Thursday Afternoon, May 12, 1960

2:00 P.M. Executive Session (Limited to Active and Senior Members)

Napoleon Room

3:00 P.M. Scientific Session: REGULAR PROGRAM

Napoleon Room

ADDRESS BY THE PRESIDENT

WILLIAM E. ADAMS, Chicago, Ill.

ADDRESS BY HONORED GUEST

ALFONSO TOPETE, Guadalajara, Mexico

Chairman, Department of Surgery

University of Guadalajara

"New Findings in the Coronary-Encephalic Perfusion in Depressive Surgical Cases"

29. Coarctation of the Aorta with Particular Emphasis upon Improved Technics of Surgical Repair.

George C. Morris Jr.(by invitation), Denton A. Cooley,

Michael E. DeBakey, and E. Stanley Crawford,

Houston, Tex

During the fifteen year period since successful surgical correction of coarctation of the aorta was first reported, extensive experience with this lesion has provided the basis for new concepts of surgical repair. The primary goal in treatment should be to relieve hypertension proximal to the coarctation and to provide a more adequate circulatory status distally. The major complications of the lesion, including left ventricular strain, hypertensive encephalopathy, renal ischemia and uremia, are effectively controlled by eliminating the obstructive process. When surgical treatment was first introduced, certain somewhat arbitrary limitations were placed upon selection of patients for operation based upon age, length of the aortic occlusion, presence of associated arterial disease, presence of myocardial ischemia, etc. Moreover, end-to-end anastomosis with an occasional homograft replacement was the only technic of repair that was recommended. The purpose of this report is to present current concepts of treatment based upon improvements in technic of arterial repair.

Many operative accidents and late complications of surgical treatment of aortic coarctation are the result of attempts to perform end-to-end anastomosis in the presence of anatomic and pathologic limitations. Although excision of the occluded segment of aorta with end-to-end anastomosis remains the treatment of choice in favorable cases, more liberal use of synthetic vascular grafts has not only removed limitations placed upon application of corrective technics but has contributed to a lower risk of operation. Aortic anastomoses which are made under tension frequently disrupt, leading to hemorrhage or late aneurysm formation. The caliber of aortic anastomosis may be controlled accurately to provide an optimum size for the individual case when synthetic grafts are used. In older patients who have extensive atherosclerotic changes in the aorta, possible myocardial ischemia, valvular lesions, etc., a bypass of the coarctation provides a simple and safe solution to an otherwise difficult technical problem. These and other considerations of technical and physiologic nature will be presented with an analysis of 150 surgical cases. Present indications and contraindications for operation will be presented based upon experience with current technics of surgical repair.

7:00 P.M. Banquet and Dancing

Casanova Room

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies.

Dinner dress preferred.