Coarctation of the aorta in infants: does the aortic arch grow after repair?

Infants with coarctation of the aorta frequently require a corrective operation during the first year of life. These patients frequently have a smaller than normal transverse aortic arch. Despite good repairs with different techniques, the proximal transverse aortic arch often remains smaller than normal. The hemodynamic molding theory predicts that growth of the aortic arch should occur when normal flow is established through the aortic arch. Preoperative and postoperative aortograms were reviewed in patients who underwent subclavian flap aortoplasty for the repair of coarctation. Patients were divided into two groups. Subclavian flap aortoplasty was performed at 1 month of age or earlier in group I, and at more than 1 month but less than 1 year of age in group II. Aortograms performed in patients without coarctation were used as age-matched controls (group III). The transverse aortic arch in groups I and II did grow and were compared with the control group. Group I patients achieved more growth than those in group II. No aortic arch gradients were present at postoperative follow-up.