Isthmus flap aortoplasty. A new approach to long-segment coarctation repair.

While not the answer for every patient with coarctation, isthmus flap aortoplasty offers excellent results for infants with long-isthmus segment defects that are the most difficult to repair by end-to-end or subclavian flap techniques. Isthmus flap aortoplasty has been used in six patients with long-isthmus segment coarctations. The surgical approach to coarctation depends on the local anatomical features in each infant. The standard subclavian flap technique seems to be quite adequate for most infants with short-isthmus coarctation. The decision about which technique to use, however, is made by the surgeon at the OR bed. The isthmus flap technique has been quite useful for this group of infants with coarctation and has given excellent results. The technique eliminates most, if not all, of the limitations of the subclavian flap technique and belongs in the armamentarium of a pediatric surgeon for difficult-to-manage patients.