Resumen de Corrección quirúrgica de la coartación de la aorta: experiencia quirúrgica durante 30 años en el Hospital México

Eduardo Induni López, Juan Pucci C, Longino Soto, Manuel Alvarado, Edgar Mendez, Carlos Salazar Vargas, Bayardo Robelo Pentzke

• español

  Presentamos aquí la experiencia quirúrgica en el tratamiento de la coartación aórtica acumulada a lo largo de 30 años en el Hospital México. Se intervinieron un total de 81 pacientes, cuyo promedio de edad es de 20.3 años, dado que inicialmente nuestro Centro contaba con un Servicio de Pediatría, existen 8 niños en la serie. Clínicamente los menores de un año se presentaron con insuficiencia cardíaca y los demás con sintomatología secundaria a hipertensión arterial o claudicación intermi tente. Durante los primeros 10 años se realizaron 27 resecciones y posteriormente se emplearon otras técnicas, pero a partir de 1984, se ha utilizado casi exclusivamente la aortoplastia con parche de duramadre. Ochenta y cuatro por ciento del grupo se tornaron normotensos, 10% mejoraron y un 6% no cambiaron. Dieciseis por ciento tuvo morbilidad postoperatoria, presentando condiciones comunes a este tipo de intervención y que se resolvieron fácilmente. La aortoplastia con parche nos ha dado buenos resultados, es técnicamente sencilla puesto que se ejecuta en el plano frontal y se hace mejor hemostasia, permite el crecimiento de la aorta en los niños y al dejar un diámetro adecuado reduce sustancialmente el gradiente.

• English

  Eighty two patients with aortic coarctation have been operated upon at the Hospital Mexico during the last 30 years. The median age is 20.3 years and since at the beginning our center also cared for children, 8 of them are here included. The clinical presentation in those below 1 year was heart failure, and the rest manifested signs and symptoms related to arterial hypertension or distal ischemia such as intermittent claudication of the lower extremities. During the first 10 years 27 resections were performed and later on other techniques were adopted, but since 1984 dura mater patch aortoplasty has been exclusively employed. Eighty four percent of the patients became normotensives, 10% improved and 6% did not change. Sixteen percent had common complications to this type of interventions which resolved with appropriate management. Two patients died (2.4%), one a 4 months old baby with heart failure and bronchopneumonia and the other a 23 year old with recoarctation who was reoperated for recurrent postoperative bleeding and developed multisystemic organ failure. The patch aortoplasty technique has given us very good results, it is easy to perform since it is done right in front of the surgeon and better hemostasis can be achieved, the remaining aortic tissue can and it will grow and allows for a wider luminal diameter reducing or abolishing pressure gradients across the coarcted segment.