Aortopulmonary index as a novel morphologic correlate of early recurrence of coarctation of aorta after surgical repair in infancy

Background: The aim of this study was to determine morphologic correlates of early reintervention for recurrent coarctation in infants undergoing surgical repair in the current era. Methods: Medical records of infants who underwent repair of coarctation were retrospectively reviewed. Z scores for aortic segments, relative aortic arch segmental dimensions (indexed to ascending or descending aortic dimension), and aortopulmonary index (the ratio of aortic to pulmonary annular diameter) were derived from preoperative echocardiograms. Results: Eighty-seven patients underwent repair (median age, 13 days). Early arch reintervention (<1 year after surgery) was performed in 11. Lower aortopulmonary index and Z scores of the aortic annulus and sinotubular junction were associated with early reintervention. Aortopulmonary index < 0.6 was the best correlate (sensitivity, 72.7%; specificity, 73.7%; area under the curve, 0.732). Aortic arch dimensions were not correlated with early reintervention. Conclusion: In the current era, aortopulmonary index rather than aortic arch hypoplasia is correlated with the need for reintervention for recurrent coarctation within 1 year of surgery.