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Ye L, Castaldi B, Cattapan I, Pozza A, Fumanelli J, Di Salvo G. Hypertension in aortic coarctation. Front Cardiovasc Med 2025; 12:1505269. [PMID: 40260103 PMCID: PMC12009809 DOI: 10.3389/fcvm.2025.1505269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 03/19/2025] [Indexed: 04/23/2025] Open
Abstract
Aortic coarctation (AoC) is a common congenital heart defect, affecting 5%-8% of patients with structural congenital anomalies. Despite advances in surgical and percutaneous interventions, hypertension remains a significant complication in AoC patients, even after successful repair. Chronic hypertension develops in 20%-70% of patients and is a leading cause of long-term cardiovascular morbidity. In these patients, hypertension is associated to renin-angiotensin system activation, residual aortic arch abnormalities, and impaired aortic elasticity. Additionally, exercise-induced hypertension and masked hypertension contribute to adverse outcomes. Management of hypertension in AoC patients requires both perioperative and long-term care. Early after correction, intravenous antihypertensive agents, such as sodium nitroprusside, esmolol, and labetalol, are commonly used to stabilize blood pressure and reduce the risk of complications like cerebral hemorrhage. Oral beta-blockers, ACE inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) are most commonly used for chronic hypertension. In this review, we discussed about diagnostic workup and therapeutical strategies for hypertension in AoC patients.
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Affiliation(s)
| | - Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy
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Zhao Z, Wu C, Dai J, Lu S, He L, Tian J, Jin X, Pan Z. End-to-side anastomosis and autologous pulmonary artery patch for aortic coarctation and hypoplastic aortic arch. J Thorac Dis 2025; 17:959-968. [PMID: 40083496 PMCID: PMC11898331 DOI: 10.21037/jtd-24-1635] [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: 09/29/2024] [Accepted: 12/20/2024] [Indexed: 03/16/2025]
Abstract
Background Aortic coarctation (CoA) is a congenital heart disease that usually combines various cardiovascular malformations, including hypoplastic aortic arch (HAA). We explore end-to-side anastomosis (ESA) and autologous pulmonary artery patch (APAP) in CoA with HAA, to provide more clinical experience. Methods This is a single-center retrospective study. The target population is patients with aortic stenosis and HAA who underwent surgery between 2015 and 2021. All cases included were consecutive, and no instances were omitted due to absent data, lack of consent, or other factors. Collect information on gender, age, and weight at the time of the operation, detailed information on the constricted segment and pressure gradient evaluated by echocardiography and computed tomography (CT), and other factors of patients, and these data were analyzed by statistical methods. Results Ninety-six patients (67 males and 29 females) with median age of 76 (41.75, 128.50) days and median weight of 4.20 (3.70, 5.10) kg were enrolled. The follow-up period was 46.20 (34.40, 54.70) months. The patients were divided into two groups based on surgery: ESA (G1, 59) and APAP (G2, 37). The combined cardiovascular malformations were treated simultaneously. None of the patients had neurological events or renal failure, and three died early after the operation. Finally, 93 patients were successfully followed-up. Cox regression showed that ESA was a risk factor for aortic arch geometry is closer to Gothic (G-AAg), elevated blood pressure (EBp), and aortic recoarctation (reCoA) after surgery. In G1, 18 patients had G-AAg (P=0.03), 13 had EBp (P=0.041), and 12 had reCoA (P=0.041), all of which were significantly higher than those in G2 (three had G-AAg, one of whom had EBp and reCoA). Conclusions It is safe and effective to repair CoA and HAA and other cardiovascular malformations through one-stage median sternotomy. Compared with ESA, APAP can lower the risks of G-AAg, EBp, and reCoA. Although APAP takes longer, the proper application of selective antegrade cerebral perfusion may lower the risks. We recommend expanding the indications for APAP when circumstances allow, which will benefit patients.
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Affiliation(s)
- Zhenjiang Zhao
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Siwei Lu
- Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Ling He
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jie Tian
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xin Jin
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
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Baz RO, Refi D, Scheau C, Axelerad A, Baz RA, Niscoveanu C. CT Angiography for Aortic Arch Anomalies: Prevalence, Diagnostic Efficacy, and Illustrative Findings. Diagnostics (Basel) 2024; 14:1851. [PMID: 39272636 PMCID: PMC11393892 DOI: 10.3390/diagnostics14171851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Aortic arch anomalies encompass a diverse spectrum of conditions. Elucidating the prevalence of these anomalies, their impact on patient wellbeing, and the most effective diagnostic tools are crucial steps in ensuring optimal patient care. This paper aims to explore the various presentations of aortic arch anomalies, emphasizing the remarkable utility of computed tomography (CT) angiography in their definitive diagnosis and characterization. We conducted a retrospective study on patients who were submitted to the CT angiography of the thoracic aorta or supra-aortic trunks, or the contrast-enhanced CT scans of the thorax and/or cervical region between January 2021 and February 2024 in our Hospital. Out of the total of 2350 patients, 18 were diagnosed with aortic arch anomalies, with an average age of approximately 55 years. The aortic arch anomalies identified in the study were as follows: left aortic arch with the aberrant origin of the right subclavian artery, right aortic arch (types I and II), double aortic arch, aortic coarctation, aortic pseudocoarctation, and ductus diverticulum. Although often asymptomatic, aortic arch anomalies require recognition and CT using advanced post-processing techniques is the optimal diagnostic method with the ability to also identify other associated cardiac or vascular malformations.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Deria Refi
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Any Axelerad
- Department of Neurology, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cosmin Niscoveanu
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
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Apithanung L, Sethasathien S, Silvilairat S, Sittiwangkul R, Makonkawkeyoon K, Saengsin K, Woragidpoonpol S. Correlation between pressure gradient from echocardiography and peak-to-peak pressure gradient from cardiac catheterization or surgery in patients with coarctation of aorta. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1193-1200. [PMID: 38558331 DOI: 10.1007/s10554-024-03086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
The gold standard for assessing pressure gradients (PG) across coarctation involves measurements obtained through cardiac catheterization or surgical intervention. There has been ongoing discussion regarding the accuracy of non-invasive methods for estimating these gradients. This study sought to establish the correlation and agreement between the systolic blood pressure (SBP) gradient between the upper and lower extremities, as well as, the mean and maximum PG derived from echocardiography, in comparison to the peak-to-peak pressure gradient obtained from either cardiac catheterization or surgery. We conducted a retrospective study on patients < 18 years diagnosed with coarctation at Chiang Mai University Hospital from 2011 to 2022. The study involved the measurement of the SBP gradient between the upper and lower extremities, mean and maximum PG using echocardiography, peak-to-peak pressure gradient obtained from cardiac catheterization, and pressure gradient recorded during surgical procedures. The Spearman's correlation and Bland-Altman analysis were employed to assess correlation and agreement. Fifty-four patients with aortic coarctation were enrolled. The mean PG measured by echocardiography showed a significantly moderate correlation (r = 0.78, p < 0.001) and the highest level of agreement according to Bland Altman plots, in comparison to the peak-to-peak pressure gradient measured during both cardiac catheterization and surgical procedure. The max PG demonstrated a notable overestimation compared to the gold standard (mean difference + 13.14 with a slope of biases + 0.64, p < 0.001). The mean PG obtained through echocardiography has more potential to be applied in practical application in predicting pressure gradient in patients with coarctation.
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Affiliation(s)
- Lalitpat Apithanung
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saviga Sethasathien
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krit Makonkawkeyoon
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kwannapas Saengsin
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Stellon M, Gober L, Culver MA, Hermsen J, Irrer D, Witzenburg C, Roldán-Alzate A, Lamers L. Surgically induced aortic coarctation in a neonatal porcine model allows for longitudinal assessment of cardiovascular changes. Am J Physiol Heart Circ Physiol 2024; 326:H1117-H1123. [PMID: 38488518 PMCID: PMC11380946 DOI: 10.1152/ajpheart.00087.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024]
Abstract
Noncritical aortic coarctation (COA) typically presents beyond early childhood with hypertension. Correction of COA does not ensure a return to normal cardiovascular health, but the mechanisms are poorly understood. Therefore, we developed a porcine COA model to study the secondary cardiovascular changes. Eight male neonatal piglets (4 sham, 4 COA) underwent left posterolateral thoracotomy with descending aorta (DAO) mobilization. COA was created via a 1-cm longitudinal DAO incision with suture closure, plication, and placement and an 8-mm external band. All animals had cardiac catheterization at 6 (11-13 kg), 12 (26-31 kg), and 20 (67-70 kg) wk of age. Aortic luminal diameters were similar along the thoracic aorta, except for the COA region [6.4 mm COA vs. 17.3 mm sham at 20 wk (P < 0.001)]. Collateral flow could be seen as early as 6 wk. COA peak systolic pressure gradient was 20 mmHg at 6 wk and persisted through 20 wk increasing to 40 mmHg with dobutamine. Pulse pressures distal to the COA were diminished at 12 and 20 wk. This model addresses many limitations of prior COA models including neonatal creation at an expected anatomic position with intimal injury and vessel sizes similar to humans.NEW & NOTEWORTHY A neonatal model of aortic coarctation was developed in a porcine model using a readily reproducible method of aortic plication and external wrap placement. This model addresses the limitations of existing models including neonatal stenosis creation, appropriate anatomic location of the stenosis, and intimal injury creation and mimics human somatic growth. Pigs met American Heart Association (AHA) criteria for consideration of intervention, and the stenoses were graded as moderate to severe.
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Affiliation(s)
- Michael Stellon
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Leah Gober
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Matthew Allen Culver
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Joshua Hermsen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Dana Irrer
- Department of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Colleen Witzenburg
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, United States
- Department of Mechanical Engineering, University of Wisconsin, Madison, Wisconsin, United States
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, Wisconsin, United States
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Luke Lamers
- Department of Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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Shhada E, Saleh M, Kf Alghazal MA, Wasel N. Un-diagnosed coarctation of the aorta in a 27-year-old adult with a rare presentation: a rare case report. Ann Med Surg (Lond) 2024; 86:1116-1119. [PMID: 38333276 PMCID: PMC10849365 DOI: 10.1097/ms9.0000000000001614] [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: 08/23/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Coarctation of the aorta (COA) is a rare form of congenital heart disease that is typically diagnosed in children. COA is known to present with hypertension, weak or absent femoral pulses, heart failure in older patients, but the presentation of COA as calf atrophy is extremely rare. This article reports the successful surgical repair of a 27-year-old adult with undiagnosed COA. Case presentation A 27-year-old-male has presented with calf atrophy, which was diagnosed as COA transthoracic echocardiography and computed tomography angiography indicate COA, which is treated with successful surgical repair. Clinical discussion COA is typically diagnosed in children with a rare incidence in adults. Calf atrophy is an extremely rare presentation and uncommon. He has calf atrophy, which led to the diagnosis of COA in 27 years. The presentation in this medium-aged population with this rare manifestation gives our case significance to be one of the unique reported cases. Conclusion COA is uncommon to be found in adults and the presentation with calf atrophy is even rare. The authors revealed that COA can be found in adults and with an unexpected manifestation and highlights the significance of early detection, and timely referral to a specialist can enable proper management, which includes surgical correction.
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Affiliation(s)
- Eman Shhada
- Pediatrics Intensive Care Department, Children’s Hospital
| | - Mohannad Saleh
- Cardiac Surgery Unit, Faculty of Medicine, Damascus University, Damascus
| | | | - Naser Wasel
- Cardiac Surgery Unit, Faculty of Medicine, Damascus University, Damascus
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Seri A, Baral N, Yousaf A, Sriramoju A, Chinta SR, Agasthi P. Outcomes of Heart Failure Hospitalizations in Adult Patients With Coarctation of Aorta: Report From National Inpatient Sample. Curr Probl Cardiol 2023; 48:101888. [PMID: 37343776 DOI: 10.1016/j.cpcardiol.2023.101888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
Coarctation of aorta (CoA) is a common congenital anomaly which portends patients to early diastolic and systolic heart failure. In this retrospective cohort study, we aimed to evaluate the impact of CoA on heart failure hospitalization. Using the national inpatient sample, the study compared the outcomes of heart failure hospitalization between patients with and without CoA. We noted increasing prevalence of CoA related heart failure admissions over the last decade. Heart failure patients with CoA were younger (mean age 57 vs 71.6 years, P < 0.001), had a longer length of stay (7.4 vs 5.4 days, P < 0.001), and a higher incidence of cardiogenic shock (6.5% vs 2.1%, P = 0.001). However, there was no statistically significant difference in in-hospital mortality (OR 1.45, 95% CI: 0.58, 3.62, P = 0.421) between both groups. These findings demonstrate that CoA increase healthcare resource utilization in patients admitted with heart failure without any significant increase in in-hospital mortality.
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Affiliation(s)
- Amith Seri
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Nischit Baral
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Amman Yousaf
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Anil Sriramoju
- Department of Internal Medicine, University of North Dakota, Fargo, ND
| | - Siddharth Reddy Chinta
- Division of Cardiology, Department of Internal Medicine, Tufts medical center, Boston, MA
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Meng X, Xue J, Cai J, Zhang H, Ma W, Wu H, Zhou X, Lou Y, Wang L. A single-center cohort of mid-aortic syndrome among adults in China: Etiology, presentation and imaging features. Am J Med Sci 2023; 365:420-428. [PMID: 35427584 DOI: 10.1016/j.amjms.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/14/2021] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mid-aortic syndrome (MAS), characterized by segmental stricture of the distal thoracic and abdominal aorta, is a heterogeneous clinical syndrome with multiple etiologies. METHODS We retrospectively analyzed 143 consecutive patients (99 females and 44 males, mean age 40.93 ± 15.31 years) with MAS seen from January 1, 2010 to January 1, 2019. RESULTS Takayasu arteritis (76.9%, 110/143) and atherosclerosis (19.6%, 28/143) were the most-common causes. There were also one patient with Behçet's disease and one with congenital MAS in the cohort. Hypertension was the most-common manifestation. Constitutional symptoms were mainly seen in Takayasu arteritis, and neurological, gastrointestinal and vascular symptoms were common in both Takayasu arteritis and atherosclerosis. The infrarenal segment was the most-commonly involved in atherosclerosis (89.3%, 25/28), whereas lesions were more distributed in Takayasu arteritis. The mean length of involved segments was longer (43.45 ± 23.64 mm vs. 30.68 ± 12.66 mm; P = 0.018) and the degree of stenosis was lower (80.20 ± 13.36% vs. 87.50 ± 13.95%, P = 0.004) in Takayasu arteritis than atherosclerosis. The most-common concurrently involved branch was the renal artery, followed by the celiac trunk and mesenteric arteries, in both Takayasu arteritis (51.8%, 32.7% and 27.3%, respectively) and atherosclerosis (53.6%, 25.0% and 17.9%, respectively). Concurrent artery involvement and coexisting lesions were absent in MAS caused by congenial coarctation of the abdominal aorta and Behçet's disease. CONCLUSIONS Takayasu arteritis and atherosclerosis were the most-common causes of MAS among these adults. Imaging tests provided evidence of involved segments and luminal and mural changes, aiding conclusive diagnoses and etiological differentiation of MAS.
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Affiliation(s)
- Xu Meng
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinhong Xue
- Department of Cardiology, The Fifth Central Hospital of Tianjin, Tianjin, China
| | - Jun Cai
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huimin Zhang
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenjun Ma
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Haiying Wu
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ying Lou
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Linping Wang
- Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Cherpak BV, Yaschuk NS, Yermolovych YV, Golovenko OS, Panichkin YV. The Choice of Optimally Necessary Devices for Endovascular Treatment of Coarctation of the Aorta. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/cy062-6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient.
Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed.
Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years.
Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.
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Empleo de by-pass parcial izquierdo para la corrección de coartación de aorta en un neonato: un procedimiento para cambio de estrategia quirúrgica. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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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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13
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Luo W, Li J, Huang X, Cai X. Late diagnosis of coarctation of the aorta in a 44-year-old male: a case report. BMC Cardiovasc Disord 2020; 20:470. [PMID: 33143642 PMCID: PMC7607745 DOI: 10.1186/s12872-020-01753-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coarctation of the aorta is a rare congenital disease. In adults, the main manifestations include hypertension, weak or absent femoral pulses, heart failure, and left ventricular hypertrophy. CASE PRESENTATION We present a case involving a late diagnosis of coarctation of the aorta detected during aortography in a 44-year-old man. The patient underwent stent implantation and aortoplasty. After 2 years of follow-up, the patient was in good condition. CONCLUSIONS This case shows that coarctation of the aorta can be cured and that hypertension caused by the condition can be controlled to some extent with medication. Based on our findings, we recommend a detailed physical examination for all patients suspected of having coarctation of the aorta; the examination should include blood pressure measurements of both the upper and lower extremities. The case of coarctation of the aorta is not common or easy to be found in medium-aged population. Better BP control, earlier repair, and transcatheter intervention may result in a good outcome in that case.
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Affiliation(s)
- Weijian Luo
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxiabei Road, Jinping District, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Jilin Li
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxiabei Road, Jinping District, Shantou, 515041, Guangdong Province, People's Republic of China.
| | - Xiaojun Huang
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxiabei Road, Jinping District, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Xiangna Cai
- Department of Plastic Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
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14
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Khoshhal SQ, Al-Mutairi MB, Alnajjar AA, Morsy MM, Salem S, Salmi AA, El-Harbi KM, Abo-Haded HM. The efficacy and safety of percutaneous balloon angioplasty for aortic coarctation in children. Acute and mid-term results in a single center experience. Saudi Med J 2020; 41:1252-1258. [PMID: 33130847 PMCID: PMC7804232 DOI: 10.15537/smj.2020.11.25452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the efficacy and safety of balloon angioplasty (BAP) procedure for treatment of coarctation of the aorta (CoA) in children. Methods: A retrospective study included 27 consecutive children, underwent BAP for either native-CoA (Na-CoA) or recoarctation (Re-CoA). Medical records, echocardiographic findings, angiographic and hemodynamic data were collected from the hospital database. Follow‑up was scheduled at 1, 3, 6, 12 months after the procedure. The study took place over a period of 4.5 years, from April 2014 to January 2019, in Madinah Cardiac Center, Madinah, Northwest region, Saudi Arabia. RESULTS The mean age of patients was 11.86±8.96 months. Seven children had Na-CoA and 20 children had Re-CoA. The success rate of the procedure was achieved in 23 children (85%), as BAP reduced the mean systolic pressure gradient across the CoA (Na-CoA: from 45.28± 18.3 to 9.8± 6.57 mm Hg, p=0.0009), and in Re-CoA groups (from 42.48±16.7 to 10.9±8.5 mm Hg, p less than 0.0001). In mid-term follow-up, the need for re-intervention occurred in 8 children of the cohort (3 children [42.8%] from the Na-CoA group, and 5 children [25%] from the Re-CoA group). Conclusions: Balloon angioplasty is considered a safe procedure for the management of CoA, but its efficacy remains questionable especially for young infants with Na-CoA type. However, it is a reliable option for managing Re-CoA children, with a lower rate of future re-intervention.
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Affiliation(s)
- Saad Q Khoshhal
- Department of Pediatrics, Faculty of Medicine, Taibah University, Madinah, Kingdom of Saudi Arabia. E-mail.
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15
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Leonardi B, D'Avenio G, Vitanovski D, Grigioni M, Perrone MA, Romeo F, Secinaro A, Everett AD, Pongiglione G. Patient-specific three-dimensional aortic arch modeling for automatic measurements: clinical validation in aortic coarctation. J Cardiovasc Med (Hagerstown) 2020; 21:517-528. [PMID: 32332378 DOI: 10.2459/jcm.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM A validated algorithm for automatic aortic arch measurements in aortic coarctation (CoA) patients could standardize procedures for clinical planning. METHODS The model-based assessment of the aortic arch anatomy consisted of three steps: first, machine-learning-based algorithms were trained on 212 three-dimensional magnetic resonance (MR) data to automatically allocate the aortic arch position in patients and segment the aortic arch; second, for each CoA patient (N = 33), the min/max aortic arch diameters were measured using the proposed software, manually and automatically, from noncontrast-enhanced three-dimensional steady-state free precession MRI sequence at five selected sites and compared ('internal comparison' referring to the same environment); third, moreover, the same min/max aortic arch diameters were compared, obtaining them independently, manually from common MR management software (MR Viewforum) and automatically from the model (external comparison). The measured sites were: aortic sinus, sino-tubular junction, mid-ascending aorta, transverse arch and thoracoabdominal aorta at the level of the diaphragm. RESULTS Manual and software-assisted measurements showed a good agreement: the difference between diameter measurements was not statistically significant (at α = 0.05), with only one exception, for both internal and external comparison. A high coefficient of correlation was attained for both maximum and minimum diameters in each site (for internal comparison, R > 0.73 for every site, with P < 2 × 10). Notably, in tricuspid aortic valve patients external comparison showed no statistically significant difference at any measurement sites. CONCLUSION The automatically derived aortic arch model, starting from three-dimensional MR images, could be a support to take the measurements in CoA patients and to quickly provide a patient-specific model of aortic arch anomalies.
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Affiliation(s)
- Benedetta Leonardi
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS
| | - Giuseppe D'Avenio
- Department of Technology and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Mauro Grigioni
- Department of Technology and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco A Perrone
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS.,Department of Cardiology, University of Rome Tor Vergata
| | | | - Aurelio Secinaro
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Allen D Everett
- Department of Pediatrics, Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giacomo Pongiglione
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS
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16
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Ibrahim SA, Al-Ethawi AES, Al-Hamash S, Al-Kaaby B. On the role of balloon angioplasty in infantile and childhood coarctation of aorta. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Ganigara M, Doshi A, Naimi I, Mahadevaiah GP, Buddhe S, Chikkabyrappa SM. Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children. Semin Cardiothorac Vasc Anesth 2019; 23:379-386. [PMID: 31535945 DOI: 10.1177/1089253219873004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. While it is a simple lesion to understand, considerable variation exists in the anatomy and pathophysiology, leading to varied clinical presentation, management options, and prognosis. On the one hand critical CoA manifests in the neonatal period as a duct-dependent lesion, while less severe forms of obstruction present later in childhood or adulthood as hypertension or incidentally noted precordial murmurs. While transthoracic echocardiography is usually adequate, older children and adults may need more advanced imaging modalities like computed tomography and magnetic resonance imaging prior to intervention. Depending on the type of lesion, management options currently available include surgery and percutaneous balloon angioplasty and stenting. Even after successful interventions, these patients need life-long surveillance for residual aortic obstruction and systemic hypertension with variable long-term clinical outcomes.
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Affiliation(s)
- Madhusudan Ganigara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Arpan Doshi
- Children's Mercy Hospitals and Clinics, Wichita, KS, USA
| | - Iman Naimi
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | | | - Sujatha Buddhe
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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18
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Oster ME, McCracken C, Kiener A, Aylward B, Cory M, Hunting J, Kochilas LK. Long-Term Survival of Patients With Coarctation Repaired During Infancy (from the Pediatric Cardiac Care Consortium). Am J Cardiol 2019; 124:795-802. [PMID: 31272703 DOI: 10.1016/j.amjcard.2019.05.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/26/2022]
Abstract
Patients who undergo coarctation repair during infancy have excellent early survival but long-term survival is unknown. We aimed to describe the long-term survival of patients with coarctation repaired during infancy and determine predictors of mortality. We performed a retrospective cohort study using data from the Pediatric Cardiac Care Consortium for patients with coarctation who underwent surgical repair before 12 months of age between 1982 and 2003. Long-term transplant-free survival was obtained by linkage with the National Death Index and the Organ Sharing Procurement Network. Kaplan Meier survival plots were constructed, and univariate and multivariable analyses were performed to determine predictors of mortality. We identified 2,424 coarctation patients who met inclusion criteria. At 20 years postoperatively, 94.5% of all patients and 95.8% of those discharged after initial operation remained alive, respectively. Significant multivariable predictors of mortality included surgical weight <2.5 kg (hazard ratio [HR] 3.70, 95% confidence interval [CI] 2.19 to 6.24), presence of a genetic syndrome (HR 2.40, 95% CI 1.13 to 5.10), and repair before 1990 (HR 1.91, 95% CI 1.09 to 3.34). None of the other factors examined including age at repair, gender, coarctation type, or surgical approach were found to be statistically significant. Over half of the deaths were due to the underlying congenital heart disease or other cardiovascular etiology. Overall long-term survival of patients who undergo coarctation repair during infancy is excellent. However, patients do experience small continued survival attrition throughout early adulthood. Ongoing monitoring of this cohort is necessary to assess late mortality risk.
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Affiliation(s)
- Matthew E Oster
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Emory University Rollins School of Public Health, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander Kiener
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Brandon Aylward
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Melinda Cory
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John Hunting
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
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19
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Lim B, Forest SJ, Schultz ML, Lipsitz E, Michler RE. Aortic recoarctation and pseudoaneurysm five decades after repair. J Card Surg 2019; 34:1374-1376. [PMID: 31421653 DOI: 10.1111/jocs.14201] [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: 11/27/2022]
Abstract
BACKGROUND Coarctation of the aorta is a congenital cardiac defect characterized by a narrowing of the proximal thoracic aorta. Despite excellent long-term results, surgical repair is rarely complicated by recoarctation. METHODS/RESULTS We describe a case with the longest time to reintervention to date, featuring surgical repair of delayed aortic recoarctation and pseudoaneurysm 53 years after the initial operation. DISCUSSION This case emphasizes the need for lifelong surveillance in this patient population and exemplifies a multidisciplinary approach in evaluating treatment options of complex aortic pathology, including open and endovascular considerations.
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Affiliation(s)
- Brian Lim
- Department of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine, New York, NY
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine, New York, NY
| | - Megan L Schultz
- Department of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine, New York, NY
| | - Evan Lipsitz
- Department of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine, New York, NY
| | - Robert E Michler
- Department of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine, New York, NY
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20
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Juffermans JF, Nederend I, van den Boogaard PJ, Ten Harkel ADJ, Hazekamp MG, Lamb HJ, Roest AAW, Westenberg JJM. The effects of age at correction of aortic coarctation and recurrent obstruction on adolescent patients: MRI evaluation of wall shear stress and pulse wave velocity. Eur Radiol Exp 2019; 3:24. [PMID: 31222473 PMCID: PMC6586735 DOI: 10.1186/s41747-019-0102-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/17/2019] [Indexed: 01/17/2023] Open
Abstract
Background Coarctation patients before curative reconstruction are exposed to abnormal flow patterns which potentially could cause wall deterioration. This study evaluated the effect of age at correction on the pulse wave velocity (PWV) and peak wall shear stress (WSS) in adolescent patients with corrected coarctation. Effects of valve morphology and presence of reobstruction were also evaluated. Methods Twenty-one patients aged 13.7 ± 2.6 years (mean ± standard deviation) were included (bicuspid aortic valve, n = 14; reobstruction, n = 9). Mean age at correction was 1.0 ± 1.8 years. PWV was determined from two high-temporal through-plane phase-contrast magnetic resonance imaging (MRI) acquisitions, for two segments: ascending aorta plus aortic arch and descending aorta. WSS was determined from four-dimensional flow MRI. Peak WSS over five systolic phases was determined for ascending aorta, aortic arch, and descending aorta. Results Patients with tricuspid aortic valve showed a significant correlation between the age at correction and descending aorta PWV (rs = 0.80, p = 0.010). Significant differences were found between patients without and with reobstruction for peak WSS in the aortic arch (3.9 ± 1.3 Pa versus 6.5 ± 2.2 Pa, respectively; p = 0.003) and descending aorta (5.0 ± 1.3 Pa versus 6.7 ± 1.1 Pa, respectively; p = 0.005). Conclusions A prolonged period of abnormal haemodynamic exposure may result in increased aortic wall stiffening. The increased peak WSS as results of a reobstruction possibly promotes different disease progression, which endorse longitudinal follow-up examination of corrected coarctation patients.
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Affiliation(s)
- Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - Ineke Nederend
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Pieter J van den Boogaard
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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21
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Computational fluid dynamics simulations as a complementary study for transcatheter endovascular stent implantation for re-coarctation of the aorta associated with minimal pressure drop: an aneurysmal ductal ampulla with aortic isthmus narrowing. Cardiol Young 2019; 29:768-776. [PMID: 31198121 DOI: 10.1017/s1047951119000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter stent implantation has been employed to treat re-coarctation of the aorta in adolescents and young adults. The aim of this work is to use computational fluid dynamics to characterise haemodynamics associated with re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing, which created minimal pressure drop, and to incorporate computational fluid dynamics's findings into decision-making concerning catheter-directed treatment. METHODS Computational fluid dynamics permits numerically solving the Navier-Stokes equations governing pulsatile flow in the aorta, based on patient-specific data. We determined flow-velocity fields, wall shear stresses, oscillatory shear indices, and particle stream traces, which cannot be ascertained from catheterisation data or magnetic resonance imaging. RESULTS Computational fluid dynamics showed that, as flow entered the isthmus, it separated from the aortic wall, and created vortices leading to re-circulating low-velocity flow that induced low and multidirectional wall shear stress, which could sustain platelet-mediated thrombus formation in the ampulla. In contrast, as flow exited the isthmus, it created a jet leading to high-velocity flow that induced high and unidirectional wall shear stress, which could eventually undermine the wall of the descending aorta. SUMMARY We used computational fluid dynamics to study re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing. Despite minimal pressure drop, computational fluid dynamics identified flow patterns that would place the patient at risk for: thromboembolic events, rupture of the ampulla, and impaired descending aortic wall integrity. Thus, catheter-directed stenting was undertaken and proved successful. Computational fluid dynamics yielded important information, not only about the case presented, but about the complementary role it can serve in the management of patients with complex aortic arch obstruction.
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22
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Garcia AF, Ahmed R, Nyktari E, Daubeney P, Voges I. Complicated coarctation repair: The importance of three-dimensional cross-sectional imaging in late postoperative assessment. Ann Pediatr Cardiol 2019; 12:178-181. [PMID: 31143052 PMCID: PMC6521650 DOI: 10.4103/apc.apc_62_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Coarctation of the aorta (CoA) represents 5%–8% of congenital heart disease patients and is one of the most common causes of neonatal surgical intervention. These patients require close lifelong follow-up due to frequent long-term complications. Although transthoracic echocardiography is the first-line technique for its diagnosis and follow-up, cross-sectional imaging with cardiovascular magnetic resonance (CMR) gives excellent anatomical and functional information, especially in complex CoA. We present the case of a 17-year-old patient who underwent complicated neonatal CoA repair and demonstrate how CMR and thorough operative records helped to define the exact anatomy of repair many years after surgery. Furthermore, we conclude that keeping surgical drawings in the patient records can be of great importance, especially in complicated cases.
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Affiliation(s)
- Andrea Fidalgo Garcia
- Department of Pediatric Cardiology, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón, Barcelona, Spain.,Department of Pediatric Cardiology and Cardiovascular Magnetic Resonance Imaging Unit, Royal Brompton Hospital, London, UK
| | - Rizwan Ahmed
- Department of Pediatric Cardiology and Cardiovascular Magnetic Resonance Imaging Unit, Royal Brompton Hospital, London, UK
| | - Evangelia Nyktari
- Department of Pediatric Cardiology and Cardiovascular Magnetic Resonance Imaging Unit, Royal Brompton Hospital, London, UK
| | - Piers Daubeney
- Department of Pediatric Cardiology and Cardiovascular Magnetic Resonance Imaging Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Department of Pediatric Cardiology and Cardiovascular Magnetic Resonance Imaging Unit, Royal Brompton Hospital, London, UK
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23
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Rothman A, Ciccolo ML, Galindo A, Evans WN. Left Subclavian Artery Test Balloon Occlusion Before Covered Stent for Recoarctation and Aneurysm. World J Pediatr Congenit Heart Surg 2019; 11:NP235-NP238. [PMID: 31010397 DOI: 10.1177/2150135118817309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 57-year-old man, with a history of coarctation patch repair at three years of age, presented with left ventricular dilatation and moderate to severe dysfunction. A computed tomographic angiogram of the chest revealed moderate residual stenosis of the distal arch and proximal descending aorta and a large aneurysm adjacent to the origin of the left subclavian artery. Due to high surgical risk, a hybrid approach was undertaken with temporary balloon occlusion of the left subclavian artery, followed by surgical left common carotid to left subclavian artery graft and percutaneous covered stent implantation to relieve the obstruction and exclude the aneurysm.
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Affiliation(s)
- Abraham Rothman
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - Michael L Ciccolo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Department of Surgery, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - Alvaro Galindo
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
| | - William N Evans
- Children's Heart Center Nevada, Las Vegas, NV, USA.,Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada Las Vegas, School of Medicine, Las Vegas, NV, USA
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24
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Cangussú LR, Lopes MR, Barbosa RHDA. The importance of the early diagnosis of aorta coarctation. ACTA ACUST UNITED AC 2019; 65:240-245. [PMID: 30892450 DOI: 10.1590/1806-9282.65.2.240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Coarctation of the aorta is a congenital heart disease characterized by a narrowing that occurs in the aortic artery. This constriction can occur anywhere along its entire length; however, it is more common between the origin of the left subclavian artery and the ductus arteriosus. Its incidence corresponds to 3 cases per 10,000 births. Thus, it is a common cardiopathy, but with high mortality and morbidity rates, which are related to a failure in the early diagnosis. METHOD In the research, articles of the national and international literature in Pubmed, Scielo and Lilacs databases were selected using the following descriptors: coarctation, aorta, diagnosis, heart diseases, congenital abnormalities. RESULTS The pathophysiology of CoA and its systemic implications in the life of newborn and adults are well elucidated. However, due to the lack of habit to palpate pulses and to check the blood pressure in both upper and lower limbs during the physical examination, it is still a pathology little diagnosed in childhood. There are several techniques used in the repair of coarctation, each with their specifics, although, when not treated, aneurysms, heart failure, coronary diseases, and stroke are the main complications arising from the evolution of this pathology, which explains the low survival rate of these patients. CONCLUSION Coarctation of the aorta is, therefore, a cardiac malformation of significant importance due to its incidence and its significant mortality risk. In this sense, the early diagnosis stands out as an essential piece for better prognosis of the patient.
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Affiliation(s)
- Luana Resende Cangussú
- Medical student, Federal University of Vale do São Francisco, Paulo Afonso, Bahia, Brasil
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25
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Hemodynamics and Wall Mechanics after Surgical Repair of Aortic Arch: Implication for Better Clinical Decisions. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9040807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Graft repair of aortic coarctation is commonly used to mimic the physiological aortic arch shape and function. Various graft materials and shapes have been adopted for the surgery. The goal of this work is to quantitatively assess the impact of graft materials and shapes in the hemodynamics and wall mechanics of the restored aortic arch and its correlation with clinical outcomes. A three-dimensional aortic arch model was reconstructed from magnetic resonance images. The fluid–structure interaction (FSI) analysis was performed to characterize the hemodynamics and solid wall mechanics of the repaired aortic arch. Two graft shapes (i.e., a half-moon shape and a crescent one) were considered. Material choices of the aortic arch repair included three commonly used graft materials (i.e., polytetrafluoroethylene (PTFE) synthetic graft, CorMatrix extracellular matrix, and pulmonary homograft) as well as one native tissue serving as a control. The pathological hemodynamic parameters, in terms of the percentage area of low wall shear stress (WSS), high oscillatory shear index (OSI), and high relative residence time (RRT), were quantified to be associated with potential clinical outcomes. Results have shown that the peak von Mises stress for the aortic arch repaired by the crescent graft was 76% less than that of the half-moon graft. Flow disturbance and recirculation were also minimized with the crescent graft. Moreover, pathological hemodynamic parameters were significantly reduced with the crescent graft. The graft material mismatch with the surrounding tissue aggregated the stress concentration on the aortic wall, but had minimal impact on flow dynamics. The present work demonstrated the role and importance of the graft geometry and materials on hemodynamics and wall mechanics, which could guide optimal graft decisions towards better clinical outcomes.
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Christopher AB, Apfel A, Sun T, Kreutzer J, Ezon DS. Diastolic velocity half time is associated with aortic coarctation gradient at catheterization independent of echocardiographic and clinical blood pressure gradients. CONGENIT HEART DIS 2018; 13:713-720. [PMID: 30395387 DOI: 10.1111/chd.12637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The most accurate noninvasive parameter to predict whether a patient with aortic coarctation will meet interventional criteria at catheterization remains elusive. We aim to determine the best independent echocardiographic predictors of a coarctation peak-to-peak pressure gradient ≥20 mm Hg at catheterization, the accepted threshold for intervention. DESIGN Retrospective query of our catheterization database from 1/2007 to 7/2016 for the diagnostic code of aortic coarctation was performed. Multiple echocardiographic measurements and blood pressure gradients prior to cardiac catheterization were collected. Univariate correlation of variables with the continuous catheterization peak were calculated using Spearman's rho. Univariate association with peak-to-peak gradient at catheterization ≥20 mm Hg was tested using Mann-Whitney U test and the Pearson chi-square test or Fisher's exact test. Multivariable logistic regression assessed the independent association of the clinically relevant metrics with gradient at catheterization ≥20 mm Hg. RESULTS Sixty-eight patients met study criteria (median age 9.25 years), of whom 84% underwent intervention at catheterization. Echocardiographic peak and mean coarctation velocity, indexed systolic and diastolic velocity half times (SVHTi, DVHTi), and blood pressure gradient all had moderate correlation (Spearman's rho = 0.529-0.617, P < .001) with the continuous catheterization gradient and were significantly associated with the binary outcome of catheterization peak ≥20 mm Hg (P < .001). Logistic regression found echocardiographic mean systolic gradient (OR 1.213 [95% CI 1.041-1.414]) and DVHTi (OR 1.039 [95% CI 1.004-1.074]) independently associate with catheterization peak ≥20 mm Hg after controlling for blood pressure gradient (OR 1.066 [0.987-1.150]). CONCLUSIONS Most echocardiographic estimates show moderate correlation with arch gradient at catheterization. Noninvasive four extremity blood pressure gradient is significantly associated with peak-to-peak gradient ≥20 mm Hg. DVHTi may provide a unique independently associated echocardiographic estimate of coarctation severity. Further study of these variables with larger cohorts may allow for development of predictive models to direct catheterization.
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Affiliation(s)
- Adam B Christopher
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Abraham Apfel
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tao Sun
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jackie Kreutzer
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - David S Ezon
- Department of Pediatric Cardiology, Mount Sinai Hospital, New York, New York
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Belin RJ, Zoretic JA, Carr J, Huffman MD, Russell H, Thomas J. Profound Aortopathy: A Rare Case of Massive Ascending and Descending Aortic Aneurysms, Type B Aortic Dissection, and Severe Aortic Valve Regurgitation in an Adult Patient With Uncorrected Congenital Aortic Coarctation. ACTA ACUST UNITED AC 2018; 1:166-170. [PMID: 30062273 PMCID: PMC6058279 DOI: 10.1016/j.case.2017.06.004] [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] [Indexed: 11/16/2022]
Abstract
Profound aortopathy involving both the ascending and descending aorta. Impressive echocardiographic images. Impressive computed tomography and cardiac magnetic resonance images. The first known case report to illustrate this level and severity of aortopathy.
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Affiliation(s)
- Rashad J Belin
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jessie Aw Zoretic
- Division of Cardiovascular Imaging, Northwestern Memorial Hospital, Chicago, Illinois
| | - James Carr
- Division of Cardiovascular Imaging, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mark D Huffman
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - James Thomas
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois
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Ma ZL, Yan J, Li SJ, Hua ZD, Yan FX, Wang X, Wang Q. Coarctation of the Aorta with Aortic Arch Hypoplasia: Midterm Outcomes of Aortic Arch Reconstruction with Autologous Pulmonary Artery Patch. Chin Med J (Engl) 2018; 130:2802-2807. [PMID: 28936993 PMCID: PMC5717858 DOI: 10.4103/0366-6999.215279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Coarctation of the aorta (CoA) with aortic arch hypoplasia (AAH) is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch (AA) reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH. Methods: Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 (Q1, Q3: 2.0, 14.0) months and the median body weight was 5.75 (Q1, Q3: 4.10, 9.38) kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test. Results: No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg (1 mmHg = 0.133 kPa), which was smaller than the preoperative pressure difference (48.30 ± 15.73 mmHg; t = −10.119, P < 0.001). The median follow-up time was 29.0 (Q1, Q3: 15.5, 57.3) months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity. Conclusion: AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.
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Affiliation(s)
- Zhi-Ling Ma
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Yan
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shou-Jun Li
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhong-Dong Hua
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fu-Xia Yan
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xu Wang
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qiang Wang
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Complications After Stent Placement for Aortic Coarctation: A Pictorial Essay of Computed Tomographic Angiography. J Thorac Imaging 2018; 32:W69-W80. [PMID: 29065009 DOI: 10.1097/rti.0000000000000303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Stent placement is commonly used to treat aortic coarctation. Although invasive angiography remains the gold standard, follow-up is often performed using computed tomography, which allows rapid, noninvasive assessment of the aorta and surrounding tissues. The goal of this pictorial essay is to provide a guide to the interpretation of these examinations. Normal and abnormal computed tomographic appearance of different stent types is shown along with reconstructions that can help assess stent integrity and the stent position in relation to the aortic wall and branches. Furthermore, imaging findings of complications including aortic wall injuries, restenosis, and intimal hyperplasia are depicted.
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Priya S, Thomas R, Nagpal P, Sharma A, Steigner M. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther 2018; 8:S26-S44. [PMID: 29850417 DOI: 10.21037/cdt.2017.10.15] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Congenital anomalies of the aortic arch include diverse subgroups of malformations that may be clinically silent or may present with severe respiratory or esophageal symptoms especially when associated with complete vascular rings. These anomalies may be isolated or may be associated with other congenital heart diseases. Volume rendered computed tomography (CT) and magnetic resonance angiography (MRA) help in preoperative surgical planning by providing information about the complex relationship of aortic arch and its branches to the trachea and esophagus. Three dimensional capabilities of both computed tomography angiography (CTA) and MRA are helpful in determining evidence of tracheal or esophageal compression or other high-risk features in patients with a complete vascular ring.
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Affiliation(s)
- Sarv Priya
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Thomas
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa, USA
| | - Arun Sharma
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Steigner
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Nakamura E, Nakamura K, Furukawa K, Ishii H, Kawagoe K. Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults. Ann Thorac Cardiovasc Surg 2018; 24:97-102. [PMID: 29459569 DOI: 10.5761/atcs.oa.17-00167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Coarctation of the aorta (CoA) in adolescents and adults is relatively rare. Several operative techniques for CoA in adolescents and adults have been reported, but there is still no consensus. This study aims to highlight the use of individual patient characteristics to select optimal treatment strategies for CoA in adolescents and adults. METHODS Surgical repair of CoA was performed in five patients (mean age: 34 ± 14 years, range: 13-58 years). All patients had primary CoA, and one had aneurysm above the CoA. One patient had undergone previous aortic valve replacement (AVR) and graft replacement of the ascending aorta. One patient underwent resection of the coarctation without cardiopulmonary bypass (CPB) followed by direct end-to-end anastomosis. Three patients underwent CoA resection with an interposition graft through a lateral thoracotomy with partial CPB. One patient underwent AVR with extra-anatomical bypass (ascending-descending aorta). RESULTS No in-hospital deaths occurred, and there were no complications. During the follow-up period, there has been no recurrence of CoA. CONCLUSION CoA in adolescents and adults is associated with different issues from those encountered in infant patients, and comprehensive surgery should be performed in all cases.
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Affiliation(s)
- Eisaku Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kunihide Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Koji Furukawa
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hirohito Ishii
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Katsuya Kawagoe
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
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Outcomes of thoracic endovascular aortic repair in adult coarctation patients. J Vasc Surg 2018; 67:369-381.e2. [DOI: 10.1016/j.jvs.2017.06.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/17/2017] [Indexed: 12/17/2022]
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Sen S, Garg S, Rao SG, Kulkarni S. Native aortic coarctation in neonates and infants: Immediate and midterm outcomes with balloon angioplasty and surgery. Ann Pediatr Cardiol 2018; 11:261-266. [PMID: 30271015 PMCID: PMC6146845 DOI: 10.4103/apc.apc_165_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature. Methods The study design was a retrospective record review. Patients with coarctation aged <1 year who underwent balloon or surgical coarctoplasty at our center (January 2010-January 2016) with >6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted. Results Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan-Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028). Conclusion In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.
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Affiliation(s)
- Supratim Sen
- Department of Pediatric Cardiology, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Sandeep Garg
- Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Suresh G Rao
- Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Snehal Kulkarni
- Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Salcher M, Naci H, Law TJ, Kuehne T, Schubert S, Kelm M, Kuehne T, Hennemuth A, Manset D, Mcguire A, Plank G, Ecabert O, Pongiglione G, Muthurangu V. Balloon Dilatation and Stenting for Aortic Coarctation: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003153. [PMID: 27296199 DOI: 10.1161/circinterventions.115.003153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/29/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no systematic assessment of available evidence on effectiveness and comparative effectiveness of balloon dilatation and stenting for aortic coarctation. METHODS AND RESULTS We systematically searched 4 online databases to identify and select relevant studies of balloon dilatation and stenting for aortic coarctation based on a priori criteria (PROSPERO 2014:CRD42014014418). We quantitatively synthesized results for each intervention from single-arm studies and obtained pooled estimates for relative effectiveness from pairwise and network meta-analysis of comparative studies. Our primary analysis included 15 stenting (423 participants) and 12 balloon dilatation studies (361 participants), including patients ≥10 years of age. Post-treatment blood pressure gradient reduction to ≤20 and ≤10 mm Hg was achieved in 89.5% (95% confidence interval, 83.7-95.3) and 66.5% (44.1-88.9%) of patients undergoing balloon dilatation, and in 99.5% (97.5-100.0%) and 93.8% (88.5-99.1%) of patients undergoing stenting, respectively. Odds of achieving ≤20 mm Hg were lower with balloon dilatation as compared with stenting (odds ratio, 0.105 [0.010-0.886]). Thirty-day survival rates were comparable. Numerically more patients undergoing balloon dilatation experienced severe complications during admission (6.4% [2.6-10.2%]) compared with stenting (2.6% [0.5-4.7%]). This was supported by meta-analysis of head-to-head studies (odds ratio, 9.617 [2.654-34.845]) and network meta-analysis (odds ratio, 16.23, 95% credible interval: 4.27-62.77) in a secondary analysis in patients ≥1 month of age, including 57 stenting (3397 participants) and 62 balloon dilatation studies (4331 participants). CONCLUSIONS Despite the limitations of the evidence base consisting predominantly of single-arm studies, our review indicates that stenting achieves superior immediate relief of a relevant pressure gradient compared with balloon dilatation.
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Affiliation(s)
- Maximilian Salcher
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Huseyin Naci
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Tyler J Law
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Titus Kuehne
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Stephan Schubert
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Marcus Kelm
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | | | | | | | | | - Alistair Mcguire
- London School of Economics and Political Science, London, United Kingdom
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Malachias MVB, Bortolotto LA, Drager LF, Borelli FAO, Lotaif LAD, Martins LC. 7th Brazilian Guideline of Arterial Hypertension: Chapter 12 - Secondary Arterial Hypertension. Arq Bras Cardiol 2017; 107:67-74. [PMID: 27819391 PMCID: PMC5319460 DOI: 10.5935/abc.20160162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Abstract
Coarctation of the aorta is an uncommon cause of treatment-resistant hypertension in adults. It is typically detected and treated in infancy or childhood with surgical or endovascular procedures. Most cases of recurrence of coarctation after repair occur in childhood or early adulthood; recurrence in older persons (>70 years) has rarely been reported. A 73-year-old woman was referred to us for the management of treatment-resistant hypertension accompanied by symptoms of claudication and headaches, which had resulted in multiple emergency room visits. Of note, 58 years earlier, a graft from the left subclavian artery had been used to bypass an aortic coarctation. During a hospitalization for severe hypertension accompanied by acute kidney injury and heart failure, diagnostic angiography revealed a complete thrombotic occlusion of the left subclavian-artery-to-descending-aorta bypass graft and a tight coarctation in the descending thoracic aorta. Balloon angioplasty and stenting across the coarctation was only transiently effective; subsequently, an ascending-to-descending graft was placed distal to the coarctation, and within a few days, the blood pressure levels and claudication improved markedly. This case demonstrates that hypertension specialists should suspect the possibility of recurrence of a coarctation in older patients who present with resistant hypertension and have a remote history of coarctation repair. Although such late recurrences are not common, as illustrated in our patient, surgical intervention may contribute to significant improvement in blood pressure control and prevent future complications.
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Huang F, Chen Q, Huang WH, Wu H, Li WC, Lai QQ. Diagnosis of Congenital Coarctation of the Aorta and Accompany Malformations in Infants by Multi-Detector Computed Tomography Angiography and Transthoracic Echocardiography: A Chinese Clinical Study. Med Sci Monit 2017; 23:2308-2314. [PMID: 28510540 PMCID: PMC5441492 DOI: 10.12659/msm.901928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to evaluate the utility of multi-detector computed tomography (MDCT) angiography and transthoracic echocardiography (TTE) in the diagnosis of congenital coarctation of the aorta (CoA) and accompanying malformations in infants. Material/Methods From January 2012 and December 2015, we enrolled 68 infants with clinically suspected CoA who underwent MDCT angiography and TTE in our hospital. Surgical correction was conducted to confirm the diagnostic accuracy of both examinations in all patients. Results In this study, the diagnosis of CoA was confirmed infants by surgical results in 55 of 68 infants. The diagnostic accuracy, sensitivity, and specificity of MDCT angiography were 95.6%, 96.4%, and 92.3%, respectively. The diagnostic accuracy, sensitivity, and specificity of TTE were 88.2%, 90.9%, and 76.9%, respectively. There was no significant difference in diagnostic accuracy, sensitivity, and specificity between MDCT angiography and TTE (χ2=2.473, p>0.05, χ2=1.373, p>0.05 and χ2=1.182, p>0.05, respectively). In the diagnosis of concomitant cardiac abnormalities with CoA, the 2 methods also play different roles. Conclusions MDCT angiography and TTE play different roles in the diagnosis of CoA and accompany malformations. MDCT angiography in the diagnosis of the extra-cardiac vascular malformations is better than TTE, and TTE is superior to MDCT angiography in diagnosing intracardiac malformation. Combined MDCT angiography and TTE is a relatively valuable, reliable, and noninvasive method in the diagnosis of CoA and accompany malformations in infants.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Wen-Han Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Wei-Cheng Li
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Qing-Quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, China (mainland)
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Salcher M, Mcguire A, Muthurangu V, Kelm M, Kuehne T, Naci H. Avoidable costs of stenting for aortic coarctation in the United Kingdom: an economic model. BMC Health Serv Res 2017; 17:258. [PMID: 28395657 PMCID: PMC5387244 DOI: 10.1186/s12913-017-2215-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Undesirable outcomes in health care are associated with patient harm and substantial excess costs. Coarctation of the aorta (CoA), one of the most common congenital heart diseases, can be repaired with stenting but requires monitoring and subsequent interventions to detect and treat disease recurrence and aortic wall injuries. Avoidable costs associated with stenting in patients with CoA are unknown. METHODS We developed an economic model to calculate potentially avoidable costs in stenting treatment of CoA in the United Kingdom over 5 years. We calculated baseline costs for the intervention and potentially avoidable complications and follow-up interventions and compared these to the costs in hypothetical scenarios with improved treatment effectiveness and complication rates. RESULTS Baseline costs were £16 688 ($25 182) per patient. Avoidable costs ranged from £137 ($207) per patient in a scenario assuming a 10% reduction in aortic wall injuries and reinterventions at follow-up, to £1627 ($2455) in a Best-case scenario with 100% treatment success and no complications. Overall costs in the Best-case scenario were 90.2% of overall costs at Baseline. Reintervention rate at follow-up was identified as most influential lever for overall costs. Probabilistic sensitivity analysis showed a considerable degree of uncertainty for avoidable costs with widely overlapping 95% confidence intervals. CONCLUSIONS Significant improvements in the treatment effectiveness and reductions in complication rates are required to realize discernible cost savings. Up to 10% of total baseline costs could be avoided in the best-case scenario. This highlights the need to pursue patient-specific treatment approaches which promise optimal outcomes.
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Affiliation(s)
- Maximilian Salcher
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Alistair Mcguire
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, Great Ormond Street Hospital, London, UK
| | - Marcus Kelm
- Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Huseyin Naci
- LSE Health and Social Care, Cowdray House; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart 2017; 103:1148-1155. [PMID: 28377475 DOI: 10.1136/heartjnl-2017-311173] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
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Kantzis M, Lehner A, Laser KT, Racolta A, Vcasna R, Fischer M, Kececioglu D, Haas NA. The "Dog Bone Technique" A Novel Easy and Safe Catheter Maneuver for Aortic Arch and Coarctation Stenting. J Interv Cardiol 2016; 30:85-92. [PMID: 27882604 DOI: 10.1111/joic.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Various techniques are described to facilitate stable stent implantation in aortic arch stenosis or coarctation. We describe an alternative technique, which due to its unique appearance during stent implantation, we have named "Dog Bone Technique" (DBT). TECHNIQUE The stent/balloon assembly is placed across the stenosis, the long sheath is retrieved to uncover the distal 20-50% of the stent. The balloon is inflated with the pressure inflator just to expand slightly the stent. Thereafter the sheath is pulled back and the proximal end is uncovered and partially inflated; therewith the assembly takes the typical "dog bone" shape before complete inflation and final positioning. Repositioning of the stent and control angiography is possible at each time of this procedure. RESULTS Between 1/2010 and 12/2014 we implanted 91 stents in 87 patients (mean age 20.2 years). About 71 patients had native or re-coarctation and 16 patients had transverse aortic arch stenosis. In 38 patients (44%) a pharmacological exercise test with Orciprenaline was performed during implantation resulting in high-cardiac output. In none of the patients reduction of cardiac output by adenosine or a rapid pacing of the right ventricle was required for stable stent implantation. All stents were implanted in the targeted position using this single balloon technique. There were no acute or short-term complications detected. CONCLUSION DBT is a safe and feasible technique for aortic stent implantation even at high-cardiac output. Other additional techniques for stent placement are not necessary to obtain a stable final position in the target region.
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Affiliation(s)
- Marinos Kantzis
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Anja Lehner
- Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Anca Racolta
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Radka Vcasna
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Marcus Fischer
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.,Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.,Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
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Bruse JL, McLeod K, Biglino G, Ntsinjana HN, Capelli C, Hsia TY, Sermesant M, Pennec X, Taylor AM, Schievano S. A statistical shape modelling framework to extract 3D shape biomarkers from medical imaging data: assessing arch morphology of repaired coarctation of the aorta. BMC Med Imaging 2016; 16:40. [PMID: 27245048 PMCID: PMC4894556 DOI: 10.1186/s12880-016-0142-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/19/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical image analysis in clinical practice is commonly carried out on 2D image data, without fully exploiting the detailed 3D anatomical information that is provided by modern non-invasive medical imaging techniques. In this paper, a statistical shape analysis method is presented, which enables the extraction of 3D anatomical shape features from cardiovascular magnetic resonance (CMR) image data, with no need for manual landmarking. The method was applied to repaired aortic coarctation arches that present complex shapes, with the aim of capturing shape features as biomarkers of potential functional relevance. The method is presented from the user-perspective and is evaluated by comparing results with traditional morphometric measurements. METHODS Steps required to set up the statistical shape modelling analyses, from pre-processing of the CMR images to parameter setting and strategies to account for size differences and outliers, are described in detail. The anatomical mean shape of 20 aortic arches post-aortic coarctation repair (CoA) was computed based on surface models reconstructed from CMR data. By analysing transformations that deform the mean shape towards each of the individual patient's anatomy, shape patterns related to differences in body surface area (BSA) and ejection fraction (EF) were extracted. The resulting shape vectors, describing shape features in 3D, were compared with traditionally measured 2D and 3D morphometric parameters. RESULTS The computed 3D mean shape was close to population mean values of geometric shape descriptors and visually integrated characteristic shape features associated with our population of CoA shapes. After removing size effects due to differences in body surface area (BSA) between patients, distinct 3D shape features of the aortic arch correlated significantly with EF (r = 0.521, p = .022) and were well in agreement with trends as shown by traditional shape descriptors. CONCLUSIONS The suggested method has the potential to discover previously unknown 3D shape biomarkers from medical imaging data. Thus, it could contribute to improving diagnosis and risk stratification in complex cardiac disease.
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Affiliation(s)
- Jan L Bruse
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK.
| | - Kristin McLeod
- Cardiac Modelling Department, Simula Research Laboratory, Oslo, Norway
- Inria Sophia Antipolis-Méditeranée, ASCLEPIOS Project, Sophia Antipolis, France
| | - Giovanni Biglino
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Hopewell N Ntsinjana
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Claudio Capelli
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Tain-Yen Hsia
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Maxime Sermesant
- Inria Sophia Antipolis-Méditeranée, ASCLEPIOS Project, Sophia Antipolis, France
| | - Xavier Pennec
- Inria Sophia Antipolis-Méditeranée, ASCLEPIOS Project, Sophia Antipolis, France
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, University College London, Institute of Cardiovascular Science & Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, UK
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Bhatia A, Mehta TH, Manning P, Kuvin JT. Adults With Left-Sided Pressure Loading Lesions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:55. [DOI: 10.1007/s11936-015-0416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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Haas NA, Happel CM, Blanz U, Laser KT, Kantzis M, Kececioglu D, Sandica E. "Intraoperative hybrid stenting of recurrent coarctation and arch hypoplasia with large stents in patients with univentricular hearts". Int J Cardiol 2015; 204:156-63. [PMID: 26657614 DOI: 10.1016/j.ijcard.2015.11.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obstruction of the reconstructed aortic arch, tubular hypoplasia and recurrent coarctation (RC) is an important risk factor in univentricular physiology. For the past two years we have adopted the concept of intraoperative hybrid stenting of RC and arch hypoplasia with large stents in patients with univentricular hearts as standard care procedure. METHOD/RESULT Retrospective analysis of the anatomy and procedural outcome of 14 patients was scheduled for intraoperative stenting of the aortic arch (12 during surgery for BCPS, 2 during Fontan completion). The median age was 5.3 months, weight 5.5 kg, height 62 cm. Five patients had tubular hypoplasia and 9 patients had distal stenosis of the aortic arch. Nine patients had a previous balloon dilatation. The mean diameter of the distal arch was 11.0mm, at the coarctation 5.1mm, at the level of the diaphragm 8.2mm (CoA-index 0.62). Intraoperative stenting was performed in 13/14 patients. Stents were implanted with a mean balloon diameter of 10.8mm (SD 3.4mm). The achieved final mean diameter was 9.8mm (mean, SD 2.8mm) with an oversized Coa-index of 1.2. There was no re-coarctation at a mean follow-up of 7.3 months (range 3 to 24), the maximum flow velocity of 2m/s across the stented lesion assessed by ECHO. CONCLUSION This hybrid approach is an easy and safe concept to manage recurrent aortic arch hypoplasia and stenosis. The use of large stents allows redilatation to adult size diameters later on.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany; Department for Pediatric Cardiology and Intensive Care, LMU-Campus Großhadern, Germany.
| | - Christoph M Happel
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Ute Blanz
- Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Marinos Kantzis
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects, Ruhr University Bochum, Germany
| | - Eugen Sandica
- Department for Surgery of Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
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Mery CM, Guzmán-Pruneda FA, Trost JG, McLaughlin E, Smith BM, Parekh DR, Adachi I, Heinle JS, McKenzie ED, Fraser CD. Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy. Ann Thorac Surg 2015. [PMID: 26209490 DOI: 10.1016/j.athoracsur.2015.04.129] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although surgical results for repair of coarctation of the aorta (CoA) have steadily improved, management of this condition remains controversial. The purposes of this study were to analyze the long-term outcomes of patients undergoing CoA repair through left thoracotomy and to define risk factors for reintervention. METHODS All patients who were less than 18 years old and who underwent initial repair of CoA through left thoracotomy from 1995 to 2013 at Texas Children's Hospital (Houston, TX) were included. Patients were classified into 3 groups: 143 (42%) neonates (0 to 30 days old), 122 (36%) infants (31 days to 1 year old), and 78 (23%) older children (1 to 18 years old). Univariate and multivariate analyses were performed. RESULTS A total of 343 patients (129 [38%] girls) with median age of 53 days (interquartile range [IQR],12 days to 9 months) and weight of 4.1 kg (IQR, 3.1 to 8.0) underwent repair with extended end-to-end anastomosis (291 patients [85%]), end-to-end anastomosis (44 patients [13%]), interposition graft (2 patients [0.6%]), or subclavian flap (6 patients [2%]). Concomitant diagnoses included genetic abnormalities (48 patients [14%]), isolated ventricular septal defects (58 patients [17%]), small left-sided structures (53 patients,16%), or other complex congenital heart disease (18 patients [5%]). Perioperative mortality was 1% (n = 4, all neonates). At a median follow-up of 6 years (7 days to 19 years), only 14 (4%) patients required reintervention (10 catheter-based procedures, 6 surgical repairs). A postoperative peak velocity of 2.5 m/s or greater was an independent risk factor for reintervention (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.4 to 11.6). Within the cohort, 95 (33%) patients were hypertensive or remained on cardiac medications a median of 12 years (6 months to 19 years) after the surgical procedure. Development of perioperative hypertension was associated with higher risk of chronic hypertension or cardiac medication dependency (OR, 1.9; 95% CI, 1.1 to 3.3). CONCLUSIONS CoA repair through left thoracotomy is associated with low rates of morbidity, mortality, and reintervention. Aortic arch obstruction should be completely relieved at the time of surgical intervention to minimize the risk of long-term recoarctation.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
| | - Francisco A Guzmán-Pruneda
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey G Trost
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Ericka McLaughlin
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Brendan M Smith
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Dhaval R Parekh
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
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Centella Hernández T, Stanescu D, Stanescu S. Coartación aórtica. Interrupción del arco aórtico. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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