Bu yaz›m›zda, 0–3 ay ve 3–24 ay aras›ndaki aort koarktasyonlu hasta gruplar›nda, rezeksiyon uçuca anastomoz, subklavyan flap aortoplasti ve modifiye subklavyan aortoplasti tekniklerinin geç postoperatif dönemde rekoarktasyon yönünden birbirleriyle karfl›laflt›rmak ve hangi prosedürün yafl gurubuna göre daha uygun oldu¤unu belirlemeyi amaçlad›k. Haziran 1987 - Aral›k 1999 tarihleri aras›nda aort koarktasyonu tan›s› nedeniyle opere edilen, 2 yafl alt›nda toplam 77 hasta çal›flmaya al›nd›. Hastalar iki grupta topland›. Grup 1, 0–3 ay aras› olup, grup 2 ise 3–24 ay aras› opere edilen hastalar idi. Cerrahi prosedür olarak, rezeksiyon uç uca anastomoz, subklavian flap aortoplasti ve modifiye subklavyan aortoplasti teknikleri kullan›ld›. Uygulanan cerrahi tekni¤ine göre hastalar yafl, postoperatif dönemde koarktasyon bölgesinden elde edilen bas›nç gradiyentlerine, reoperasyona göre karfl›laflt›r›ld›. Grup 1'de, 4 hastam›z› postoperatif dönemde kaybettik. Bu hastalar›n preoperatif dönemde ileri derece kalp yetersizli¤ i bulgular› ve kompleks kalp patolojileri olan hastalard›. Grup'1 de, 4(%12) hastada rekoarktasyon görüldü. 3 hastaya subklavyan flap angioplasti 1 hastaya da, reseksiyon uç uca anastomoz cerrahi teknikleri uygulanm›flt›. 3 hasta rekoarktasyon nedeniyle ameliyata al›nd›. 1 hastan›n ise koarktasyonu balon anjioplasti ile geniflletildi. Grup 2'de mortaliteye rastlanmad›. Fakat ancak Grup 2'de reseksiyon uç uca anastomoz sonras› 1 hastada rekoarktasyon görüldü ve balon anjioplasti ile geniflletildi. Çal›flmam›z›n sonucuna göre 3 ay alt› çocuklarda reseksiyon uç uca anastomoz tekni¤i güvenilir bir cerrahi prosedürdür. Cerrahi yönden gerekli oldu¤u durumlarda e¤er subklavyan flap veya modifiye subklavyan aortoplasti tekni¤ i kullan›lacaksa flap mümkün oldu¤unca kaorkte segmentin distaline kadar uzat›lmal›d›r.

Resection End To End Anastomosis, Subclavian Flap Aortoplasty And Modifed Subclavian Aortoplasty Surgical Techniques of the Aortic Coarctation Compared by The Insidancy Of Recoartation We try to evaluate the incidence of recoarctation after the surgical repair techniques for aortic coarctation in two group of patients ages between 0-3 months and 3–24 months. These techniques are resection end to end anastomosis, subclavian flap aortoplasty and modified subclavian aortoplasty. We aim to figure out which operation appears to have a clear superiority according to the age groups. From June, 1987, to December, 1999, a consecutive series of 72 patients less than 2 year of age were referred to our clinic for aortic coarctation repair. Patients diveded into two groups by means of their ages. The group 1; ages were between 0–3 months, group 2; ages were between 3–24 months old. The surgical techniques were resection end to end anastomosis, subclavian flap aortoplasty and modified subclavian aortoplasty. The patients were evaluated according to their ages, coarctation gradient and reoperations depending on the surgical techniques that was done before.We lost 4 patient in group 1 at the early period of the operations. These patients had severe congestive heart failure and complex cardiac pathologies prior to the operations Recoarctation was occurred in 4 patients in group 1. 3 of these patient had subclavian flap aortoplasty and one had resection end to end anastomosis before. All 3 recoarctation cases were successfully treated by surgery. One patient had a balloon angioplasty. Recoarctation occurred in 1 patient in group 2 ( below the age 24 months). This patient operated by the surgical technique of resection end to end anastomosis and thereafter successfully treated by balloon angioplasty. According to our surgical experiences resection end to end anastomosis can be safely performed below the age of 3 months. For surgical necessities subclavian flap aortoplasty and modified subclavian aortoplasty are admirable for relief of the coarctation in infants with low recurrence rates and acceptable operative and intermediate survival. But the subclavian flap should be extended distally over the coarctated segment.