Hemodynamic and clinical appraisal of coarctation four to seven years after resection and end-to-end anastomosis of the aorta.

This study was undertaken to ascertain whether coarctation of the aorta produces permanent hemodynamic abnormalities that may persist despite resection and end-to-end anastomosis. The results of studies in 10 patients 4 to 7 years after operation are compared to those obtained before and immediately after operation. The most significant finding was continued decrease in residual coarctation, in addition to dramatic immediate postoperative improvement in the degree of circulatory impairment. P REVIOUS studies in this laboratoryl-4 and elsewhere5 have reported the changes in circulatory dynamics produced by resection of that portion of the aorta affected by coarctation, followed by end-to-end anastomosis. However, these studies were conducted soon after operation and at intervals during the succeeding 18 months. The present report compares the hemodynamic changes in 10 patients studied before and immediately after operation and at intervals during the next 4 to 7 years. METHODS The long-term study included physical examination , determinations of blood hemoglobin and leukocytes, urinalysis, electrocardiograms, and teleroentgenograms of the thorax. Cathe-terization of the right side of the heart was performed in addition to puncture of the radial and femoral arteries. Data were recorded by means of the photokymographic methods previously described.6' 7 Arterial oxygen saturation was monitored during the procedure by means of earpiece oximeters, while oxygen saturation in the chambers of the right heart and the venous inflow tracts was determined by means of the cuvette oximeter.' The Van Slyke method9 of analysis of blood samples was used for determining the cardiac output From the Mayo Foundation, a part of the Graduate by means of the Fick principle. A second and independent method, the dye-dilution tech-nic,10-12 also was used to calculate cardiac output. These determinations were made after the patient was stabilized while breathing 100 per cent oxygen and were done nearly simultaneously to permit comparison of the output by the 2 methods. The studies were conducted 1 to 2 hours after a light meal and with the patient in the supine position. Premedication consisted of 1½1 grains of allyl (1-methylbutyl) barbiturate and 12 grain of codeine. RESULTS Clinical Evaluation. All patients were in good health at the time of the long-term study. Two patients (cases 2 and 9, table 1) had had uneventful pregnancies terminated by elective cesarean section (elsewhere) 28 and 42 months, respectively, after surgical correction of the coarctation. Preoperative systolic murmurs of varying intensity were noted over the precordium in all 10 …