,
- Pascal Vouhé, MDa and
- Daniel Sidi, MDa
- ↵*Reprint requests and correspondence:
Dr. Damien Bonnet, Service de Cardiologie Pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15
We propose a new strategy using coarctation repair together with a polidioxanone absorbable pulmonary artery banding to limit operative risk and to spare infants with aortic coarctation subsequent operations.
The alternative for the surgical management of aortic coarctation associated with ventricular septal defect (VSD) is single-stage repair versus coarctation repair with or without banding of the pulmonary artery.
Eleven infants (mean weight 2,560 ± 1,750 g, range 1,320 to 3,800 g) underwent a coarctation repair with a polydioxanone banding. Seven had a trabecular and four a perimembranous VSD. The mean size of the VSD was 5 ± 0.7mm (range 4 to 7 mm). The systolic pulmonary pressure was >80% of the aortic pressure in all. The pulmonary band was tightened until the systolic pulmonary pressure fell below 50% of the aortic pressure.
There were no hospital deaths. The reabsorption of the banding was complete after 5.7 months in all patients (3 to 6.5 months). The VSD closed completely in four infants and partially in six, in whom the pulmonary artery pressure was normal without evidence for significant left-to-right shunt. One patient with a large trabecular VSD underwent surgical closure of his defect after four months. Finally, a subsequent open-heart surgery could be avoided in 91% (10/11) of patients.
Provided the VSD belongs to types prone to close spontaneously, this policy may reduce the number of surgical procedures per infant as well as in-hospital mortality and morbidity rates. It should be proposed as an alternative to more complex procedures.
- Received September 23, 1998.
- Revision received April 9, 1999.
- Accepted May 16, 1999.
- American College of Cardiology