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Egunov OA, Krivoshchekov EV, Cetta F, Sokolov AA, Sviazov EA, Shipulin VV. Surgery for aortic recoarctation in children less than 10 years old: A single-center experience in Siberia, Russia. J Card Surg 2022; 37:1627-1632. [PMID: 35315136 DOI: 10.1111/jocs.16435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 02/06/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persistence or recurrence of stenosis is a complication of initial coarctation repair. This study aims to report short-term outcomes of surgical management of recurrent coarctation and initial repair analysis. METHODS We retrospectively reviewed our experience with 51 patients undergoing recoarctation surgical repair between 2008 and 2019 using antegrade cerebral perfusion (ACP) technique. RESULTS Surgical correction included prosthetic patch aortoplasty in 23 (45%), resection with wide end-to-end anastomosis in 15 (29%), and a tube interposition graft in 13 (25%) patients. The median age at initial correction and reintervention was 12 months and 9 years. The median interval from primary repair to reintervention was 60 months. Initial repair analysis revealed 33% of patients had initial correction in the neonatal period, 72.5% of patients were done via a left thoracotomy approach and 63% of patients had end-to-end anastomosis at initial surgery. CONCLUSION Our study demonstrates that surgical repair of recurrent coarctation of the aorta using ACP technique can be performed safely and with excellent results.
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Affiliation(s)
- Oleg A Egunov
- Department of Cardiovascular Surgery , Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Evgeny V Krivoshchekov
- Department of Cardiovascular Surgery , Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Frank Cetta
- Department of Cardiovascular Diseases, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander A Sokolov
- Department of Cardiovascular Surgery , Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Evgenii A Sviazov
- Department of Cardiovascular Surgery , Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - Vladimir V Shipulin
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Tomsk, Russia
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Loneker AE, Luketich SK, Bernstein D, Kalra A, Nugent AW, D'Amore A, Faulk DM. Mechanical and microstructural analysis of a radially expandable vascular conduit for neonatal and pediatric cardiovascular surgery. J Biomed Mater Res B Appl Biomater 2017; 106:659-671. [PMID: 28296198 DOI: 10.1002/jbm.b.33874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/20/2017] [Accepted: 02/20/2017] [Indexed: 01/29/2023]
Abstract
In pediatric cardiovascular surgery, there is a significant need for vascular prostheses that have the potential to grow with the patient following implantation. Current clinical options consist of nonexpanding conduits, requiring repeat surgeries as the patient outgrows the device. To address this issue, PECA Labs has developed a novel ePTFE vascular conduit with the capability of being radially expanded via balloon catheterization. In the described study, a systematic characterization and comparison of two proprietary ePTFE expandable conduits was conducted. Conduit sizes of 8 and 16 mm inner diameters for both conduits were evaluated before and after expansion with a 26 mm balloon. Comprehensive mechanical testing was completed, including quantification of circumferential, and longitudinal tensile strength, suture retention strength, burst strength, water entry pressure, dynamic compliance, and kink radius. Scanning electron microscopy was used to investigate the microstructural properties. Automated extraction of the fiber architectural features for each scanning electron micrograph was achieved with an algorithm for each conduit before and after expansion. Results showed that both conduits were able to expand significantly, to as much as 2.5× their original inner diameter. All mechanical properties were within clinically acceptable values following expansion. Analysis of the microstructure properties of the conduits revealed that the circumferential main angle of orientation, orientation index, and spatial periodicity did not significantly change following expansion, whereas the node area fraction decreased post expansion. Successful proof-of-concept of this novel product represents a critical step toward clinical translation and provides hope for newborns and growing children with congenital heart disease. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 659-671, 2018.
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Affiliation(s)
- Abigail E Loneker
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania
| | - Samuel K Luketich
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania
| | | | - Arush Kalra
- PECA Labs, Pittsburgh, Penninsylvania, 15224
| | - Alan W Nugent
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Antonio D'Amore
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Penninsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania.,Department of Surgery, University of Pittsburgh, Pittsburgh, Penninsylvania.,School of Medicine, University of Pittsburgh, Pittsburgh, Penninsylvania.,RiMED Foundation, Palermo, Italy
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He L, Liu F, Wu L, Qi CH, Zhang LF, Huang GY. Percutaneous balloon angioplasty for severe native aortic coarctation in young infants less than 6 months: medium- to long-term follow-up. Chin Med J (Engl) 2015; 128:1021-5. [PMID: 25881593 PMCID: PMC4832939 DOI: 10.4103/0366-6999.155069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Although balloon angioplasty (BA) has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta (CoA) during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role of percutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods: The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient's weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results: The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient (PG) across the coarctation was 41.0 ± 16.0 mmHg (range 13–76 mmHg). The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm (range 0.5–2.8 mm). All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg (range 0–40 mmHg), and the diameter of coarctation significantly improved to 3.8 ± 0.9 mm (range 2.5–5.3 mm). No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year: (1) The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; (2) in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; (3) tricuspid regurgitation and pulmonary hypertension improved in all patients; (4) all patients were doing well and were asymptomatic. Conclusions: Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.
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Affiliation(s)
| | - Fang Liu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
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Adjagba PM, Hanna B, Miró J, Dancea A, Poirier N, Vobecky S, Déry J, Lapierre C, Dahdah N. Percutaneous angioplasty used to manage native and recurrent coarctation of the aorta in infants younger than 1 year: immediate and midterm results. Pediatr Cardiol 2014; 35:1155-61. [PMID: 24748038 DOI: 10.1007/s00246-014-0909-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
Balloon angioplasty (BAP) used to manage native coarctation of the aorta (CoAo) in infants remains controversial. This study aimed to compare short- and midterm results of BAP between native CoAo (NaCo) and postsurgical recoarctations (ReCo) in infants younger than 1 year. This retrospective study compared the clinical, echocardiographic, hemodynamic, and angiographic data for infants who underwent BAP between July 2003 and September 2012. The 12 NaCo and 13 ReCo patients in this study underwent BAP at 4.61 ± 3.69 and 4.88 ± 3.07 months (p = 0.84) and weighed 5.49 ± 2.57 and 6.10 ± 2.11 kg (p = 0.52), respectively. Their respective heights were 60.58 ± 10.58 and 61.15 ± 6.74 cm (p = 0.87). All the ReCo patients had their initial surgery before the age of 3 months. The minimal CoAo diameter was 2.81 ± 0.96 mm in the NaCo group and 2.86 ± 1.0 mm in the ReCo group (p = 0.90). The relative gradient reduction was 62.79 ± 32.43 % in the NaCo group and 73.37 ± 20.78 % in the ReCo group (p = 0.33). The in situ complication rate (pseudoaneurysm) was 8.33 % in the NaCo group and 7.69 % in the ReCo group (p = 0.74). During the early follow-up evaluation, five NaCo patients (41.66 %) presented with recoarctation requiring BAP reintervention within 1.75 ± 1.41 months (all had their initial BAP before 3 months of age) compared with 1 ReCo patient (7.69 %) (p = 0.165). The mean follow-up period was 3.09 ± 2.69 years for the NaCo patients and 3.6 ± 3.18 years for the ReCo patients (p = 0.69), during which the blood pressure gradient was 12.33 ± 9.67 for the NaCo patients and 7.80 ± 8.78 for the ReCo patients (p = 0.17), with corresponding Doppler peak instantaneous gradients of 21.29 ± 11.19 and 16.20 ± 10.23 (p = 0.24). The resultant diameter ratio between the minimal isthmus diameter and the aortic diameter at the diaphragmatic level was 0.81 ± 0.15 in the NaCo group and 0.85 ± 0.12 in the ReCo group (p = 0.53). The immediate and midterm results of BAP for the NaCo and ReCo infants were comparable. Accordingly, BAP seems to be an acceptable alternative to surgery for infants older than 3 months.
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Affiliation(s)
- Philippe Mahouna Adjagba
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine, Montreal, QC, H3T 1C5, Canada
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The Neonate After Cardiac Surgery: What do You Need to Worry About in the Emergency Department? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Untreated thoracic aortic coarctation leads to early death predominantly because of hypertension and its cardiovascular sequelae. Surgical treatment has been available for > 50 years and has improved hypertension and survival. More recently, endovascular techniques have offered a minimally invasive alternative to traditional open repair. Early and intermediate results suggest angioplasty and stenting have an important role in the management of aortic coarctation, particularly in adults and older children.
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Affiliation(s)
- D R Turner
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
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Dilawar M, El Said HG, El-Sisi A, Ahmad Z. Safety and efficacy of low-profile balloons in native coarctation and recoarctation balloon angioplasty for infants. Pediatr Cardiol 2009; 30:404-8. [PMID: 19365667 DOI: 10.1007/s00246-008-9317-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/13/2008] [Accepted: 09/15/2008] [Indexed: 11/26/2022]
Abstract
Background Traditionally, high-profile/high-pressure balloons have been used for angioplasties, whereas low-profile/low-pressure balloons have been used for valvuloplasties. High-profile balloons require larger introducing sheaths, which can be a limiting factor for percutaneous catheter interventions in infants. This report aims to report the author's experience with the efficacy of low-profile balloons using smaller introducing sheaths for coarctation balloon angioplasty in infants. Methods From April 2004 to April 2008, 15 infants, representing both native coarctation and recoarctation indications, underwent coarctation balloon angioplasty and were retrospectively reviewed. The arterial access was achieved using 4-Fr (Cook) introducing sheaths and Tyshak (NuMED, Hallenweg-Netherlands) balloons 5 to 8 mm in diameter for coarctation angioplasty in the study group. Results In this study, 15 infants (7 with native coarctation and 8 with postoperative recoarctation) underwent balloon angioplasty. These infants ranged in age from 2 to 9 months (median, 4 months) and in weight from 3.5 to 10.8 kg (median, 5.7 kg). The peak-to-peak coarctation gradient was reduced from 46.2 +/- 28 mmHg before angioplasty to 10 +/- 8 mmHg afterward (p = 0.001). The angiographic diameter of the coarctation segment was increased from 2.4 +/- 1.0 mm before angioplasty to 5 +/- 0.8 mm afterward (p = 0.001). There were no immediate major or minor complications. During a follow-up period up to 48 months, only one patient from the native coarctation group experienced recoarctation and underwent successful reballooning, and none of the patients experienced aneurysms. Conclusion This study shows that the use of low-profile/low-pressure balloons is an effective treatment for infants. Furthermore, low-profile balloons required smaller introducing sheaths, which provides a clear advantage of minimizing vascular complications with coarctation ballooning in younger infants.
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Affiliation(s)
- Muhammad Dilawar
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar.
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Dave HH, Buechel ERV, Prêtre R. Muscle-Sparing Extrapleural Approach for the Repair of Aortic Coarctation. Ann Thorac Surg 2006; 81:243-8. [PMID: 16368375 DOI: 10.1016/j.athoracsur.2005.06.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 06/13/2005] [Accepted: 06/20/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND This paper describes a muscle-sparing, extrapleural approach to repair aortic coarctation, and evaluates the results with established standards. METHODS Forty consecutive patients with aortic coarctation (median age, 8 days; weight, 3.3 kg) were approached with a less invasive technique consisting of a short posterior thoracotomy, with only minimal (24 patients) or no (16 patients) division of thoracic wall muscles and a subperiosteal-extrapleural approach. Extended resection of the coarctation with enlargement of the distal aortic arch was performed in all patients. The median cross-clamp and operative times were 22 and 90 minutes, respectively. RESULTS The repair was possible in all patients without needing conversion. There was no intraoperative or postoperative related complication. Two patients died early of low cardiac output as a result of ventricular fibroelastosis and respiratory failure. One patient died late of unrelated cause. The perioperative mean gradients across the neoarch were less than 5 mm Hg in all but 3 patients with proximal (2 patients) or mid arch (1) stenosis. The median ventilation time, intensive care unit stay, and hospital stay in isolated coarctation repairs was 2, 4.5, and 11 days, respectively. One patient had a recurrent stenosis at the site of surgical repair. Two patients underwent successful balloon dilatation, and 2 had surgical enlargement plasty of the proximal aortic arch at the time of intracardiac repair. None of the patients required chronic antihypertensive medication. At 29 months, freedom from reintervention on the isthmus and arch plus isthmus was 97.1% and 89.7%, respectively. CONCLUSIONS A muscle-sparing, extrapleural approach for the repair of aortic coarctation is possible and provides results similar to conventional techniques. The approach reduces postoperative morbidity related to division of thoracic wall muscles and handling of the lung, restores a normal intercostal space, and produces superior cosmetic results, while at the same time leading to early and permanent relief of proximal hypertension.
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Affiliation(s)
- Hitendu Hasmukhlal Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland.
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Fesseha AK, Eidem BW, Dibardino DJ, Cron SG, McKenzie ED, Fraser CD, Price JF, Chang AC, Mott AR. Neonates With Aortic Coarctation and Cardiogenic Shock: Presentation and Outcomes. Ann Thorac Surg 2005; 79:1650-5. [PMID: 15854946 DOI: 10.1016/j.athoracsur.2004.11.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2004] [Indexed: 12/01/2022]
Abstract
BACKGROUND Some neonates with coarctation of the aorta (COA) present with cardiogenic shock and secondary end-organ injury. The management of this subgroup imposes unique challenges. We review our perioperative strategy and outcomes for neonates with COA who presented with cardiogenic shock. METHODS Neonates (younger than 30 days) with isolated COA or COA with aortic arch hypoplasia were identified. Retrospective review was performed to identify and characterize patients who presented with cardiogenic shock, defined as impaired left ventricular (LV) or right ventricular (RV) systolic function, or both, respiratory failure requiring tracheal intubation, and metabolic acidosis. RESULTS Thirteen neonates presented in cardiogenic shock and underwent surgical repair. No patients required catheter or surgical reintervention for recoarctation. There were no deaths at a mean follow-up of 54 months. Group I neonates (isolated COA, n = 7) underwent end-to-end anastomosis through left thoracotomy. The mean age and pH at presentation were 9 (+/-1.1) days and 7.07 (+/-0.21), respectively. The mean preoperative and postoperative LV myocardial performance indices (MPI) were 0.81 (+/-0.22) and 0.37 (+/-0.16), respectively (p = 0.002). Group II neonates (COA with arch hypoplasia +/- ventricular septal defect, n = 6) underwent aortic arch advancement and ventricular septal defect closure through median sternotomy. The mean time from diagnosis to surgery in group II was 5.5 (+/-1.9) days versus 2.4 (+/-1.5) days in group 1 (p = 0.01). The mean age and pH at presentation were 11.8 (+/-9.3) days and 7.02 (+/-0.21), respectively. The mean preoperative and postoperative LV MPI were 0.46 (+/-0.13) and 0.35 (+/-0.11), respectively (p = 0.02). The total hospital length of stay in group II patients was 18 (+/-6.23) days versus 11.3 (+/-5. 7) days in group I (p = 0.04). CONCLUSIONS Timely intervention with a strategy individualized to the patient anatomy can be performed with excellent outcomes in neonates with COA and cardiogenic shock. Neonates with isolated COA had worse preoperative LV MPI, which reflects more significant global left ventricular systolic dysfunction in this subgroup. The elapsed time from diagnosis to surgery was decreased in neonates with isolated COA.
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Affiliation(s)
- Assaf K Fesseha
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Hernández-González M, Solorio S, Conde-Carmona I, Rangel-Abundis A, Ledesma M, Munayer J, David F, Ortegón J, Jiménez S, Sánchez-Soberanis A, Meléndez C, Claire S, Gomez J, Teniente-Valente R, Alva C. Intraluminal aortoplasty vs. surgical aortic resection in congenital aortic coarctation. A clinical random study in pediatric patients. Arch Med Res 2003; 34:305-10. [PMID: 12957528 DOI: 10.1016/s0188-4409(03)00055-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated. METHODS A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05. RESULTS There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant. CONCLUSIONS Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.
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Affiliation(s)
- Martha Hernández-González
- Servicio de Cardiopatías Congénitas, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Abstract
BACKGROUND Previous results show that the success rate of balloon angioplasty for pulmonary artery stenosis is low. Mortality and morbidity are significant in balloon angioplasty for coarctation of the aorta. METHODS A review of the experience of balloon angioplasty for pulmonary artery stenosis and coarctation of the aorta at our institution was performed. A review of scientific reports of balloon angioplasty for these lesions was investigated. RESULTS Review of our results indicates that balloon angioplasty for pulmonary artery stenosis can be performed with a high success rate (80-90%), (i) by performing it at an appropriate time, (ii) by using high-pressure balloons, (iii) by using stents, and (iv) by using intravascular ultrasound (IVUS). Major complications occurred in 3% at our institution in balloon angioplasty for pulmonary artery stenosis. Incomplete dilation has been noted in 10-25% of patients of coarctation of the aorta. Aortic aneurysm has been reported in 2-7% of patients. Re-stenosis and/or hypertension also occur. The re-stenosis rate may be decreased if the aorta is dilated until signs of intimal tear are observed. Systemic hypertension may be noted in the long term after balloon angioplasty of coarctation of the aorta, even in patients with fairly good anatomical repair. The mechanisms for hypertension are not clear, but residual stenosis, even mild, may result in upper body hypertension. CONCLUSIONS Although there are significant limitations in the procedures, balloon angioplasty is effective in the management of pulmonary artery stenosis and coarctation of the aorta.
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Affiliation(s)
- T Nakanishi
- Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical, University, Tokyo, Japan.
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Maroto Monedero C, Enríquez de Salamanca F, Herráiz Sarachaga I, Zabala Argüelles JI. [Clinical guidelines of the Spanish Society of Cardiology for the most frequent congenital cardiopathies]. Rev Esp Cardiol 2001; 54:67-82. [PMID: 11141456 DOI: 10.1016/s0300-8932(01)76265-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of diagnostic and therapeutic techniques is very important to ensure optimum, effective treatment in patients with heart disease to thereby obtain an adequate cost-benefit relationship. The aim of establishing guidelines for the evaluation and management is to achieve this relationship, but these guidelines are difficult to establish in pediatric cardiology despite 50 years of experience in this field. At present a large group of patients may benefit from these guidelines due to the improvement in the diagnostic techniques and better treatment results in congenital heart disease in the newborn. Protocols have been established in some groups and in others in which this is not possible, descriptive analysis and therapeutic schedules have been determined.
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Affiliation(s)
- C Maroto Monedero
- Servicio de Cardiologia Pediatrica, Hospital General Universitario Gregorio Marañón, Madrid
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Mann C, Goebel G, Eicken A, Genz T, Sebening W, Kaemmerer H, Hammerer I, Hess J. Balloon dilation for aortic recoarctation: morphology at the site of dilation and long-term efficacy. Cardiol Young 2001; 11:30-5. [PMID: 11233395 DOI: 10.1017/s1047951100012397] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We undertook this study to assess the immediate and long-term outcome of balloon angioplasty performed for recurrent or residual coarctation of the aorta, and to assess the changes in the vessel wall caused by this procedure. METHODS Clinical, echocardiographic, angiographic and hemodynamic data from 71 patients who underwent balloon angioplasty for recoarctation between January 1987 and January 1998 were analysed retrospectively. RESULTS Angioplasty was performed after a median of 82.6 months (range 1.4 mo-20.9 y, mean 88.5 mo) following surgery for coarctation. Mean systolic pressure gradients were reduced from 27 +/- 15 mmHg to 11 +/- 11 mmHg after angioplasty (p < 0.0001). The mean diameter at the site of recoarctation increased from 5.5 +/- 2.5 to 7.5 +/- 2.7 mm (p < 0.0001). Outpouchings of contrast agents, indicating the disruption of the inner layers of the vessel wall, were defined as extravasations. They were observed in one-quarter of the angiograms performed immediately after the intervention. Immediate success of angioplasty was achieved in 71%, and persisted in 69% of patients during long-term follow up. The main determinant for immediate success was the age at the time of the procedure (p < 0.05), while the main determinant for long-term success was the increase achieved in diameter. Extravasations did not progress to aneurysms, neither acutely nor during echocardiographic follow-up studies. For further follow-up, more sensitive imaging techniques will be necessary to delineate the morphology of the site of extravasation observed immediately after angioplasty.
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Affiliation(s)
- C Mann
- Department of Pediatric Cardiology, University Children's Hospital, Innsbruck, Austria.
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Maroto Monedero C, Camino López M, Girona Comas JM, Malo Concepción P. [Clinical guidelines of the Spanish Society of Cardiology in congenital cardiopathy of the newborn]. Rev Esp Cardiol 2001; 54:49-66. [PMID: 11141455 DOI: 10.1016/s0300-8932(01)76264-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of diagnostic and therapeutic techniques is very important to ensure optimum, effective treatment in patients with heart disease to thereby obtain an adequate cost-benefit relationship. The aim of establishing guidelines for the evaluation and management is to achieve this relationship, but these guidelines are difficult to establish in pediatric cardiology despite 50 years of experience in this field. The physiopathologic peculiarities of newborns, in addition to the complex anatomical features of many heart diseases and their clinical presentation, diagnostic and therapeutic difficulties and the presence of residue, sequela and complications of the surgical technique make the elaboration of such guidelines at this age complex. Guidelines for some heart diseases are presented together with a descriptive analysis and a therapeutic schedule of other congenital heart diseases.
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Affiliation(s)
- C Maroto Monedero
- Sociedad Española de Cardiología, Hospital General Universitarío Gregorio Marañón, Madrid
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Qureshi SA, Redington AN, Wren C, Ostman-Smith I, Patel R, Gibbs JL, de Giovanni J. Recommendations of the British Paediatric Cardiac Association for therapeutic cardiac catheterisation in congenital cardiac disease. Cardiol Young 2000; 10:649-67. [PMID: 11117403 DOI: 10.1017/s1047951100008982] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of these recommendations are to improve the outcome for patients after, and to provide acceptable standards of practice of therapeutic cardiac catheterisation performed to treat congenital cardiac disease. The scope of the recommendations includes all interventional procedures, recognising that for some congenital malformations, surgical treatment is equally as effective as, or occasionally preferable to, interventional treatment. The limitations of the recommendations are that, at present, no data are available which compare the results of interventional treatment with surgery, and certainly none which evaluate the numbers and types of procedures that need to be performed for the maintenance of skills. Thus, there is a recognised need to collect comprehensive data with which these recommendations could be reviewed in the future, and re-written as evidence-based guidelines. Such a review will have to take into account the methods of collection of data, their effectiveness, and the latest developments in technology. The present recommendations should, therefore, be considered as consensus statements, and as describing accepted practice, which could be used as a basis for ensuring and improving the quality of future care.
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18
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Strife JL, Sze RW. Radiographic evaluation of the neonate with congenital heart disease. Radiol Clin North Am 1999; 37:1093-107, vi. [PMID: 10546668 DOI: 10.1016/s0033-8389(05)70251-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Remarkable advances in pediatric cardiology have been spurred by the explosion of technologies both in interventional and surgical techniques and the ability to manipulate the genome of experimental animals. After a brief discussion concerning the striking advances in the molecular understanding of congenital heart disease, this article focuses on clues to the diagnosis of congenital heart disease and on chest radiography and common, specific lesions of the neonate such as hypoplastic left heart, transposition of the great vessels, and severe tetralogy of Fallot. The impact of treatment protocols involving interventional cardiology in the neonate also are discussed.
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Affiliation(s)
- J L Strife
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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19
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Sakopoulos AG, Hahn TL, Turrentine M, Brown JW. Recurrent aortic coarctation: is surgical repair still the gold standard? J Thorac Cardiovasc Surg 1998; 116:560-5. [PMID: 9766583 DOI: 10.1016/s0022-5223(98)70161-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE We reviewed our experience with surgical repair compared with balloon aortoplasty of recurrent coarctations of the aorta. METHODS This is a retrospective review of 1 institution's 27-year experience with surgical repair of recurrent aortic coarctation. A thorough chart review was performed of all pediatric patients undergoing surgical repair for recurrent aortic coarctation (n = 56) from January 1970 through July 1996. RESULTS The vast majority of recoarctations were repaired with a prosthetic patch technique, with a greater than 96% success rate. No deaths or major complications occurred in the 56 patients. Although a direct comparison with balloon aortoplasty cannot be done, we have reviewed the data available in the literature and found higher complication rates and lower success rates than we obtained in our series. CONCLUSIONS Although the treatment of aortic coarctation has improved significantly during the past decades, persistent hypertension after repairs at an older age and recurrent coarctation after repairs in neonates occur in all institutions. Surgeons have not agreed on the optimal approach to primary coarctation repair, and invasive cardiologists have challenged operative intervention for both recurrent and primary coarctation. This study demonstrates that surgical repair of recurrent coarctation of the aorta can be performed safely and with excellent results. We believe it is still the gold standard in the management of recurrent coarctation of the aorta.
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Affiliation(s)
- A G Sakopoulos
- Department of Surgery, Riley Children's Hospital, Indiana University, Indianapolis, USA
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20
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BENSON LEEN, OVAERT CAROLINE, NYKANEN DAVID, FREEDOM ROBERTM. Nonsurgical Management of Coarctation of the Aorta. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00137.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Shirali GS, Cephus CE, Kuhn MA, Ogata KK, Vander Dussen LK, Chinnock RE, Mulla NF, Johnston JK, Bailey LL, Gundry SR, Razzouk AJ, Larsen RL. Posttransplant recoarctation of the aorta: a twelve year experience. J Am Coll Cardiol 1998; 32:509-14. [PMID: 9708484 DOI: 10.1016/s0735-1097(98)00235-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation. BACKGROUND Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta. METHODS This was a retrospective review of all children (age <18 years) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, details of the transplant procedure and posttransplant data including development of recoarctation of the aorta, interventions for recoarctation and the most recent follow-up assessment of the aortic arch. RESULTS Two hundred eighty-eight transplants were performed on 279 children (follow-up = 1,075 patient-years; range 0 to 133 months, median 43.7). Thirty-two of 152 patients (21%) who underwent extended aortic arch reconstruction subsequently developed recoarctation. All but one patient developed recoarctation within 2 years after transplant; 87% were hypertensive at presentation. Of 30 patients who underwent intervention for recoarctation (balloon angioplasty [n = 26] and surgical repair of recoarctation [n = 4]), 26 (87%) have remained recurrence-free (follow-up = 133 patient-years; range 8 to 106 months, median 47). CONCLUSIONS The high frequency of recoarctation after cardiac transplantation with extended aortic arch reconstruction mandates serial echocardiographic evaluation of the aortic arch. Patients typically present with systemic hypertension within the first two years after transplantation. Balloon angioplasty is a safe, effective and durable method of treatment.
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Affiliation(s)
- G S Shirali
- Department of Pediatrics, Loma Linda University Children's Hospital, California, USA.
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22
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Allen HD, Beekman RH, Garson A, Hijazi ZM, Mullins C, O'Laughlin MP, Taubert KA. Pediatric therapeutic cardiac catheterization: a statement for healthcare professionals from the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1998; 97:609-25. [PMID: 9494035 DOI: 10.1161/01.cir.97.6.609] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Affiliation(s)
- A Rothman
- Division of Pediatric Cardiology, University of California-San Diego, USA
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24
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Park Y, Lucas VW, Sklansky MS, Kashani IA, Rothman A. Balloon angioplasty of native aortic coarctation in infants 3 months of age and younger. Am Heart J 1997; 134:917-23. [PMID: 9398104 DOI: 10.1016/s0002-8703(97)80015-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The use of balloon dilation to treat native aortic coarctation is controversial, particularly in infants. Between January 1991 and September 1996, 12 patients < or = 3 months of age with native coarctation of the aorta (CoA) underwent balloon angioplasty (BA). All 12 lesions were dilated successfully with a mean reduction in peak systolic gradient from 49.3 +/- 16.5 mm Hg to 6.8 +/- 4.0 mm Hg (p < 0.001) and a mean increase in minimum CoA diameter from 2.4 +/- 0.6 mm to 5.5 +/- 1.3 mm (p < 0.001). Intimal flaps or tears were detected immediately after BA in 4 (33%) of 12 patients by angiography and in 8 (89%) of 9 patients by intravascular ultrasonography. No deaths or major complications related to the BA occurred. One patient had documented asymptomatic femoral artery obstruction, and one patient with hydrops fetalis and congenital pleural effusions died with gram-negative sepsis 1 week after the procedure. Follow-up was available for 10 patients (1 was lost to follow-up) between 2 months and 4.1 years (mean 2.4 +/- 1.3 years) after BA. No patient had an aortic aneurysm. Restenosis occurred in 5 (50%) of 10 patients, requiring reintervention a mean of 2.6 +/- 2.1 months after BA. One patient underwent surgical repair. Repeat BAs were performed in the other four patients; three were successful, and one with partial gradient relief required surgical repair. Five patients have not required reintervention a mean of 2.9 +/- 1.0 years after the initial BA. Among these five patients, follow-up intravascular ultrasound performed in three patients a mean of 2.0 +/- 1.9 years after BA showed favorable endovascular remodeling. There was a tendency for early reintervention in patients < 1 month of age and coexistence of a patent ductus arteriosus at the time of BA. In conclusion, selected infants < or = 3 months of age with discrete native CoA may be treated initially with balloon dilation. Most patients who have restenosis respond successfully to repeat BA.
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Affiliation(s)
- Y Park
- Division of Pediatric Cardiology, University of California, San Diego School of Medicine, 92103, USA
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25
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Abstract
This review focuses on the individual dilation mechanism, the possible cause of restenosis after balloon angioplasty and the clinical application of a stent in coarctation of the aorta. Balloon angioplasty is still not the first choice of therapy in neonates with native coarctation because of the potential risk of aortic disruption, the high incidence of restenosis and the satisfactory results of surgical coarctectomy. Intravascular ultrasound imaging provides the individual mechanism of aortic dilation by balloon, and this will be a new modality for assessing the relationship between restenosis and aortic luminal morphology after balloon dilation. Although the cause of restenosis after balloon angioplasty remains uncertain, it may be due to a combination of elastic recoil by ductal tissue constriction, intimal hyperplasia and arterial remodelling. A stent could be an effective alternative to conventional balloon angioplasty in native coarctation of the aorta, preventing ductal tissue constriction. However, the problematic relationship between patient growth and relative stenosis of the stent should be clarified before clinical application of a stent for this disease.
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Affiliation(s)
- T Ino
- Department of Pediatrics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
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26
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Qureshi SA, Rosenthal E, Tynan M. Should balloon angioplasty be used instead of surgery for native aortic coarctation? Heart 1997; 77:86-7. [PMID: 9038703 PMCID: PMC484643 DOI: 10.1136/hrt.77.1.86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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27
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McCrindle BW, Jones TK, Morrow WR, Hagler DJ, Lloyd TR, Nouri S, Latson LA. Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. J Am Coll Cardiol 1996; 28:1810-7. [PMID: 8962571 DOI: 10.1016/s0735-1097(96)00379-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study sought to compare the immediate results and risk factors for suboptimal outcomes of percutaneous balloon angioplasty for native versus recurrent aortic obstruction. BACKGROUND Some cardiology centers have been reluctant to adopt balloon angioplasty for treatment of native aortic coarctation, while advocating balloon angioplasty over an operation for treatment of postsurgical or recurrent aortic obstruction. METHODS Acute results were analyzed from 970 procedures (422 native and 548 recurrent lesions) performed between 1982 and 1995 in 907 patients from 25 centers. An acute suboptimal outcome was defined as one or more of the following: residual systolic pressure gradient > or = 20 mm Hg, residual proximal to distal systolic pressure ration > or = 1.33 or a major complication (death, aortic transmural tear, stroke). RESULTS Bal loon angioplasty significantly (p = 0.0001) increased lesion diameter fo r both native (mean [+/= SD] 128 +/= 94%) and recurrent aortic obstruction (97 +/= 87%), with a significantly greater increase in the native group (p = 0.0001). A reduction in systolic pressure gradients was significant in both groups (p = 0.0001), but slightly higher (p = 0.01) for native (-74 +/- 24%) versus recurrent obstruction (-70 +/- 31%). Death associated with angioplasty was reported in 0.7% of patients with native and in 0.7% of patients with recurrent lesions (p = 1.00). An acute suboptimal outcome was noted with angioplasty in 19% of native and in 25% of recurrent lesions (p = 0.04). Significant independent risk factors included higher preangioplasty systolic gradient (odds ratio [OR] 1.39/10-mm Hg increment; 95% confidence interval [CI] 1.28 to 1.50, p = 0.0001), earlier study date (OR 0.92/1-year increment, 95% CI 1.02 to 1.26, p = 0.02) and recurrent obstruction (OR 1.39 vs. native lesions, 95% CI 1.00 to 1.94, p = 0.05). CONCLUSIONS Acute results and complications of balloon angioplasty of native coarctation appear to be equivalent or slightly superior to those of recurrent aortic obstructions.
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Affiliation(s)
- B W McCrindle
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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28
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Kaine SF, Smith EO, Mott AR, Mullins CE, Geva T. Quantitative echocardiographic analysis of the aortic arch predicts outcome of balloon angioplasty of native coarctation of the aorta. Circulation 1996; 94:1056-62. [PMID: 8790046 DOI: 10.1161/01.cir.94.5.1056] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of balloon angioplasty for treatment of native aortic coarctation is controversial. Cineangiographic data suggest that aortic arch hypoplasia and isthmic narrowing are associated with angioplasty failure. This study of echocardiographic measurements of preangioplasty aortic arch morphology was performed to identify potential anatomic predictors of outcome noninvasively. METHODS AND RESULTS The preangioplasty echocardiograms of 105 patients 3 days to 17 years old with native coarctation of the aorta were analyzed off-line. Angioplasty was considered successful if the residual coarctation gradient was < 20 mm Hg and no intervention for recoarctation occurred. Univariate analysis identified young age at angioplasty, presence of a patent ductus arteriosus, and the diameters of the aortic isthmus, distal transverse arch, and aortic valve as predictors of early and late outcomes. Multivariate analysis showed that the preangioplasty aortic isthmus z value was the best independent predictor of outcome, eliminating the effect on outcome of age and associated cardiac defects. An isthmus z value < or = -2.16 predicted early failure with 91% sensitivity and 85% specificity. Kaplan-Meier analysis demonstrated that 90% of patients with an isthmus z value > -1.0 remained free of recoarctation at late follow-up, whereas 89% of patients with a preangioplasty isthmus z value < or = -2.0 developed recoarctation within 36 months. CONCLUSIONS Echocardiographic measurements of the aortic arch predict both early and late outcomes of balloon angioplasty for native aortic coarctation, and the preangioplasty aortic isthmus z value was the best independent predictor. Quantitative aortic arch analysis may improve selection of angioplasty candidates who are likely to benefit from the procedure.
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Affiliation(s)
- S F Kaine
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, USA
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29
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Aydogan U, Dindar A, Gurgan L, Cantez T. Late development of dissecting aneurysm following balloon angioplasty of native aortic coarctation. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:226-9. [PMID: 8542629 DOI: 10.1002/ccd.1810360307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Acute aortic dissection during balloon angioplasty for coarctation of the aorta or aneurysm formation during follow-up are well-known complications of this procedure. Dissecting aneurysm development during long-term follow-up after balloon angioplasty of a native coarctation has not been previously reported. We report a case in which a huge dissecting aneurysm developed 3 years after the native coarctation angioplasty procedure. The aneurysm required surgical repair.
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Affiliation(s)
- U Aydogan
- Faculty of Medicine of Istanbul University, Department of Pediatric Cardiology, Turkey
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30
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Abstract
Balloon angioplasty of native coarctations of the aorta is one of the most controversial facets of the pediatric interventional cardiologist's practice. We have evaluated the history and experimental rationale of this technology. Presently accepted techniques are outlined and controversies intrinsic in performance of this procedure are discussed. Acute, short-term, and long-term results are reviewed with particular emphasis on differences in success of the procedure as related to patient age. Common and significant complications are discussed and in some cases compared to analogous surgical complications. Newer technologies and approaches to interventional therapy for coarctation of the aorta are also discussed.
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Affiliation(s)
- A M Mendelsohn
- Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA
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31
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Johnson MC, Strauss AW. The jury is still out regarding balloon therapy for native aortic coarctation. J Am Coll Cardiol 1994; 24:1589-90. [PMID: 7930295 DOI: 10.1016/0735-1097(94)90160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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32
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Rao P, Chopra PS. Reply. J Am Coll Cardiol 1994. [DOI: 10.1016/0735-1097(94)90161-9] [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: 10/19/2022]
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33
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Abstract
Many structural congenital heart defects present at birth, and most are diagnosed by 1 year of age. Arrhythmias also are common during this time and may be particularly problematic. Identification of infants who may have a serious underlying congenital heart defect is important because many require prompt medical and surgical treatment. This article is a guide to the clinical findings that may assist the practitioner in the evaluation of infants with potential cardiac problems.
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Affiliation(s)
- D A Burton
- Children's Heart Clinic, Minneapolis, Minnesota
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34
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35
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Johnson MC, Strauss AW, Canter CE, Spray TL. Reply. Am Heart J 1993. [DOI: 10.1016/0002-8703(93)90567-s] [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: 10/26/2022]
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36
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Timmis GC. Interventional Cardiology: A Comprehensive Bibliography. J Interv Cardiol 1993. [DOI: 10.1111/j.1540-8183.1993.tb00864.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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