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Ghimire J, Shrestha P, Homagain S, Paudel S, Bhusal R. Delayed Detection of Coarctation of the Aorta Causing Resistant Hypertension in Elderly With Bilateral Parvus et Tardus Renal Doppler Flow Pattern Serving as a Gateway to Diagnosis-A Case Report. Clin Case Rep 2024; 12:e9587. [PMID: 39559289 PMCID: PMC11570417 DOI: 10.1002/ccr3.9587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/01/2024] [Accepted: 10/11/2024] [Indexed: 11/20/2024] Open
Affiliation(s)
| | - Prabin Shrestha
- Department of Internal MedicineTribhuvan University Teaching HospitalKathmanduNepal
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2
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Peng Z, Qiu J, Wang D, Yang X, Yu C, Zhang L. Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions. Vasc Endovascular Surg 2021; 56:11-17. [PMID: 34488512 DOI: 10.1177/15385744211042194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the efficacy and safety of ascending aortoiliac bypass surgery for one-stage repair of adult coarctation of the aorta (CoA) and concomitant cardiac disease. METHODS From March 2012 to October 2018, 51 consecutive CoA patients were treated with ascending aorta to bilateral iliac artery bypass concomitant with and cardiac surgerical procedures performed for a variety of reasons. A Y-shaped graft was used for the bypass procedure. We evaluated early outcomes, including postoperative death, systolic blood pressure and differences between upper and lower limb blood pressure. RESULTS The average age was 41 years and 64.7% of patients were men. Simultaneous cardiac procedures included aortic valve replacement, ventricular septal defect repair, Bentall procedures and Wheat procedures. No deaths occurred in the early postoperative period. Three patients had delayed healing at the site of the abdominal lower quadrant incisions. The average systolic pressure in the upper limb and the average difference between the upper- and lower-limb blood pressure decreased significantly after surgery (162.7 ± 13.4 mmHg vs 128.4 ± 6.7 mmHg, P = .000; 69.6 ± 15.6 mmHg vs 8.7 ± 7.6 mmHg, P = .000, respectively); The systolic blood pressure in the lower limb increased after bypass surgery (93.1 ± 6.2 mmHg vs 119.6 ± 7.7 mmHg, P = .000). The follow-up rate was 100%, with an average follow-up time of 61 months. Six patients (11.8%) had graft stenosis or occlusion. Three patients (5.9%) underwent endovascular embolectomy. CONCLUSIONS In our small series, ascending aortoiliac bypass for one-stage repair of CoA with concomitant cardiac lesions appears safe and efficacious in effectively reduceing differences between upper and lower limb systolic blood pressure. Further study with larger sample size and longer follow-up is needed.
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Affiliation(s)
- Zhan Peng
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
| | - Juntao Qiu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - De Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiubin Yang
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
| | - Cuntao Yu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, 34736Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liang Zhang
- Department of cardiac surgery, Beijing Anzhen Hospital, 12667Capital Medical University, Beijing, Institute of Heart, Lung and Blood vessel Disease, Beijing, China
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3
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Saran N, Pochettino A. Management of Coarctation and Aortic Arch Anomalies in the Adult. Semin Thorac Cardiovasc Surg 2021; 33:1061-1068. [PMID: 34091017 DOI: 10.1053/j.semtcvs.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Congenital Aortic arch malformations are rare in adults. Often they present with hypertension or tracheoesophageal compression. The involved anatomy is dependent on the sidedness of the aortic arch and the variable development of the primitive pharyngeal arches. Sternotomy and thoracotomy are usually required for surgical repair, while need for circulatory arrest is not uncommon. With caution and adequate planning, surgery can be carried out with satisfactory results.
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Affiliation(s)
- Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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4
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Pu X, Wang M, Huang X, Zhang H, Huang L. Case report: a novel approach for the emergency repair of acute aortic rupture associated with congenital aortic Coarctation. J Cardiothorac Surg 2021; 16:170. [PMID: 34112233 PMCID: PMC8191040 DOI: 10.1186/s13019-021-01552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital aortic coarctation (CoA) associated with aortic rupture is a rare but extremely lethal condition. In pregnant patients, the condition becomes very risky. CASE PRESENTATION We presented a case of a pregnant (20 weeks gestation) patient with CoA associated with ruptured aortic pseudoaneurysm who was successfully rescued using a novel hybrid strategy. CONCLUSIONS This hybrid approach may be a life-saving bridging intervention in patients with CoA associated with devastating complications, such as ruptured aneurysms, especially with extremely narrowed access.
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Affiliation(s)
- Xin Pu
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyong Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Uehara K, Matsuda H, Yokawa K, Inoue Y, Shijo T, Seike Y, Sasaki H. Open anatomical repair for primary coarctation of the aorta in adults. Gen Thorac Cardiovasc Surg 2021; 69:1532-1538. [PMID: 34089477 DOI: 10.1007/s11748-021-01657-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Although endovascular repair has become an alternative treatment for coarctation of the aorta (CoA) in adults, open repair provides concomitant repair of other cardiac complications, including post-stenotic aneurysm, ascending aortic aneurysm, and intracardiac diseases. We evaluated open anatomical repair for CoA repair in adults. METHODS Eleven patients (6 men, age range 21-63 years) underwent primary CoA repair. Complicating conditions included post-stenotic aortic aneurysm in the descending aorta in 5 patients (45.5%) and ascending aortic aneurysm in 3 (27.3%). Two patients (18.2%) had a bicuspid aortic valve, and one (9.1%) had a quadricuspid aortic valve. Ventricular septal defect was detected in 1 patient (9.1%). Eight patients (72.7%) underwent descending aorta replacement through a left thoracotomy, comprising partial cardiopulmonary bypass in 4 and deep hypothermic circulatory arrest in 4. Of those, the left subclavian artery was reconstructed in 4 patients. The remaining 3 patients (27.3%) underwent total arch replacement, through a median sternotomy in 1 and using a combination of median sternotomy and thoracotomy in 2. RESULTS No in-hospital mortality was observed. No spinal cord ischemia or neurological events were encountered, but 1 patient (9.1%) who underwent CoA repair via median sternotomy and thoracotomy required prolonged ventilatory support for more than 48 h. During the follow-up of 90 months (interquartile range 65-124 months), no patient died or required reintervention for the repaired segment. CONCLUSIONS CoA in adults could be anatomically repaired with graft replacement both through the median sternotomy, the left thoracotomy, and the combination of both approaches, according to the complicated aortic or intracardiac lesions.
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Affiliation(s)
- Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
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Abjigitova D, Mokhles MM, Witsenburg M, van de Woestijne PC, Bekkers JA, Bogers AJJC. Surgical repair of aortic coarctation in adults: half a century of a single centre clinical experience. Eur J Cardiothorac Surg 2020; 56:1178-1185. [PMID: 31549166 PMCID: PMC7043140 DOI: 10.1093/ejcts/ezz259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Djamila Abjigitova
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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7
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Beckmann E, Jassar AS. Coarctation repair-redo challenges in the adults: what to do? J Vis Surg 2018; 4:76. [PMID: 29780722 DOI: 10.21037/jovs.2018.04.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.
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Affiliation(s)
- Erik Beckmann
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Yin K, Zhang Z, Lin Y, Guo C, Sun Y, Tian Z, Xie Q, Wang C. Surgical management of aortic coarctation in adolescents and adults. Interact Cardiovasc Thorac Surg 2017; 24:430-435. [PMID: 28011739 DOI: 10.1093/icvts/ivw353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Coarctation of the aorta (CoA) in adolescents and adults is often complicated by other cardiac or aortic problems and may carry additional surgical difficulties. Limited studies have reported the surgical outcomes of CoA repair in this particular patient population. We reviewed our contemporary experience of open surgical management of CoA in adolescents and adults. Methods From 2008 to 2016, a total of 60 adolescents and adults (mean age, 32 years) underwent CoA repair at our centre. Of this cohort, 43 patients only underwent CoA repair (isolated group), while the remaining 17 underwent other concomitant cardiac procedures (concomitant group). Ascending-to-descending aortic bypass was the preferred repair technique in the concomitant group. Aortic valve replacement and a Bentall/David procedure were the two most frequently combined procedures. Results There were no in-hospital deaths in the isolated group compared with three in the concomitant group (0% vs 17.6%, P = 0.029). The median intensive care unit stay (1 vs 2 days, P <0.01) and postoperative hospital stay (6 vs 9 days, P <0.01) were significantly longer in the concomitant group. Postoperative respiratory failure occurred more frequently in the concomitant group (0% vs 17.6%, P = 0.029). The isolated group had better overall survival during follow-up ( P = 0.037). The 5-year overall survival rate was 98% in the isolated group and 82% in the concomitant group. Conclusions Surgical management of coarctation in adolescents and adults can achieve similar satisfactory outcomes as their neonatal counterparts, but the complexity of the concomitant procedures is a risk factor for this particular patient population.
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Affiliation(s)
- Kanhua Yin
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiqi Zhang
- Center for Vascular Disease and Translational Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.,Centre for Experimental Medicine, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yi Lin
- Department of Physiology , Liaoning Medical University , Jinzhou , Liaoning , China
| | - Changfa Guo
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziwei Tian
- Fetal Heart Program, The Cardiac Center at The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA, USA
| | - Qiuchen Xie
- Department of Cardiology, Shanghai Jia Ding District Central Hospital, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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Misumi Y, Masai T, Kainuma S, Sawa Y. Staged open repair for a complex adult aortic coarctation. J Card Surg 2017; 32:500-503. [PMID: 28833633 DOI: 10.1111/jocs.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a two-stage open repair for a complex aortic coarctation in an adult. A total arch replacement with an elephant trunk was performed via a median sternotomy followed in 10 days by a replacement of the descending aorta through a left thoracotomy.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Noly PE, Legris-Falardeau V, Ibrahim R, El-Hamamsy I, Cartier R, Lamarche Y, Bouchard D, Dorval JF, Poirier N, Demers P. Results of a multimodal approach for the management of aortic coarctation and its complications in adults. Interact Cardiovasc Thorac Surg 2017; 25:335-342. [DOI: 10.1093/icvts/ivx039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/23/2017] [Indexed: 01/23/2023] Open
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11
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Pogorzelski R, Wołoszko T, Toutounchi S, Fiszer P, Krajewska E, Jakuczun W, Szostek MM, Celejewski K, Gałązka Z. Intravascular Treatment of Left Subclavian Artery Aneurysm Coexisting with Aortic Coarctation in an Adult Patient. Open Med (Wars) 2017; 12:1-4. [PMID: 28401193 PMCID: PMC5385974 DOI: 10.1515/med-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/12/2016] [Indexed: 12/13/2022] Open
Abstract
Coexistence of aortic coarctation with aneurysm of subclavian artery is a uncommon situation and may require unusual treatment in patients. A 40-year-old patient diagnosed incidentally with left subclavian artery aneurysm coexisting with aortic coarctation. Patient was initially referred for hybrid treatment. Initially ostium of the left subclavian artery was covered with a stent-graft. Over a 30-month follow-up period aneurysm became thrombosed all the way up to the ostium of internal mammary artery. The patient did not present with neurological symptoms or signs of upper limb ischemia. Taking into consideration good blood supply to the axillary artery via reversed blood flow in the thyreocervical trunk, hence we decided not to proceed with cervicoaxillary bypass grafting. Implantation stent-graft into aorta coarctation with covering axillary artery is proper way of treatment and may need no other surgical procedures.
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Affiliation(s)
- Ryszard Pogorzelski
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Tomasz Wołoszko
- Department of General and Endocrynology Surgery Medical University of Warsaw, Banacha 1a street, Poland
| | - Sadegh Toutounchi
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Patryk Fiszer
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Ewa Krajewska
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Wawrzyniec Jakuczun
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Małgorzata M Szostek
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Krzysztof Celejewski
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General and Endocrynology Surgery Medical University of Warsaw, Poland
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Yousif A, Kloppenburg G, Morshuis WJ, Heijmen R. Repair of adult aortic coarctation by resection and interposition grafting. Interact Cardiovasc Thorac Surg 2016; 23:526-30. [PMID: 27354467 DOI: 10.1093/icvts/ivw206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Aortic coarctation presenting during adult life most frequently represents cases of re-coarctation, following previous transcatheter or surgical therapy, or missed cases of native coarctation. In the area of evolving endovascular therapy, we believe that there is still a place for durable open repair by means of resection and interposition grafting. We, therefore, evaluated our results in adult patients with primary aortic coarctation or complications of a previous coarctation repair. METHODS A total of 38 patients were operated between 1989 and 2014. Median age was 43 years (range 18-69 years), and 20 were male (52.6%). Seventeen patients (44.7%) had recurrent coarctation or dilatation after previous repair during childhood; the remaining 21 (55.3%) had primary coarctation diagnosed at adult age. Data were retrospectively reviewed and analysed for indications, type of repair, operative details and outcomes. RESULTS Resection and interposition grafting was performed primarily with the use of left-left bypass (mean cross-clamping time 41 ± 13 min). There were no in-hospital deaths, stroke, spinal cord ischaemia, renal or respiratory failure. No patient had evidence of symptomatic aortic re-coarctation or pseudoaneurysm formation on follow-up. Long-term survival after 20 years was 94.7%. CONCLUSIONS Open surgical repair of primary, recurrent or complicated adult aortic coarctation by interposition grafting is a safe and feasible therapeutic option, providing durable long-term results and excellent long-term survival.
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Affiliation(s)
- Afram Yousif
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Geoffrey Kloppenburg
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
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Torok RD, Campbell MJ, Fleming GA, Hill KD. Coarctation of the aorta: Management from infancy to adulthood. World J Cardiol 2015; 7:765-775. [PMID: 26635924 PMCID: PMC4660471 DOI: 10.4330/wjc.v7.i11.765] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/19/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient’s anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.
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Hafez H, Jamjoom R, Yuones E, Khan Z, Ashour M. Endovascular repair of a mycotic thoracic aortic aneurysm in a patient with aortic coarctation. J Vasc Surg Cases 2015; 1:154-156. [PMID: 31724653 PMCID: PMC6849998 DOI: 10.1016/j.jvsc.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022] Open
Abstract
This report describes the management of a 28-year-old female patient who presented with septicemia and mediastinal mass-effect secondary to a proximal mycotic aneurysm of the descending aorta. The patient had an infected bicuspid aortic valve, aortic coarctation, and a left vertebral artery arising directly from the aortic arch. Evidence of disseminated embolization affecting her posterior cerebral circulation, the left axillary, and the superior mesenteric arteries was noted. The patient had a considerably small aorta. An urgent thoracic endovascular aortic repair was performed successfully with a chimney stent to the left vertebral artery. The report discusses the planning and technique used in managing this complex case.
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Affiliation(s)
- Hany Hafez
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Reda Jamjoom
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Elsayed Yuones
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Zahid Khan
- Department of Interventional Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Majed Ashour
- Department of Interventional Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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15
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Botta L, Cannata A, Bruschi G, Martinelli L. Pseudoaneurysm of the aortic isthmus involving a right aberrant subclavian artery long after multiple coarctation repairs. Interact Cardiovasc Thorac Surg 2015; 20:868-9. [PMID: 25796275 DOI: 10.1093/icvts/ivv054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/24/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardio-Thoracic Department, Niguarda Hospital, Milan, Italy
| | - Aldo Cannata
- Cardiac Surgery Unit, Cardio-Thoracic Department, Niguarda Hospital, Milan, Italy
| | - Giuseppe Bruschi
- Cardiac Surgery Unit, Cardio-Thoracic Department, Niguarda Hospital, Milan, Italy
| | - Luigi Martinelli
- Cardiac Surgery Unit, Cardio-Thoracic Department, Niguarda Hospital, Milan, Italy
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