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Yang ZX, Han Y, Zhang J, Yu YH, Zhu M. A Case of Postnatal Aortic Arch Atresia. J Inflamm Res 2023; 16:4265-4270. [PMID: 37791118 PMCID: PMC10543475 DOI: 10.2147/jir.s428231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
Background Aortic arch atresia is a rare congenital cardiac defect that may occur after birth. Pregnant women with gestational diabetes mellitus may increase the risk of aortic arch atresia in newborns after birth. Case Description A 16-day-old infant was referred to our hospital on the 15th postnatal day after an interrupted or atretic aortic arch was discovered. No obvious abnormality was detected in the infant during the prenatal ultrasound. Laboratory tests showed elevated inflammatory marker levels. Transthoracic echocardiography showed stenosis of the transverse arch of the aorta and a blind end at the distal end of the left subclavian artery. During surgery, it was found that the isthmus of the aorta was uninterrupted but completely occluded due to inflammation. Conclusion This case demonstrates that type A interrupted aortic arch and coarctation of the aorta can be acquired after birth, and if coarctation of the aorta is complicated by inflammation or if the pregnant women have gestational diabetes mellitus, it can result in aortic arch atresia as the patient's condition worsens. It is advised to consider aortic arch atresia when imaging reveals type A interrupted aortic arch.
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Affiliation(s)
- Zi-Xin Yang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Ying Han
- Department of Ultrasound, Zaozhuang Maternity and Child Health Care, Zaozhuang, Shandong, 277102, People’s Republic of China
| | - Jie Zhang
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Mei Zhu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
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Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults. Cardiol Young 2023; 33:354-361. [PMID: 36259152 DOI: 10.1017/s1047951122003237] [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] [Indexed: 11/07/2022]
Abstract
We report our experience and early outcomes of using the BeGraft aortic stent in children, adolescents, and young adults. BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) requires a smaller long sheath compared to other covered stents, and it has a low profile and adequate radial power. With these features, it can overcome some limitations in the treatment of coarctation, especially in children. This is a single centre retrospective analysis of 11 implanted BeGraft aortic stents in coarctation of the aorta between July 2020 and November 2021. The eleven stents were successfully implanted in 11 patients (10 males). The median age of the patients was 13.7 years (interquartile range 12-16 years), and the median weight was 43 kg (interquartile range 35-62 kg). In five patients, after the stents were opened completely by the first balloon, they were exchanged with a Z-MED II™ balloon, 1-3 mm larger in diameter, and the stents were redilated. The median catheter-derived systolic peak-to-peak pressure gradient was 23 mm Hg (interquartile range 16-37 mmHg) before the procedure and 3 mm Hg (interquartile range 1-5 mm Hg) after the procedure. Except for the partial femoral artery thrombosis in two patients, no other procedural complications were observed in our study. The median follow-up duration was 5 months (interquartile range 2-12 months). During follow-up, only one patient (9%) had stent narrowing that required dilation. Our initial results and short-term follow-up showed that the BeGraft aortic stent implantation and redilation can be performed effectively, safely, and successfully in the treatment of coarctation of the aorta.
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Ramachandran A, Argilla M, Saharan S, Halpern D, Small A. Short-Segment Type B Interrupted Aortic Arch Presenting With Subarachnoid Hemorrhage With Subsequent Primary Percutaneous Repair. JACC Case Rep 2021; 3:1607-1609. [PMID: 34729511 PMCID: PMC8543161 DOI: 10.1016/j.jaccas.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022]
Abstract
This report describes a young adult man presenting with subarachnoid hemorrhage secondary to an intracranial aneurysm who was found to have a short-segment type B interrupted aortic arch. We describe the clinical presentation, evaluation, and management of this patient and highlight imaging findings and percutaneous repair of the aneurysm and interrupted aortic arch. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Abhinay Ramachandran
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael Argilla
- Division of Pediatric Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA
| | - Sunil Saharan
- Division of Pediatric Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dan Halpern
- Adult Congenital Heart Disease, Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam Small
- Adult Congenital Heart Disease, Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
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Goldstein BH, Kreutzer J. Transcatheter Intervention for Congenital Defects Involving the Great Vessels: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:80-96. [PMID: 33413945 DOI: 10.1016/j.jacc.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
Since the development of balloon angioplasty and balloon-expandable endovascular stent technology in the 1970s and 1980s, percutaneous transcatheter intervention has emerged as a mainstay of therapy for congenital heart disease (CHD) lesions throughout the systemic and pulmonary vascular beds. Congenital lesions of the great vessels, including the aorta, pulmonary arteries, and patent ductus arteriosus, are each amenable to transcatheter intervention throughout the lifespan, from neonate to adult. In many cases, on-label devices now exist to facilitate these therapies. In this review, we seek to describe the contemporary approach to and outcomes from transcatheter management of major CHD lesions of the great vessels, with a focus on coarctation of the aorta, single- or multiple-branch pulmonary artery stenoses, and persistent patent ductus arteriosus. We further comment on the future of transcatheter therapies for these CHD lesions.
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Affiliation(s)
- Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Kreutzer
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Chessa M, Favoccia C, Jha N, Carminati M, Fernandez Gonzalez L, Eicken A, Butera G, Ferreira Martins J, Pinto F, Tofeig M, Khan M. Long-term follow-up after recanalisation of aortic arch atresia. EUROINTERVENTION 2021; 16:e1274-e1280. [PMID: 31235456 PMCID: PMC9724876 DOI: 10.4244/eij-d-18-00857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Aortic arch atresia (AAA) is one of the rarest obstructive defects. The presence of this anomaly in adult age is uncommon. The typical anatomic feature consists of a complete occlusion of the membranous obstruction resulting in an acquired atresia without flow continuity between the proximal and distal segments. This feature is important in determining the feasibility of percutaneous intervention. The aim of the present study was to share long-term follow-up data of adult patients with AAA requiring percutaneous interventions for the management of this rare anomaly involving five different centres. METHODS AND RESULTS Retrospective data of 19 patients (12 males, 63.2%, mean age 32.2±18.9 years) diagnosed with AAA treated in five different centres between 1999 and 2017 were collected. All patients underwent percutaneous recanalisation by (1) radiofrequency (RF) system (five patients, 26.3%), (2) extra-stiff guidewire (12 patients, 63.2%), and (3) transseptal needle (two patients, 10.5%). All procedures were subsequently followed by covered stent implantation. Two patients developed complications during the procedure and one of them died. Over a median follow-up of 4.94 years, four (21%) patients were able to be weaned from medications for hypertension. All the patients underwent reassessment for recurrence or restenosis during the follow-up. Seven (36.8%) patients underwent successful stent dilatation with a balloon. After the intervention, one patient experienced a late complication; however, one patient died due to an unknown cause believed to be unrelated to the previous recanalisation procedure. CONCLUSIONS Percutaneous treatment of AAA is feasible with good long-term survival. This study reports the largest case series so far available in the literature.
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Affiliation(s)
- Massimo Chessa
- Pediatric and Adult Congenital Heart Centre, IRCCS, Policlinico San Donato Hospital, Via Morandi, 30, 20097 San Donato Milanese, Milan, Italy
| | - Carla Favoccia
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | - Neerod Jha
- Pediatric Cardiac Surgery Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | - Luis Fernandez Gonzalez
- Hospital Universitario de Cruces, Sección de Hemodinámica y Cardiología Intervencionista, Baracaldo, Vizcaya, Spain
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Gianfranco Butera
- Pediatric and Adult Congenital Heart Centre – IRCCS - Policlinico San Donato, Milan, Italy
| | | | - Fatima Pinto
- Pediatric Cardiology Department, Santa Marta Hospital, CHLC, Lisbon, Portugal
| | - Magdi Tofeig
- Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mohammad Khan
- Paediatric Cardiology & Adult Congenital Heart Diseases Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Initial experience with a novel ePTFE-covered balloon expandable stent in patients with near-atretic or severe aortic coarctation and small femoral arterial access. Cardiol Young 2021; 31:224-228. [PMID: 33172512 DOI: 10.1017/s1047951120003728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We report our experience of using the Bentley BeGraft Aortic stent in patients with severe or near-atretic aortic coarctation and small femoral arterial access. BACKGROUND Use of covered stent is recommended in some settings such as aortic coarctation with associated aneurysm, Turner syndrome, and coarctation with aortic atresia. However, currently available covered stents need larger sheaths that may limit their use in children and patients with smaller arterial access. Newer stents may overcome this limitation. METHODS Single-centre retrospective study of patients with severe or near-atretic aortic coarctation and small femoral arterial access. RESULTS Between July and October, 2019, five patients (median age 15 years) with near-atretic or severe coarctation were treated with a Bentley BeGraft Aortic stent. Long sheaths between 9 and 11 Fr were used to implant stents, which were dilated up to 12-16 mm. None of the patients had residual coarctation (gradient >20 mm of mercury) after stenting. None of the patients developed acute vascular injuries or local access related complications at the end of the procedure or during follow-up (range 6-10 months). CONCLUSIONS Bentley BeGraft aortic stents are important to consider in patients with severe coarctation and provided acute procedural success in patients with small femoral arterial access and widen the applicability in this patient population.
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Electrification of a Guidewire to Assist in Crossing an Aortic Coarctation (The BEACON Technique). Am J Cardiol 2020; 125:153-156. [PMID: 31699361 DOI: 10.1016/j.amjcard.2019.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
Aortic coarctation presents in adult life in a significant number of patients. The preferred treatment in this age group is percutaneous stent implantation without which life expectancy is reduced due to the complications of uncontrolled hypertension. We present the first case of an "uncrossable" aortic coarctation transversed using the BEACON (Brief Electrification of a guidewire to assist in crossing an Aortic CoarctatiON) technique, a novel approach incorporating the electrification of a guidewire. It requires standard transcaval equipment and techniques but crosses from aortic lumen-to-lumen instead of cava-to-aorta, thus creating a rail for successful stent delivery.
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A Double Lane for a Better Circulation: Percutaneous Duplication of the Thoracic Aorta in a Child. Cardiovasc Intervent Radiol 2018; 41:968-971. [DOI: 10.1007/s00270-018-1913-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
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Fernández González L, García San Román K, Blanco Mata R, Arriola Meabe J, Astorga Burgo JC, Alcibar Villa J. Percutaneous Stent Placement to Treat Coarctation of Aorta Due to Atresia in Adult Patients. ACTA ACUST UNITED AC 2016; 69:1109-1111. [PMID: 27522278 DOI: 10.1016/j.rec.2016.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Luis Fernández González
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain.
| | - Koldobika García San Román
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - Roberto Blanco Mata
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - Josune Arriola Meabe
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - Juan Carlos Astorga Burgo
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
| | - Juan Alcibar Villa
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, Spain
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