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Post Procedure Life

Mortality Data

  • Looking at a study conducted by the Divisions of Pediatric Cardiology at the University of Minnesota School of Medicine, University of Connecticut Medical School, and University of Michigan where research was done on 252 survivors of the coarctation procedure, age of the patient at the time of their surgery is crucial in the longevity of their lives. Patients with the greatest chance of survival were administered the procedure at very young ages with children between the ages one and five having the lowest mortality rate. A further break down of the relationship between mortality rate and certain age groups proves to be a major factor of how important early detection and diagnosis is. Ninety-five percent of the 252 patients were still alive at ten years post surgery, Eighty-nine percent at twenty years, eighty-two percent at thirty years, and seventy-nine percent at forty years. The causes of late death vary but the most common cause was due to coronary artery disease. At the mean age of fifty-three years, ten patients were diagnosed and deceased from this disease. All of these patients were older the ten years old when the initial coarctation procedure occurred. Seven patients died during a second cardia operation: aortic valve replacement cause three patients to die, recoarctation surgery led to two patients deaths, and mitral valve operation caused two others to die. In seven different patients sudden death occurred and of these seven patients six of them were older then ten years old at the time of the initial coarctation repair. Ruptured aortic aneurysm causes the death of six subjects; fives occurred of ascending aortic dissection and rupture while the last patient passed away from an aneurism occurring in the site of the original repair.
Cause of Late Death No.
Coronary artery disease 10
Second cardiac operation 7
Aortic dissection 6
Sudden unexplained 7
Automobile accident 3
Other 7
Unknown 5

Other=Suicide, endocarditis, cardiomyopathy, alcohol, cancer, autoimmune deficiency syndrome; and prostate surgery.

Side Effects

  • Hypertension is defined when a patients blood pressure in their right arm exceeds 160/90 mm Hg under normal conditions. This is a severe problem for the heart and can cause many other complications. In study of 120 coarctation repair recipients done over seas in Groningen, The Netherlands, twenty-nine patients (25%) experience hypertension in the later years of their life due to the repair. While hypertension has many different factors that lead to this stage of blood pressure, people who have had a coarctation repair, regardless of the age at which the operation was performed, are at a much higher risk of hypertension later in their lives then the general public. Undetected chronic hypertension can lead to sudden death among patients of the coarctation repair at higher rates as time progresses.
  • Angioplasty is a procedure done to dialate an abnormally narrow section of a blood vessel to allow better blood flow. This is done in a cardiac catheterization laboratory. Typically taking two to three hours, the procedure may take longer but usually patients are able to leave the hospital the same day. After a coarctation repair 20-60% of infant patients may experience reoccurring stenosis at the site of the original operation. This can be fixed by either another coarctation or by the procedure of choice among cardiologists; angioplasty.
  • Coronary artery disease, or simply known as heart disease, is a major issue for patients who have undergone a coarctation repair. Many years after the procedure is done, heart disease not only has an increased chance of effecting coarctation patients but also progresses through the levels of severity at an alarmingly increased rate. In a study conducted by Mare Cohen, MD, et al, one fourth of the patients who experienced a coarctation passed away due to heart disease not only late in life but at younger ages.

Follow Up

  • Leaving the hospital after a coarctation is only step on in a life long process.Just because the coarctation was fixed does not mean that the patient is cured. It is extremely important to visit the cardiologist on a regular basis. Depending on the severity of the patient, which is evaluated on a case by case level, visiting a cardiologist can be a once a year surveillance check up. Keeping a regular schedule of appointments with a cardiologist after the coarctation is complete helps increase the chances of survivability for the patients.

References

  • The American Journal of Cardiology, Volume 89, Issue 5, 1 March 2002, Pages 541–547
  • SURGERY FOR CONGENITAL HEART DISEASE: Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repairIncluding long-term results after elective aortic coarctation repair with a follow-up from 25 to 44 years. René M. H. J. Brouwer, MD, Michiel E. Erasmus, MD, Tjark Ebels, MD, PhD, Anton Eijgelaar, MD, PhD
  • Journal of Human Hypertension 25, 739-745 Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function. G Di Salvo, B Castaldi, L Baldini, S Gala, F del Gaizo, A D'Andrea, G Limongelli, A F D'Aiello, G Scognamiglio, B Sarubbi, G Pacileo, M G Russo and R Calabrò
  • Beekman, Robert H., Albert P. Rocchini, Douglas M. Behrendt, Edward L. Bove, Macdonald Dick II, Dennis C. Crowley, A. Rebecca Snider, and Amnon Rosenthal. "Long-term Outcome after Repair of Coarctation in Infancy: Subclavian Angioplasty Does Not Reduce the Need for Reoperation." Journal of the American College of Cardiology 8.6 (1986): 1406-411. Print.
  • Cohen, Marc, MD, Valentin Fuster, MD, Peter M. Steele, MBBS, David Driscoll, MD, and Dwight C. McGoon, MD. "Coarctation of the Aorta Long-term Follow-up and Prediction of Outcome After SurgicalCorrection." Circulation 80 (1989): 840-45. Print.
  • Celermajer, D. S. "Survivors of Coarctation Repair: Fixed but Not Cured." Heart 2002 88.2 (2002): 113-14. Print.