The internal mammary artery as subclavian artery substitute in repair of coarctation of the aorta with subclavian flap technique.

In three children, aged 11, 11 and 13 years, long isthmic tubular hypoplasia of the aorta technically precluded resection and end-to-end anastomosis. The coarctation was instead corrected by means of a subclavian flap. Anastomosis between the distal end of the left internal mammary artery and the descending aorta permitted perfusion of the remaining portion of the subclavian artery. At invasive reexamination 6 months after surgery, there was adequate functional and anatomic relief of coarctation in all three children. The three mammary artery-aorta anastomoses were patent, which probably prevented the potential ischemia of the left arm after ligation of the subclavian artery.