Modified end-to-end anastomosis combined with subclavian flap aortoplasty for repair of coarctation of the aorta with extended hypoplasia of the aortic isthmus

Recoarctation is a serious complication of the surgical repair of coarctation of the aorta. A combined technique using end-to-end anastomosis and subclavian flap angioplasty has shown good results. However, this technique is not entirely free from longitudinal traction in cases of extended hypoplasia of the aortic isthmus. To obviate these problematic sequelae, we have modified the combined technique for repair of coarctation of the aorta having extended hypoplasia of the aortic isthmus. Almost the entire aortic isthmus is left unresected and a lesser period of interruption of blood flow through the descending aorta is required. During the period from 1991 to 1998, five infants with this abnormality underwent surgical repair with the modified method. The results were excellent with no postoperative death and no recoarctation during the follow-up period.