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Nair PJ, Pfaller MR, Dual SA, McElhinney DB, Ennis DB, Marsden AL. Non-invasive Estimation of Pressure Drop Across Aortic Coarctations: Validation of 0D and 3D Computational Models with In Vivo Measurements. Ann Biomed Eng 2024; 52:1335-1346. [PMID: 38341399 DOI: 10.1007/s10439-024-03457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
Blood pressure gradient ( Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0D and 3D deformable wall simulations. Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17). 0D simulations were performed first and used to tune boundary conditions and initialize 3D simulations. Δ P across the CoA estimated using both 0D and 3D simulations were compared to invasive catheter-based pressure measurements for validation. The 0D simulations were extremely efficient ( ∼ 15 s computation time) compared to 3D simulations ( ∼ 30 h computation time on a cluster). However, the 0D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3D simulations improved this to 88%. Overall, a combined approach, using 0D models to efficiently tune and launch 3D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Affiliation(s)
- Priya J Nair
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Martin R Pfaller
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Seraina A Dual
- Department of Biomedical Signaling and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Doff B McElhinney
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Daniel B Ennis
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA.
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA.
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA.
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Santiago J, Karl G, Florez C, Molina Y, Castro J, Hurtado A, García V. Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2023084. [PMID: 38126604 PMCID: PMC10742369 DOI: 10.1590/1984-0462/2024/42/2023084] [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: 05/15/2023] [Accepted: 09/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.
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Affiliation(s)
- Justo Santiago
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Gabriela Karl
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Claudia Florez
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Yudisay Molina
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Javier Castro
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Alexandra Hurtado
- Cardiovascular Foundation of Colombia, Bucaramanga, Santander, Colombia
| | - Valeria García
- Santander University Hospital, Bucaramanga, Santander, Colombia
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Nair PJ, Pfaller MR, Dual SA, McElhinney DB, Ennis DB, Marsden AL. Non-invasive estimation of pressure drop across aortic coarctations: validation of 0D and 3D computational models with in vivo measurements. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.05.23295066. [PMID: 37732242 PMCID: PMC10508787 DOI: 10.1101/2023.09.05.23295066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Purpose Blood pressure gradient (Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0 D and 3 D deformable wall simulations. Methods Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17 ). 0 D simulations were performed first and used to tune boundary conditions and initialize 3 D simulations. Δ P across the CoA estimated using both 0 D and 3 D simulations were compared to invasive catheter-based pressure measurements for validation. Results The 0 D simulations were extremely efficient (~15 secs computation time) compared to 3 D simulations (~30 hrs computation time on a cluster). However, the 0 D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3 D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0 D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0 D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3 D simulations improved this to 88%. Conclusion Overall, a combined approach, using 0 D models to efficiently tune and launch 3 D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Affiliation(s)
- Priya J. Nair
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Martin R. Pfaller
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Seraina A. Dual
- Department of Biomedical Signaling and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Doff B. McElhinney
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Daniel B. Ennis
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
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Buckley AD, Han Um KY, Ganame JI, Salehian O, Karbassi A. Prevalence of Intracranial Aneurysms in Patients With Coarctation of the Aorta: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100394. [PMID: 38938992 PMCID: PMC11198084 DOI: 10.1016/j.jacadv.2023.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2024]
Abstract
Background Coarctation of the aorta (CoA) is associated with intracranial aneurysms (IAs); however, the prevalence and risk factors (RFs) are not well described. Current practice guidelines offer inconsistent recommendations on screening for IAs in this patient population ranging from "not recommended" (European Society of Cardiology 2020) to "recommended" (American Heart Association 2018). Objectives The purpose of this study was to determine the prevalence and RFs for IAs in patients with CoA. Methods We completed a systematic review and meta-analysis of studies utilizing computed tomography or magnetic resonance angiographic screening for IAs in patients with CoA. Results Five cohort studies were included, representing 442 patients. The pooled prevalence of IAs in patients with CoA was 3.8% [95% CI: 0.1%-12.3%]. The results met our prespecified definition for high heterogeneity. Of 5 RFs evaluated, only hypertension was associated with the development of IAs with an odds ratio of 3.1 [95% CI: 1.1-8.2; P = 0.03]. There was an observed downward trend over time in the prevalence of IAs among the studies included. Conclusions The development of IAs is likely multifactorial in etiology and there may be modifiable RFs in their development. Considering the low prevalence of IAs in the pooled result, routine screening of patients with CoA for IAs is likely of low-value.
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Affiliation(s)
- Alvan D. Buckley
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Yo Han Um
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Javier I. Ganame
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Omid Salehian
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Arsha Karbassi
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
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Bhatt K, Sanghavi U, Desai D, Kothari J. A case report: A severe juxta-ductal coarctation of aorta with post coarctation aortic aneurysm. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Objective: Coarctation of aorta with post coarctation aneurysm is a congenital malformation of the aorta which usually occurs in undiagnosed and long standing coarctation and present in third to fifth decade of life. In this case, we present technique of differential hypothermia used to repair coarctation and post coarctation aneurysm: meticulous repair of coarctation segment and aneurysm without compromising blood flow to the vital organs distal to the coarctation segment.
Case report: A 44-year old male patient with severe juxtaductal coarctation of aorta with post coarctation aortic aneurysm who was relatively asymptomatic until he presented with hypertension since 6 months in his fifth decade of life was admitted to our hospital. The patient was managed with surgery of coarctation of aorta and aneurysm repair using dual arterial cannulation and maintaining selective antegrade cerebral perfusion.
Conclusion: Differential hypothermia allows meticulous repair of coarctation segment and post coarctation aneurysm without compromising blood flow to vital organs and and better neurological recovery.
Key words: Aortic coarctation, aortic surgery, post coarctation aneurysm, ventral repair
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Abuji K, Vaddavalli VV, Kumar D, Maheshwari N, Gorsi U, Kaman L, Savlania A. Coarctation of the aorta in a young female treated with left subclavian artery to descending thoracic aorta bypass: a case report. J Vasc Bras 2023; 21:e20220018. [PMID: 36660101 PMCID: PMC9844980 DOI: 10.1590/1677-5449.202200182] [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: 02/13/2022] [Accepted: 07/22/2022] [Indexed: 01/15/2023] Open
Abstract
Coarctation of the aorta is a rare congenital abnormality, with an incidence of 6-8% of all congenital heart problems. It is usually diagnosed in childhood during routine clinical examination and adults mostly present with hypertension. Various investigations like transthoracic echocardiography, computed tomography, and magnetic resonance angiography can help with diagnosis. Prognosis depends on age at presentation and the severity of coarctation. Treatment options available are open and endovascular repair. Extra-anatomical bypass is the preferred option in cases with unfavorable anatomy. Long term follow up is required post repair due to risk of restenosis and aneurysm formation. Here is a case in which a young female presented with hypertension, was diagnosed with coarctation of the aorta, and was treated a left subclavian artery to descending thoracic aorta bypass. Her postoperative course was uneventful and she had improvement in hypertension.
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Affiliation(s)
- Kishore Abuji
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | | | - Deepak Kumar
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Naveen Maheshwari
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Ujjwal Gorsi
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Lileswar Kaman
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Ajay Savlania
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
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Nolte D, Bertoglio C. Inverse problems in blood flow modeling: A review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3613. [PMID: 35526113 PMCID: PMC9541505 DOI: 10.1002/cnm.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Mathematical and computational modeling of the cardiovascular system is increasingly providing non-invasive alternatives to traditional invasive clinical procedures. Moreover, it has the potential for generating additional diagnostic markers. In blood flow computations, the personalization of spatially distributed (i.e., 3D) models is a key step which relies on the formulation and numerical solution of inverse problems using clinical data, typically medical images for measuring both anatomy and function of the vasculature. In the last years, the development and application of inverse methods has rapidly expanded most likely due to the increased availability of data in clinical centers and the growing interest of modelers and clinicians in collaborating. Therefore, this work aims to provide a wide and comparative overview of literature within the last decade. We review the current state of the art of inverse problems in blood flows, focusing on studies considering fully dimensional fluid and fluid-solid models. The relevant physical models and hemodynamic measurement techniques are introduced, followed by a survey of mathematical data assimilation approaches used to solve different kinds of inverse problems, namely state and parameter estimation. An exhaustive discussion of the literature of the last decade is presented, structured by types of problems, models and available data.
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Affiliation(s)
- David Nolte
- Bernoulli InstituteUniversity of GroningenGroningenThe Netherlands
- Center for Mathematical ModelingUniversidad de ChileSantiagoChile
- Department of Fluid DynamicsTechnische Universität BerlinBerlinGermany
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Simultaneous interventional therapy for coarctation of the aorta combined with intracristal ventricular septal defect in older age adult. J Geriatr Cardiol 2022; 19:481-484. [PMID: 35845156 PMCID: PMC9248280 DOI: 10.11909/j.issn.1671-5411.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Miller SM, Madueme PC, Wearden PD, Nelson JS. Aortic arch atresia in Williams syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101510] [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: 10/18/2022]
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10
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Yang H, Wang H, Li Z, Yan J, Song YE, Zeng H, He X, Li R, Wang DW. Aortic Coarctation Associated With Hypertrophic Cardiomyopathy in a Woman With Hypertension and Syncope: A Case Report With 8-Year Follow-Up. Front Cardiovasc Med 2022; 8:818884. [PMID: 35146008 PMCID: PMC8821647 DOI: 10.3389/fcvm.2021.818884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation with aortic narrowing in the region of the ligamentum arteriosum. Hypertrophic cardiomyopathy (HCM) is a primary cardiomyopathy that is characterized by left ventricular wall thickening and likely left ventricular outflow tract (LVOT) obstruction. They are two irrelevant diseases, and their coexistence has not been reported before. Here, we described a young female patient who concurrently has CoA and HCM. Case Presentation The patient has had hypertension since 18-years old and complained of chest discomfort on effort and fatigue thereafter. Initially, she was diagnosed as having hypertrophic cardiomyopathy and primary hypertension. The presence of CoA was not found until she was 35 years old when she had an onset of paroxysmal supraventricular tachycardia (PSVT) and presented with syncope. Failure of the ablation procedure via the femoral artery revealed the possibility of CoA and PDA that was confirmed by aortic CTA and angiography. CoA was then treated successfully with a covered stent, and the symptoms of the patient improved remarkably. Additionally, the patient had typical imaging features of HCM, and two novel HCM-causing heterozygous mutations were identified by genetic testing, DSP-encoding desmoplakin, and MYBPC3-encoding myosin-binding protein C. The HCM was suspected to be contributing to the clinical presentations of the patient and challenged the timely diagnosis of CoA. The 8-year follow-up on aortic CTA and angiography revealed no stent graft-related complications. Moreover, no changes in HCM-related imaging features were found in the follow-up echocardiography 8 years after the correction of aortic coarctation, which strengthened the diagnosis of HCM. Conclusion Here, we reported the diagnostic challenges, management, and 8-yeasr follow-up findings in a rare case of CoA combined with HCM. The case highlighted the importance for physicians to exclude CoA in young hypertensive patients, and proved the efficacy of stent repair in treating CoA in older patients.
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Takayama H, Patel VI, Willey JZ. Stroke and Other Vascular Syndromes of the Spinal Cord. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Arora H, Vidya PL, Ghosh A, Mishra S, Shouche S, Sethi B, Mishra S, Nagi G. Midterm safety and outcome of balloon angioplasty of native aortic coarctation in neonates and young infants and initial experience of prepartial dilatation using high-pressure noncompliant balloon. Ann Pediatr Cardiol 2022; 15:121-127. [PMID: 36246746 PMCID: PMC9564400 DOI: 10.4103/apc.apc_197_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications. Aim: This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon. Materials and Methods: Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all. Results: A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34–80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A (P < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients (P < 0.001), in those with borderline/mildly hypoplastic arch (P = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg (P = 0.02). Median time to re-coarctation was significantly delayed in Group B (P < 0.001). There were no major complications or mortality in either group. Conclusions: BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.
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Zhang W, Xing W, Zhu M, Zhong X, He J. Interventional treatment for acute cerebral infarction with large vessel occlusion combined with aortic arch interruption: A case report. Medicine (Baltimore) 2021; 100:e27879. [PMID: 34797332 PMCID: PMC8601316 DOI: 10.1097/md.0000000000027879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Aortic arch interruption is a type of congenital vascular malformation that is often observed in childhood. Most children die of congestive heart failure due to rapid deterioration. Children can only survive to adulthood if they have extremely rich collateral circulation. Cases of acute cerebral infarction with large vessel occlusion receiving interventional treatment in adult patients with interrupted aortic arch have not been reported. PATIENT CONCERNS A 55-year-old man with a history of atrial fibrillation and smoking but without a family history of stroke was admitted to our hospital with a 5-hour history of left limb weakness and speech difficulties. DIAGNOSES Emergency brain computed tomography showed a large cerebral infarction in the right frontal temporal parietal lobe. He was suspected to have aortic arch interruption in the early stage of endovascular interventional therapy through the femoral artery approach, and was converted to the transradial artery pathway. The aortic arch was disconnected, and the right internal carotid artery was occluded. INTERVENTIONS Considering the possibility of cardiogenic embolism, a middle catheter was used for thrombus aspiration of the right internal carotid artery. After removal of the dark red thrombus was removed, the right internal carotid artery was successfully recanalized. OUTCOMES The patient recovered well after the operation. However, the patient and his family refused further treatment for aortic arch interruption. The modified Rankin Scale score was 0 at 3 months and 1 year of follow-up which meant that he recovered quite well. LESSONS Adult patients with acute cerebral infarction with large vessel occlusion are rarely complicated with aortic arch interruption, and emergency thrombectomy via the radial artery approach is feasible.
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Hayes D, French B, Tan SL. Objective Improvement in Cognitive Function following Aortic Coarctation Repair in an Adult. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:33-34. [PMID: 34607382 PMCID: PMC8489994 DOI: 10.1055/s-0041-1724004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Coarctation of the aorta is a rare finding in adults and can present with vague symptoms. We report a case of a 64-year-old cognitively impaired female who presented with fatigue and tinnitus. After extensive workup, she was diagnosed with coarctation of the aorta and subsequently underwent repair. After operative intervention for her coarctation, her cognitive impairment was found to have an objective improvement evidenced by the Montreal Cognitive Assessment.
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Affiliation(s)
- Danielle Hayes
- Department of General Surgery, Swedish Medical Center, Seattle, Washington
| | - Bryce French
- Department of General Surgery, Swedish Medical Center, Seattle, Washington
| | - Swee Lian Tan
- Department of Vascular Surgery, Virginia Mason, Seattle, Washington
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Harrington B, McPherson I, Bayliss C, Barnard S, McCaslin J, Williams R, Booth K. Using an Endovascular Strategy in the Open Setting: The Challenges of Hybrid Repair Using Frozen Elephant Trunk in an Extensively Dilated Aorta Associated with Coarctation. AORTA 2021; 9:190-192. [PMID: 34879401 PMCID: PMC8654517 DOI: 10.1055/s-0041-1732398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With both stenosis and aneurysm, repairing a severely tortuous and coarcted aorta can present certain difficulties. The advent of hybrid arch frozen elephant trunk techniques, as well as other endovascular solutions, has produced safer surgical repair methods for such cases. We present the reconstruction and repair of a Type-1 thoracoabdominal aortic aneurysm using a staged approach in less-than-optimal anatomy. Interventions included hybrid frozen elephant trunk, balloon dilation, and thoracic endovascular repair.
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Affiliation(s)
- Bertram Harrington
- Newcastle University Medical School, Framlington Place, Newcastle-upon-Tyne, United Kingdom
| | - Iain McPherson
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Christopher Bayliss
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Sion Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - James McCaslin
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Robin Williams
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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Hsue W, Sharpe AN, Darling SL, Visser LC, Choi E, Stern JA. Aorto-left atrial fistula secondary to infective aortic endocarditis and endarteritis in a cat with valvular aortic stenosis. J Vet Cardiol 2021; 35:101-107. [PMID: 33906113 DOI: 10.1016/j.jvc.2021.03.007] [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: 01/01/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
A cat previously diagnosed with valvular aortic stenosis developed acute respiratory distress. A new continuous heart murmur was noted on physical exam. Echocardiographic examination revealed vegetative lesions on the aortic valve and continuously shunting blood flow from the aorta into the left atrium. Despite initial treatment for left-sided congestive heart failure, the cat died suddenly. In addition to confirming aortic valve endocarditis and an acquired aorto-left atrial shunt, pathological examination identified vegetative lesions on the luminal surface of the ascending aorta. Although antemortem aerobic blood culture, 16s bacterial ribosomal DNA PCR, and Bartonella PCR failed to identify causative organisms, Escherichia coli was identified on postmortem tissue culture of the aortic lesion. This represented a unique case of primary valvular aortic stenosis with secondary infective aortic endocarditis, infective aortic endarteritis, and aorto-left atrial fistula in a cat. It highlighted potential adverse outcomes of aortic stenosis that are more commonly recognized in humans and dogs.
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Affiliation(s)
- W Hsue
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA.
| | - A N Sharpe
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA
| | - S L Darling
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA
| | - L C Visser
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA
| | - E Choi
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA
| | - J A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA
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17
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Rajbanshi BG, Acharya A, Neupane P, Gautam M, Sharma A, Kayastha B, Ghimire RK, Sharma R, Joshi LN. Double Aortic Arch with Coarctation of Aorta in an Adolescent: Unraveling the Vascular Ring. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 8:169-171. [PMID: 33761563 PMCID: PMC8043805 DOI: 10.1055/s-0040-1721746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We report the case of a 12-year-old girl with balanced double aortic arch with coarctation of the aorta presenting with symptoms of respiratory and swallowing difficulty. On investigation, the patient had a double aortic arch with coarctation and clinically nonsignificant disease in the infrarenal aorta. Division of the nondominant aortic arch was done through a left thoracotomy, along with resection of the coarctation segment and placement of an interposition Dacron tube graft.
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Affiliation(s)
- Bijoy G Rajbanshi
- Department of Cardiothoracic and Vascular Surgery, Nepal Mediciti, Lalitpur, Nepal
| | - Anil Acharya
- Department of Cardiothoracic and Vascular Surgery, Nepal Mediciti, Lalitpur, Nepal
| | | | - Milan Gautam
- Department of Cardiology, Nepal Mediciti, Lalitpur, Nepal
| | - Apurb Sharma
- Department of Anesthesiology, Nepal Mediciti, Lalitpur, Nepal
| | | | - Ram K Ghimire
- Department of Radiology, Nepal Mediciti, Lalitpur, Nepal
| | - Ranjit Sharma
- Department of Cardiology, Nepal Mediciti, Lalitpur, Nepal
| | - Lava N Joshi
- Department of Cardiology, Nepal Mediciti, Lalitpur, Nepal
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18
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Qin K, Yang J, Tang M, Iroegbu CD, Hu S, Fan C. Delayed Therapy of Descending Aortic Coarctation Results in Anterior Cerebral Rupture: A Case Report. Front Pediatr 2021; 9:654705. [PMID: 34671581 PMCID: PMC8522551 DOI: 10.3389/fped.2021.654705] [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] [Received: 01/17/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Coarctation of the aorta (CoA) is the congenital constriction or narrowing of the aortic lumen. These constrictions are primarily located in the descending aorta causing significant discrepancies in systolic blood pressures of the upper and lower extremities. Thus, a delay in diagnosis and treatment may lead to severe and adverse consequences. Case presentation: Herein, we present a 13-year-old boy with anterior cerebral rupture following a delayed diagnosis for descending CoA. Percutaneous transluminal balloon dilatation and endovascular stent implantation were urgently and successfully performed alongside cerebral clipping of the vascular aneurysm. Conclusion: An early diagnosis is crucial for CoA's successful treatment and management to prevent complications, including anterior cerebral rupture.
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Affiliation(s)
- Kele Qin
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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19
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Mikami T, Kamada T, Uchiyama H, Kuroda Y, Harada R, Naraoka S, Kawaharada N. A rare case of pseudoaneurysm at the site of untreated coarctation of the aorta in an adult patient. Gen Thorac Cardiovasc Surg 2020; 69:740-743. [PMID: 33111217 PMCID: PMC7981309 DOI: 10.1007/s11748-020-01525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022]
Abstract
Here we report a rare case of pseudoaneurysm at the site of aortic coarctation. Aortic coarctation and a saccular aortic aneurysm protruding from the site of this coarctation were detected in a 50-year-old woman. Owing to the shape of the aneurysm and high risk of rupture, an open surgical repair was performed. The pathological findings of the removed aneurysm revealed a pseudoaneurysm consisting of only a thin adventitial wall. Adult uncorrected aortic coarctation has a poor prognosis. One of its causes may be the formation of such a pseudoaneurysm.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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20
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Aslan S, Mass P, Loke YH, Warburton L, Liu X, Hibino N, Olivieri L, Krieger A. Non-invasive Prediction of Peak Systolic Pressure Drop across Coarctation of Aorta using Computational Fluid Dynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2295-2298. [PMID: 33018466 DOI: 10.1109/embc44109.2020.9176461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper proposes a novel method to noninvasively measure the peak systolic pressure difference (PSPD) across coarctation of the aorta for diagnosing the severity of coarctation. Traditional non-invasive estimates of pressure drop from the ultrasound can underestimate the severity and invasive measurements by cardiac catheterization can carry risks for patients. To address the issues, we employ computational fluid dynamics (CFD) computation to accurately predict the PSPD across a coarctation based on cardiac magnetic resonance (CMR) imaging data and cuff pressure measurements from one arm. The boundary conditions of a patient-specific aorta model are specified at the inlet of the ascending aorta by using the time-dependent blood velocity, and the outlets of descending aorta and supra aortic branches by using a 3-element Windkessel model. To estimate the parameters of the Windkessel model, steady flow simulations were performed using the time-averaged flow rates in the ascending aorta, descending aorta, and two of the three supra aortic branches. The mean cuff pressure from one arm was specified at the outlet of one of the supra aortic branches. The CFD predicted PSPDs of 5 patients (n=5) were compared with the invasively measured pressure drops obtained by catheterization. The PSPDs were accurately predicted (mean µ=0.3mmHg, standard deviation σ =4.3mmHg) in coarctation of the aorta using completely non-invasive flow and cuff pressure data. The results of our study indicate that the proposed method could potentially replace invasive measurements for estimating the severity of coarctations.Clinical relevance-Peak systolic pressure drop is an indicator of the severity of coarctation of the aorta. It can be predicted without any additional risks to patients using non-invasive cuff pressure and flow data from CMR.
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21
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Abstract
Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and lifelong surveillance to identify long-term complications.
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Affiliation(s)
- Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Lauren Andrade
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen C Cook
- Adult Congenital Heart Disease Program, Congenital Heart Center, Helen DeVos Children's Hospital, Frederik Meijer Heart & Vascular Institute, Pediatrics and Human Development, Michigan State University, 25 Michigan Street NE Suite 4200, Grand Rapids, MI 49503, USA
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22
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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23
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Marlevi D, Ha H, Dillon-Murphy D, Fernandes JF, Fovargue D, Colarieti-Tosti M, Larsson M, Lamata P, Figueroa CA, Ebbers T, Nordsletten DA. Non-invasive estimation of relative pressure in turbulent flow using virtual work-energy. Med Image Anal 2020; 60:101627. [PMID: 31865280 DOI: 10.1016/j.media.2019.101627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/11/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
Vascular pressure differences are established risk markers for a number of cardiovascular diseases. Relative pressures are, however, often driven by turbulence-induced flow fluctuations, where conventional non-invasive methods may yield inaccurate results. Recently, we proposed a novel method for non-turbulent flows, νWERP, utilizing the concept of virtual work-energy to accurately probe relative pressure through complex branching vasculature. Here, we present an extension of this approach for turbulent flows: νWERP-t. We present a theoretical method derivation based on flow covariance, quantifying the impact of flow fluctuations on relative pressure. νWERP-t is tested on a set of in-vitro stenotic flow phantoms with data acquired by 4D flow MRI with six-directional flow encoding, as well as on a patient-specific in-silico model of an acute aortic dissection. Over all tests νWERP-t shows improved accuracy over alternative energy-based approaches, with excellent recovery of estimated relative pressures. In particular, the use of a guaranteed divergence-free virtual field improves accuracy in cases where turbulent flows skew the apparent divergence of the acquired field. With the original νWERP allowing for assessment of relative pressure into previously inaccessible vasculatures, the extended νWERP-t further enlarges the method's clinical scope, underlining its potential as a novel tool for assessing relative pressure in-vivo.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, 14152, Huddinge, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyds sjukhus, Mörbygårdsvägen, Danderyd, 18288, Sweden.
| | - Hojin Ha
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping Unversity, Linköping, SE-58185, Sweden; Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea.
| | - Desmond Dillon-Murphy
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom.
| | - Joao F Fernandes
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom.
| | - Daniel Fovargue
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom.
| | - Massimiliano Colarieti-Tosti
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, 14152, Huddinge, Sweden.
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Hälsovägen 11, 14152, Huddinge, Sweden.
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom.
| | - C Alberto Figueroa
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom; Department of Surgery and Biomedical Engineering, University of Michigan, 2800 Plymouth Rd, 48109, Ann Arbor, MI, USA.
| | - Tino Ebbers
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping Unversity, Linköping, SE-58185, Sweden.
| | - David A Nordsletten
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, SE1 7EH, United Kingdom; Department of Surgery and Biomedical Engineering, University of Michigan, 2800 Plymouth Rd, 48109, Ann Arbor, MI, USA
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24
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Williams T, Lluri G, Boyd EK, Kratzert WB. Perioperative Echocardiography in the Adult With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 34:1292-1308. [PMID: 32001150 DOI: 10.1053/j.jvca.2019.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
Survival of patients with congenital heart disease has significantly improved over the last 2 decades, confronting interventionalists, surgeons, anesthesiologists, cardiologists, and intensivists with often unfamiliar complex pathophysiology in the perioperative setting. Aside from cardiac catheterization, echocardiography has become the main imaging modality in the hospitalized adult with congenital heart disease. The great variety of congenital lesions and their prior surgical management challenges practitioners to generate optimal imaging, reporting, and interpretation of these complex anatomic structures. Standardization of echocardiographic studies can not only provide significant benefits in the surveillance of these patients, but also facilitate understanding of pathophysiologic mechanism and assist clinical management in the perioperative setting. Knowledge in obtaining and interpreting uniform imaging protocols is essential for the perioperative clinician. In this publication, the authors review current international consensus recommendations on echocardiographic imaging of adults with congenital heart disease and describe the fundamental components by specific lesion. The authors will emphasize key aspects pertinent to the clinical management when imaging these patients in the perioperative setting. The goal of this review is to familiarize the perioperative physician on how to structure and standardize echocardiographic image acquisition of congenital heart disease anatomy for optimal clinical management.
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Affiliation(s)
- Tiffany Williams
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gentian Lluri
- Ahmanson/UCLA ACHD Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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25
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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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26
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Shayan G, Shao J, Wang Y, Si L, Shen J, Chen Y, Liu B, Zheng Y. Management of cervical aortic arch complicated by multiple aneurysms. Interact Cardiovasc Thorac Surg 2019; 29:295–301. [PMID: 30903156 DOI: 10.1093/icvts/ivz087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cervical aortic arch with aneurysm formation is considered an extremely rare condition. Here, we summarize our experience in treating 8 patients. We validated extra-anatomic ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity without circulatory arrest as an alternative treatment for patients with a tortuous arch that was unsuitable for endovascular repair. METHODS From March 2015 to April 2018, 8 patients (7 women; median age 46 years) diagnosed with cervical aortic arch complicated with aneurysm formation were treated at Peking Union Medical College Hospital and the Affiliated Hospital of Qingdao University. After assessment of the anatomical characteristics, 4 patients underwent endovascular repair. Three patients with a tortuous aortic arch and saccular aneurysm formation between the left common carotid artery and the left subclavian artery were treated with an extra-anatomic ascending-to-infrarenal abdominal aorta bypass and aneurysm indwelling. One patient refused surgical intervention and is being followed up on a yearly basis at our outpatient clinic. No circulatory arrest was required during surgery. RESULTS No severe postoperative complications were observed during follow-up (6-36 months). Postoperative computed tomography angiography revealed patent blood flow in the prosthetic aortic graft bypass. No endoleak, migration or stenosis of the stent grafts was observed in patients following endovascular repair. The left subclavian artery was preserved in 3 patients. Follow-up computed tomography angiography revealed satisfactory postoperative results in all patients, with no signs of aortic dilation or coarctation. CONCLUSIONS Ascending-to-infrarenal abdominal aorta bypass through the retroperitoneal cavity is a safe and effective treatment for cervical aortic arch with a tortuous aorta complicated by aneurysm formation and coarctation.
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Affiliation(s)
- Gulidanna Shayan
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuewei Wang
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Loubin Si
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Junyue Shen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical Collage Hospital, Beijing, China
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27
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Nolte D, Bertoglio C. Reducing the impact of geometric errors in flow computations using velocity measurements. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3203. [PMID: 30932361 PMCID: PMC6619346 DOI: 10.1002/cnm.3203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/26/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
Numerical blood flow simulations are typically set up from anatomical medical images and calibrated using velocity measurements. However, the accuracy of the computational geometry itself is limited by the resolution of the anatomical image. We first show that applying standard no-slip boundary conditions on inaccurately extracted boundaries can cause large errors in the results, in particular the pressure gradient. In this work, we therefore propose to augment the flow model calibration by slip/transpiration boundary conditions, whose parameters are then estimated using velocity measurements. Numerical experiments show that this methodology can considerably improve the accuracy of the estimated pressure gradients and 3D velocity fields when the vessel geometry is uncertain.
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Affiliation(s)
- David Nolte
- Bernoulli InstituteUniversity of GroningenGroningenNetherlands
- Center of Mathematical ModelingUniversity of ChileSantiagoChile
| | - Cristóbal Bertoglio
- Bernoulli InstituteUniversity of GroningenGroningenNetherlands
- Center of Mathematical ModelingUniversity of ChileSantiagoChile
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28
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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: 0.4] [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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Williamson J. Echocardiogram reveals unexpected finding in the investigation of murmur in a hypertensive postpartum patient. SONOGRAPHY 2019. [DOI: 10.1002/sono.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marlevi D, Ruijsink B, Balmus M, Dillon-Murphy D, Fovargue D, Pushparajah K, Bertoglio C, Colarieti-Tosti M, Larsson M, Lamata P, Figueroa CA, Razavi R, Nordsletten DA. Estimation of Cardiovascular Relative Pressure Using Virtual Work-Energy. Sci Rep 2019; 9:1375. [PMID: 30718699 PMCID: PMC6362021 DOI: 10.1038/s41598-018-37714-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022] Open
Abstract
Many cardiovascular diseases lead to local increases in relative pressure, reflecting the higher costs of driving blood flow. The utility of this biomarker for stratifying the severity of disease has thus driven the development of methods to measure these relative pressures. While intravascular catheterisation remains the most direct measure, its invasiveness limits clinical application in many instances. Non-invasive Doppler ultrasound estimates have partially addressed this gap; however only provide relative pressure estimates for a range of constricted cardiovascular conditions. Here we introduce a non-invasive method that enables arbitrary interrogation of relative pressures throughout an imaged vascular structure, leveraging modern phase contrast magnetic resonance imaging, the virtual work-energy equations, and a virtual field to provide robust and accurate estimates. The versatility and accuracy of the method is verified in a set of complex patient-specific cardiovascular models, where relative pressures into previously inaccessible flow regions are assessed. The method is further validated within a cohort of congenital heart disease patients, providing a novel tool for probing relative pressures in-vivo.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Maximilian Balmus
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Desmond Dillon-Murphy
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Daniel Fovargue
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, The Netherlands
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
| | - Massimiliano Colarieti-Tosti
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - C Alberto Figueroa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - David A Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom.
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Fox EB, Latham GJ, Ross FJ, Joffe D. Perioperative and Anesthetic Management of Coarctation of the Aorta. Semin Cardiothorac Vasc Anesth 2019; 23:212-224. [PMID: 30614372 DOI: 10.1177/1089253218821953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated coarctation of the aorta is a relatively common form of congenital heart disease that is characterized by variable degrees of obstruction to aortic outflow. The clinical presentation varies from asymptomatic arterial hypertension to cardiogenic shock. The treatment options include surgical repair or interventional therapy with aortic balloon dilation and stent placement. This article will summarize the pathophysiology as well as describe the surgical and interventional procedures. The anesthetic management for those interventions will be reviewed.
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Affiliation(s)
- Eric B Fox
- 1 Seattle Children's Hospital, Seattle, WA, USA
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Abstract
Congenital heart disease (CHD) is the most common birth defect, occurring in approximately 0.8% to 1.0% of neonates. Advances in medical and surgical therapies for children with CHD have resulted in a growing population of patients reaching adulthood, with survival rates exceeding 85%. Many of these patients, especially if managed inappropriately, face the prospect of future complications including heart failure and premature death. For adults with uncorrected or previously palliated CHD, percutaneous therapies have become the primary treatment for many forms of CHD. In this article, we discuss the role of transcatheter interventions in the treatment of adults with CHD.
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Affiliation(s)
- Hussam S Suradi
- Interventional Cardiology, Structural Heart & Valve Center, St. Mary Medical Center, 1500 South Lake Park Avenue, Suite 100, Hobart, IN 46342, USA; Department of Cardiology, Community Hospital, Munster, IN 46321, USA; Rush Center for Structural Heart Disease, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Ziyad M Hijazi
- Sidra Cardiac Program, Department of Pediatrics, Sidra Medical & Research Center, Weill Cornell Medicine, PO Box 26999, Doha, Qatar
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Pericas P, Noris Mora M, Fernández-Palomeque C, Massot Rubio M, Grau Sepulveda A, Peral Disdier V. Aortic coarctation endarteritis: The importance of a systematic echocardiographic study. J Cardiol Cases 2018; 17:56-58. [PMID: 30279855 DOI: 10.1016/j.jccase.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/01/2017] [Accepted: 09/18/2017] [Indexed: 11/17/2022] Open
Abstract
Aortic coarctation determines a favorable anatomical condition for the development of endocarditis-endarteritis due to the presence of an alteration in blood flow dynamics that favors the appearance of endothelial damage and the adhesion of microorganisms. At present, endarteritis of aortic coarctation is a rare entity due to early detection and surgical treatment of patient carriers of aortic coarctation. We present a case of a patient affected with a previously unknown aortic coarctation, who developed infective endarteritis with secondary formation of mycotic aneurysm. The echocardiography techniques proved determinant in establishing the diagnosis of aortic coarctation, as well as the associated infectious complications. <Learning objectives: In this paper we show an infrequent case of vascular infection nowadays, as a complication of a congenital heart disease. Physical examination and echocardiography were clues for an early diagnosis, and should emphasize the performance of a complete echocardiography that includes the suprasternal view.>.
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Affiliation(s)
- Pere Pericas
- Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Noris Mora
- Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Montse Massot Rubio
- Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Andrés Grau Sepulveda
- Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Vicente Peral Disdier
- Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Murakami T. Enhanced Aortic Pressure Wave Reflection in Patients with Aortic Coarctation after Aortic Arch Repair. Pulse (Basel) 2018; 5:82-87. [PMID: 29761081 DOI: 10.1159/000478530] [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] [Received: 05/02/2017] [Revised: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background In patients with aortic coarctation after successful aortic arch repair, it is well known that early-onset cardiovascular diseases can develop. Summary We studied the pressure waveform in patients after aortic arch repair focusing on a pressure wave reflection. In patients after aortic arch repair, the repaired portion generates a new reflected pressure wave. As a result, the newly generated pressure wave causes aortic pressure augmentation, loss of pressure amplification, and left ventricular hypertrophy with fibrosis. Balloon dilatation of the aortic arch may also generate a new pressure wave reflection. Key Messages In patients with aortic coarctation after aortic arch repair, the reconstructed site generates a new pressure wave reflection. This could be one of the causes of their future cardiovascular diseases.
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Affiliation(s)
- Tomoaki Murakami
- Department of Cardiology, Chiba Children's Hospital, Chiba, Japan
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36
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Wani Z, Tiwari D, Gehlot R, Kumar D, Chhabra S, Sharma M. A rare case of acyanotic congenital heart disease, large patent ductus arteriosus with pre-ductal coarctation of descending thoracic aorta with patent ductus arteriosus closure and extra anatomical bypass grafting. Ann Card Anaesth 2018; 20:365-368. [PMID: 28701609 PMCID: PMC5535585 DOI: 10.4103/aca.aca_46_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of 18-year-old female patient with large patent ductus arteriosus (PDA)-preductal coarctation of descending thoracic aorta. She underwent large PDA closure with a prosthetic graft from ascending aorta to descending thoracic aorta by mid-sternotomy on cardiopulmonary bypass machine under total hypothermic circulatory arrest.
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Affiliation(s)
- Zara Wani
- Department of Anaesthesia and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Deepak Tiwari
- Department of Anaesthesiology and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rajeev Gehlot
- Department of Anaesthesiology and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Deepak Kumar
- Department of Anaesthesiology and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sushil Chhabra
- Department of Anaesthesiology and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Meenaxi Sharma
- Department of Anaesthesia and Critical Care, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
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Bertoglio C, Nuñez R, Galarce F, Nordsletten D, Osses A. Relative pressure estimation from velocity measurements in blood flows: State-of-the-art and new approaches. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34. [PMID: 28884520 DOI: 10.1002/cnm.2925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 06/01/2017] [Accepted: 09/02/2017] [Indexed: 06/07/2023]
Abstract
The relative pressure difference across stenotic blood vessels serves as an important clinical index for the diagnosis of many cardiovascular diseases. While the clinical gold standard for relative pressure difference measurements is invasive catheterization, Phase-Contrast Magnetic Resonance Imaging has emerged as a promising tool for enabling a noninvasive quantification, by linking highly spatially resolved velocity measurements with relative pressures via the incompressible Navier-Stokes equations. In this work, we provide a review and analysis of current methods for relative pressure estimation and propose 3 additional techniques. Methods are compared using synthetic data from numerical examples, and sensitivity to subsampling and noise was explored. Through our analysis, we verify that the newly proposed approaches are more robust with respect to spatial subsampling and less sensitive to noise and therefore provide improved means for estimating relative pressure differences noninvasively.
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Affiliation(s)
- Cristóbal Bertoglio
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
- Johann Bernoulli Institute, University of Groningen, Groningen, The Netherlands
| | - Rodolfo Nuñez
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
| | - Felipe Galarce
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
- Civil Engineering School, Pontificia Universidad Católica de Valparaiso, Valparaiso, Chile
| | - David Nordsletten
- Department of Biomedical Engineering, King's College of London, London, UK
| | - Axel Osses
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
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Murakami T, Takeda A. Preserved Cardiac Blood Supply-Workload Balance in Pediatric Patients After Aortic Arch Repair. Pediatr Cardiol 2018; 39:294-298. [PMID: 29079985 DOI: 10.1007/s00246-017-1754-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/21/2017] [Indexed: 11/28/2022]
Abstract
One of the most important problems in patients with aortic coarctation after aortic arch repair is future cardiovascular disease. We have previously reported that the enhancement of aortic pressure wave reflection in patients could be one of the causes of future cardiovascular diseases, because it results in an increase of the left ventricular workload and is disadvantageous for coronary circulation. Seventeen patients who had undergone aortic arch repair without pressure gradient in their aortic arch were enrolled. An ascending aortic pressure waveform was recorded by a pressure-sensor-mounted catheter, and a subendocardial viability ratio, which measures cardiac blood supply-workload balance, was calculated. The values were compared with those in age-matched controls. The patients' mean age was 6.8 ± 2.8 years. The mean ascending aortic systolic pressure was higher (100.4 ± 12.9 vs. 90.2 ± 8.9 mmHg, p = 0.0011) and the pulse pressure was wider (38.1 ± 7.1 vs. 32.5 ± 5.4 mmHg, p = 0.0072) in patients than in control subjects. There was no difference in the mean subendocardial viability ratio (1.01 ± 0.25 vs. 1.01 ± 0.24, ns), while the mean tension time index (27.4 ± 5.6 vs. 23.0 ± 3.3, p = 0.0001) and diastolic pressure time index (28.4 ± 11.1 vs. 23.6 ± 8.0, p = 0.0082) were higher in patients than in controls. The cardiac blood supply-workload balance was preserved in patients after aortic arch repair, despite an increase in their cardiac workload.
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Affiliation(s)
- Tomoaki Murakami
- Department of Cardiology, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan.
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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39
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McClary AC, Sacks LD, Purohit PJ, Hussain E. Toddler With Hemoptysis. Clin Pediatr (Phila) 2018; 57:109-112. [PMID: 28084086 DOI: 10.1177/0009922816684618] [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: 11/16/2022]
Affiliation(s)
- Ashley C McClary
- 1 McDowell Pediatrics, Mission Children's, Marion, NC, USA.,2 Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Loren D Sacks
- 2 Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Prashant J Purohit
- 2 Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.,3 Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Elora Hussain
- 2 Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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Di Tommaso L, Mannacio VA, Di Tommaso E, Pinna GB, Fontana I, Iannelli G. Endovascular Treatment of Distal Aortic Arch Aneurysm Associated with Coarctation of Aorta in a Jehovah's Witness. Tex Heart Inst J 2017; 44:399-401. [PMID: 29276439 DOI: 10.14503/thij-16-6093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta. Our experience suggests that this procedure is a useful and safe alternative to open surgery in patients who have aneurysms associated with coarctation of the aorta.
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Chua CB, Hsu CW, Wu HY, Chang CS, Lee KH. Stanford type B aortic dissection in an elderly patient with silent aortic coarctation. Tzu Chi Med J 2017; 29:183-184. [PMID: 28974916 PMCID: PMC5616002 DOI: 10.4103/tcmj.tcmj_65_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Choon-Bing Chua
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Chih-Wei Hsu
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Hsuan-Yin Wu
- Division of Cardiovascular Surgery, Department of Surgery, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Chao-Sheng Chang
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Hsin Lee
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
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Makani S, Mitchell J, Metton O, Di Filippo S, Henaine R, Ninet J. Surgical repair of a pseudocoarctation with cervical aortic arch complicated by multiple aneurysms of the aorta: a case report. Pan Afr Med J 2017; 26:236. [PMID: 28690750 PMCID: PMC5491740 DOI: 10.11604/pamj.2017.26.236.11800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 11/11/2022] Open
Abstract
Aortic pseudocoarctation is a rare congenital anomaly characterized by elongation and deformity of the aortic arch and is known to be associated with aneurysmal formation. Several studies unite to say it leads to a surgical sanction as soon as symptomatic or associated with aneurysms of the aortic arch. Our patient is a 12 years old boy, followed since birth for a little tight pseudocoarctation with a cervical aortic arch and transverse aortic arch hypoplasia. Close clinical and paraclinical monitoring including angioscans, showed the gradual enlargement of the superior mediastinum, in relation with the appearance of three aneurysms of the aortic arch. The intervention, performed by sternotomy, has consisted of the resection of the aneurysmal area and the interposition of a Dacron tube to repair the aortic arch and the reimplantation of the left subclavian artery into the left carotid artery. The postoperative course was uneventful. Management of pseudocoarctation associated with cervical aortic arch and aneurysms remains surgical. Close monitoring of patients with pseudocorctation, seems to be essential to avoid fatal complications such as aneurysmal rupture.
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Affiliation(s)
- Said Makani
- Department of Cardiovascular and Congenital Surgery, Louis Pradel Hospital, Bron, Lyon, France
| | - Julia Mitchell
- Department of Cardiovascular and Congenital Surgery, Louis Pradel Hospital, Bron, Lyon, France
| | - Olivier Metton
- Department of Cardiovascular and Congenital Surgery, Louis Pradel Hospital, Bron, Lyon, France
| | - Sylvie Di Filippo
- Department of Paediatric and Congenital Cardiology, Louis Pradel Hospital, Bron, Lyon, France
| | - Roland Henaine
- Department of Cardiovascular and Congenital Surgery, Louis Pradel Hospital, Bron, Lyon, France
| | - Jean Ninet
- Department of Cardiovascular and Congenital Surgery, Louis Pradel Hospital, Bron, Lyon, France
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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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Abstract
Techniques for repair of the aorta currently include open and endovascular methods, hybrid approaches, minimally-invasive techniques, and aortic branch vessel reimplantation or bypass. Collaboration among radiologists and vascular and cardiothoracic surgeons is essential. An awareness of the various surgical techniques, expected postoperative appearance, and potential complications is essential for radiologists. This review will cover the postoperative appearance of the thoracic aorta with a focus on the ascending aorta. The value of three-dimensional image evaluation will also be emphasized.
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46
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Loss of pulse pressure amplification between the ascending and descending aorta in patients after an aortic arch repair. J Hypertens 2017; 35:533-537. [DOI: 10.1097/hjh.0000000000001190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jashari H, Lannering K, Mellander M, Ibrahimi P, Rydberg A, Henein MY. Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates. CONGENIT HEART DIS 2016; 12:218-225. [DOI: 10.1111/chd.12430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Katarina Lannering
- Department of Pediatric Cardiology; Queen Silvia Children's Hospital, Sahlgrenska University Hospital; Göteborg Sweden
| | - Mats Mellander
- Department of Pediatric Cardiology; Queen Silvia Children's Hospital, Sahlgrenska University Hospital; Göteborg Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Annika Rydberg
- Department of Clinical Sciences; Umeå University; Umeå Sweden
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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Raissadati A, Nieminen H, Haukka J, Sairanen H, Jokinen E. Late Causes of Death After Pediatric Cardiac Surgery. J Am Coll Cardiol 2016; 68:487-498. [DOI: 10.1016/j.jacc.2016.05.038] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/10/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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Galiñanes EL, Krajcer Z. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly. AORTA (STAMFORD, CONN.) 2016. [PMID: 27069944 DOI: 10.12945/j.aorta.2015.14-049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Concomitant percutaneous treatment of aortic coarctation and associated intercostal aneurysms: pre-procedural recognition is key. Cardiol Young 2016; 26:390-5. [PMID: 26089120 DOI: 10.1017/s104795111500116x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intercostal aneurysms are associated with aortic coarctation. Their aetiology is not well-understood but may be related to intrinsic vascular pathology and altered flow dynamics through the intercostal artery. We present the cases of two patients with coarctation and intercostal aneurysms. The aneurysms were recognised on pre-catheterisation imaging studies and were selectively occluded during the same procedure to treat the coarctation. There were no complications; both the patients have no residual coarctation at the most recent follow-up. Intercostal aneurysms associated with coarctation can have significant consequences including late rupture, paralysis, and even death. These aneurysms are common with an incidence of up to 40% with adult-diagnosed coarctation; one treatment plan is to treat both the coarctation and aneurysm during a single catheterisation. Pre-catheterisation CT or MRI may play a role in this strategy.
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