Coarctation of the thoracic aorta: an 18-year experience.

From 1960 to 1978, 80 patients from 2 weeks to 49 years of age underwent operations for coarctation of the aorta. Twelve patients were under 3 months old, and 68 were older. All of the infants presented with congestive heart failure and multiple cardiac defects. In the older patients, hypertension was the most common presenting symptom; 14 were asymptomatic. All patients under 3 months old received primary correction. Seven (58%) died of complications associated with other cardiac anomalies. In the older group, there was 59 primary reconstructions, six interposition grafts, and three other procedures. There were two deaths in this group. There were three re-explorations, two for bleeding and one for false aneurysm at the suture line. Seven older patients exhibited paradoxical hypertension: three developed abdominal symptoms and two required laparotomy. Three patients originally operated on during infancy developed recurrent coarctation with reoperation in two. Nine of the older patients had chronic hypertension, all of whom were operated on after age 15. Surgical correction of coarctation in infants carries a high mortality rate secondary to associated defects. The operative mortality rate in older patients is minimal, and correction should be undertaken early to prevent the long-standing complications of hypertension.