Subclavian flap for repair of aortic coarctation

Hey there dear guest. I need to admit that your topic is a little bit confusing to me. I know that a lot of kids have problems with it and I could tell you something about it, but since you have it I am not sure can I help you. I know that repair of aortic coarctation is usually performed via a left thoracotomy without cardiopulmonary bypass. But that is what I have heard, I am not sure is it correct or not. Also, there are a number of techniques available to repair the coarctation, each with its own advantages and disadvantages. Can you tell us more?

Hi Guest,

This is quite an old procedure and hasn't been used much. It is actually first tried somewhere around 1980 but it hasn't been used much since.

 Subclavian flap repair of infant coarctation has been criticized and in many centers abandoned in favor of resection with end-to-end anastomosis. However, after several studies done, subclavian flap aortoplasty remains the procedure of choice for isthmic coarctation in a lot of hospitals, as it is a simple, technically straightforward technique with a low incidence of re-stenosis and serious early and late morbidity. Furthermore, subclavian flap re-stenoses are easily treated with percutaneous intervention and seldom require surgical re-intervention via thoracotomy.

This technique consists of a complete mobilization of the left subclavian artery extended to the origin of its first branches. The aorta need not be extensively mobilized and the intercostal arteries are individually controlled with snares. After all the proper clamping, the left subclavian artery is detached from the aorta at its origin and is opened longitudinally on its posterior aspect. The anterior wall of the aorta is then incised, beginning with the opening at the origin of the left subclavian artery and extending distally to the descending aorta 12 to 15 mm past the coarctation. The coarctation membrane is excised and the ductus is ligated and divided. The opened left subclavian artery, now forming a flap, is pulled down and sutured to the edges of the aorta, widening the coarctation site and also preserving the blood flow to the left arm.

Hey everyone,

I was also interested to know more about this procedure ever since I've heard about it a couple of years ago but I totally forgot about it since then and never found out anything about it, how cool that I ran on to this topic here.

I'm trying to catch up with what you just wrote there Doc, but I'm afraid that I'm not doing very well there. Is there any way that you can say it in a more less complicated way? If not you, can anyone else try to explain this to me and Guest in a kind of a simple way?

Hey there everyone. Adria 18 exactly the same thing happened to me but whenever I tried to did some research about it I was not able to find what I was looking for. Whatever I found I was not able to understand I am was really lucky at this moment when I saw this topic. Also, I have to agree that I am not sure what Doc exactly wanted to tell us because those are professional terms, right? Anyone could tell us at less complicated way?

Hey there guys. Thank you so much for trying to explain to me, but I think that I don't understand it very well. I don't know are there some risk, some complications that can happen and as you can see - you are using too many professional terms which I don't understand. Actually, I am sure that no one can understand it that well. So the main thing that I really want to know is how people can recover from this procedure and are there some side - effects that can occur, some problems as well? Thank you.