Blood Flow and Development of Upper Limbs after Subclavian Flap Repair of Coarctation of the Aorta

The development of the arm and blood flow distribution were studied in seven patients with coarctation of the aorta at mid-term who had undergone subclavian flap method. Age of patients at time of operation was 1±0.8 month. Average follow up period after operation was 20.1±11 months. The length and circumference of both arms were measured and compared. Blood flow distribution was analized by difference of temperature indicated by thermography. The blood pressure gradient between arm and lower extremity, and height and body weight were also measured and compared with those of healthy children with no congenital heart disease. Preoperative blood pressure difference between arm and lower extremity was 30±16 mmHg reducing to 7±5 mmHg postoperatively. Height and body weight of the patients at 20.1±11 months after operation were 97±5% and 94±11% of normal value, respectively. Difference in length of the right and left arm showed 98±2% (p<0.05) compared to the control group. Circumference of the arm was also 96±3% of the normal value. There was a statistical inverse correlation in length (p<0.01) and circumference (p<0.01) during the follow up period. Difference in skin temperature in both arms was 1.1 degrees centigrade, but there was no significant difference in skin temperature during the follow up period. However, we could obtain no clinical significances in the development of the arm, nor any clinical symptoms where the subclavian arterial blood flow had been cut off. From this study we concluded that there was no significant clinical ischemic impairment in growth of arm and body weight which encourages use of the subclavian flap operation. However, as we observed minimum but statistically significant differences in growth of arm during follow up period, development of the arm and blood flow distribution still require further study in a larger number of patients over a longer period.