Surgical repair of coarctation of aorta harbinger of newer complications??
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Surgical repair of coarctation of aorta harbinger of newer complications?? Niraghatam Harshavardhan 1 & P. Ramesh Menon 2 & Akshay Kumar Bisoi 1 & Ujjwal Kumar Chowdhury 1 Received: 31 August 2020 / Accepted: 8 September 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
The role of surgical repair in the treatment of this anomaly is well established as it undeniably has the advantage of offering better life expectancy when compared with other less invasive forms of treatment [1]. In the early postoperative period following surgical repair, various complications like systemic arterial hypertension, abdominal discomfort with hypoactive bowel sounds as result of mesenteric arteritis (5–10%), chylothorax (5%) [2], and paraplegia (0.41%) [3] are well known. Oliveira et al. [4] published their 30 years of experience with surgical repair of coarctation of aorta in which they mentioned the following early postoperative complications such as systemic arterial hypertension (81.8%), bradycardia (3.6%), bleeding (3.6%), myocardial failure (3.6%), respiratory failure (1.8%), ventricular fibrillation (1.8%), pleural effusion (1.8%), and seizures (1.8%). Choy et al. [5] reported the incidence of paradoxical hypertension during postoperative period of surgical repair of coarctation of aorta due to activation of sympathetic nervous system and renin angiotensin system which is not observed in patients treated with balloon angioplasty of coarctation segment. At our tertiary care center during the last 2 years (august 2018–2019), a total of 20 cases of surgical repair of coarcta-
* P. Ramesh Menon [email protected] Niraghatam Harshavardhan [email protected] Akshay Kumar Bisoi [email protected] Ujjwal Kumar Chowdhury [email protected] 1
Department of CTVS, All India Institute of Medical Sciences, New Delhi 110029, India
2
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
tion of aorta have been performed. Among them 3 cases underwent associated surgical closure of ventricular septal defect (VSD), in 2 cases concomitant repair of arch hypoplasia was performed, in 1 case concomitant closure of atrial septal defect (ASD) was performed, and in 1 case concomitant pulmonary artery banding was performed in a patient with coarctation of aorta with multiple apical muscular VSDs. One case succumbed to death in which concomitant arch repair for hypoplastic aortic arch along with repair of coarctation of aorta was performed. The immediate postoperative complications we noted were systemic arterial hypertension until 5th postoperative day for which vasodilators like sodium nitroprusside and nitroglycerine infusions were used in 18 cases. Abdominal distension with absent bowel sounds for 24 to 48 h in the postoperative period was managed conservatively with nil per oral (NPO) status with nasogastric tube in situ in 16 patients. Chylothorax in 2 patients was managed with octreotide infusion. Recurrent collapse of left lung was noted in 3 patients and surgical
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