This document discusses the management options for coarctation of the aorta (CoA) accompanied by a ventricular septal defect (VSD). It outlines the associated lesions that can be present and the surgical repair approaches, which include single-stage full repair versus staged repair. A retrospective analysis of 141 neonates with CoA and VSD compared outcomes of staged repair versus full repair. The conclusion is that neonates with this condition need assessment for left ventricular outflow tract obstruction and that both primary and staged surgical approaches can have acceptable outcomes, with CoA repair alone preferred if the VSD may close spontaneously.

1. Coarctation and VSD
Overview and management options
Mohammad Shihata MD
Pediatric Cardiac Surgeon, Madinah Cardiac Center
Assistant Professor of Surgery, Taibah University

2. The First step…..

3. Associated Lesions
 Hypoplastic Arch
 Sub-AS (posterior malalignment, ridge, or tunnel)
 Hypoplastic Aorta
 MV abnormalities

4. The Spectrum of Arch
Obstruction and LVOTO
HLHS CoA with Valvular Stenosis

5. HLHS or
Variants
IAA/CoA
+/-
VSD
Biventricular
Repair
1 or 2 stage
Single Ventricle
Norwood  BCPC
 TCPC
VSD
Normal MV
Complex LVOTO
Yasui (or)
Norwood/Rastelli
(or)
Ross/Konno +
Arch repair

6. Type and Size of the VSD
 May influence the surgical approach.
 Large vs. Small (VSD/ AO)
 Posterior malalignment, inlet, muscular,
subarterial, or multiple

7. Surgical Options
 Single stage repair:
 Arch repair
 VSD closure
 +/- Subaortic resection
 +/- Aortic valvuluplasty

8. Staged Repair
Stage One
CoA repair
CoA repair + PA Band
Stage Two
VSD closure
VSD closure + Debanding
Debading alone !!

9. A retrospective analysis of 141 neonates with CoA and VSD based on the
initial management strategy.
Group A: Staged repair
Group B: Full repair

11. Freedom From Secondary VSD
Closure

12. VSD/AO Ratio

13. Redo Arch Surgery

14. Development of Sub-AS

15. One stage (2 incisions)

16. Patient Characterestics

17. Operative outcomes

18. Conclusion
 Neonates with CoA + VSD need to be carefully assessed
for the presence of associated LVOTO.
 Both Primary and staged approaches have acceptable
outcomes.
 If the VSD is likely to close spontaneously, Coarctation
repair alone is preferred.