ABSTRACT
Crafoord was the first to successfully repair coarctation of the aorta in 1944. The techniques of resection and end-toend anastomosis had been thoroughly studied in laboratory animals by Gross, who soon followed with his own clinical success in 1945. The procedure had been limited to older children until 1955, when Mustard succeeded in repairing the lesion in a newborn infant. Resection and end-to-end anastomosis in small infants, however, often resulted in inadequate vessel growth at the circumferential suture line, leading to a high incidence of recurrent coarctation. In response to this problem, Waldhausen introduced the subclavian flap technique in 1966. Other surgeons, emphasizing the need to resect all ductal tissue, continued to obtain satisfactory results with the end-to-end technique. Neither technique specifically addressed the problem of arch hypoplasia, which was being seen at an increased frequency as more neonates with critical coarctation came to surgery. The maintenance of ductal patency with prostaglandin E1, introduced by Elliott in 1975, permitted stabilization of many newborns who otherwise would not have survived to surgical intervention. Zannini and colleagues in 1985 introduced the concept of an extended end-to-end anastomosis to deal with the hypoplastic aortic arch.
