Particularities of neonatal isthmic aortic coarctation ( Tunisian study).

Abstract

Introduction
Coarctation of the  aorta(CoA)  in new born  is a diagnosticand therapeutic  emergency.
The purpose of the work was to identify the clinical, echocardiographic  and therapeutic features of CoA  in neonates  and to determine echocardiographic signs  in favor of its constitution in the fetus.

METHODS:
a  retrospective study including  47 patients with isthmic Co A  diagnosed in    ante et postnatal périod  hospitalized in  pediatric cardiology departement  of la  Rabta Hospital during the period from 2000 to 2017
 Results:
They were  36 girls and 11 boys  with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod  in eight cases. In postnatal period heart failure  was observed in (38.5%) , abolition of femoral pulse (74%),  a tension asymetry  was found in all patients.  Antenatal echocardiography  suspected  indicators   of  fetal coarctation especially  ventriculo-arterial asymmetryechocardiography confirmed  the diagnosis of CoA ,The ejection fraction was impaired in 31% of the cases.The abnormalities associated with coarctation were dominated by the patent  ductus arteriosus (68%), atrial septal defect (55.5%), . aortic hypoplasia  , bicuspidia  in respectively in 34% and 31% coarctation syndrome in (23.4%). Prostaglandin  wasneccessary  in (89.3%) . forty two patients   were operated  with good immédiaterésults .  the early postoperative  mortality was 12.5% . In the long term, we deplored two late deaths, six cases of recoarctation with a follow-up of 14 months treated by  percutaneous angioplasty  with a result considered good in all cases
Conclusion
Coarctation of the aorta in neonates is a special form of  aorticcoarctaion that differs from the child and adult forms in clinical, echocardiographic, and therapeutic characteristics . His clinical diagnosis must be early, if possible in antenatal , to asssure optimal management.