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Aslan S, Liu X, Wu Q, Mass P, Loke YH, Johnson J, Huddle J, Olivieri L, Hibino N, Krieger A. Virtual Planning and Patient-Specific Graft Design for Aortic Repairs. Cardiovasc Eng Technol 2024; 15:123-136. [PMID: 37985613 DOI: 10.1007/s13239-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Patients presenting with coarctation of the aorta (CoA) may also suffer from co-existing transverse arch hypoplasia (TAH). Depending on the risks associated with the surgery and the severity of TAH, clinicians may decide to repair only CoA, and monitor the TAH to see if it improves as the patient grows. While acutely successful, eventually hemodynamics may become suboptimal if TAH is left untreated. The objective of this work aims to develop a patient-specific surgical planning framework for predicting and assessing postoperative outcomes of simple CoA repair and comprehensive repair of CoA and TAH. METHODS The surgical planning framework consisted of virtual clamp placement, stenosis resection, and design and optimization of patient-specific aortic grafts that involved geometrical modeling of the graft and computational fluid dynamics (CFD) simulation for evaluating various surgical plans. Time-dependent CFD simulations were performed using Windkessel boundary conditions at the outlets that were obtained from patient-specific non-invasive pressure and flow data to predict hemodynamics before and after the virtual repairs. We applied the proposed framework to investigate optimal repairs for six patients (n = 6) diagnosed with both CoA and TAH. Design optimization was performed by creating a combination of a tubular graft and a waterslide patch to reconstruct the aortic arch. The surfaces of the designed graft were parameterized to optimize the shape. RESULTS Peak systolic pressure drop (PSPD) and time-averaged wall shear stress (TAWSS) were used as performance metrics to evaluate surgical outcomes of various graft designs and implantation. The average PSPD improvements were 28% and 44% after the isolated CoA repair and comprehensive repair, respectively. Maximum values of TAWSS were decreased by 60% after CoA repair and further improved by 22% after the comprehensive repair. The oscillatory shear index was calculated and the values were confirmed to be in the normal range after the repairs. CONCLUSION The results showed that the comprehensive repair outperforms the simple CoA repair and may be more advantageous in the long term in some patients. We demonstrated that the surgical planning and patient-specific flow simulations could potentially affect the selection and outcomes of aorta repairs.
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Affiliation(s)
- Seda Aslan
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA.
| | - Xiaolong Liu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - Qiyuan Wu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Paige Mass
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | | | - Laura Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
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2
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Dos Santos FJ, Hernandez BA, Santos R, Machado M, Souza M, Capello Sousa EA, Andrade A. Bioabsorbable Polymeric Stent for the Treatment of Coarctation of the Aorta (CoA) in Children: A Methodology to Evaluate the Design and Mechanical Properties of PLA Polymer. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4403. [PMID: 37374585 DOI: 10.3390/ma16124403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.
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Affiliation(s)
- Flávio José Dos Santos
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Bruno Agostinho Hernandez
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Rosana Santos
- Department of Engineering, PUC-Pontifical Catholic University of São Paulo, São Paulo 05014-901, Brazil
| | - Marcel Machado
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Mateus Souza
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Edson A Capello Sousa
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Aron Andrade
- CEAC-Centre for Engineering in Circulatory Assistance, Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil
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Moon RJ, Spadaccio C, Duncan AJ, Bittar MN. Repair of a Late Presentation Thoracic Aortic Aneurysm following Coarctation Repair. AORTA (STAMFORD, CONN.) 2023; 11:44-46. [PMID: 36848912 PMCID: PMC9970751 DOI: 10.1055/s-0042-1757950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Abstract
We report the case of a 44-year-old gentleman who underwent coarctation repair at the age of 7 years. He was lost to follow-up and represented. Computed tomography scan demonstrated a 9.8-cm diameter aortic aneurysm involving the distal aortic arch and proximal descending aorta. Open surgery was performed to repair the aneurysm. The patient made an unremarkable recovery. He was followed up 12 weeks later, and significant improvement in preoperative symptoms was observed. This case demonstrates the importance of long-term follow-up.
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Affiliation(s)
- Robert J. Moon
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Andrew J. Duncan
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Mohamad N. Bittar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
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4
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Osztrogonacz P, Berczeli M, Chinnadurai P, Chang SM, Shah DJ, Lumsden AB. Dynamic Imaging of Aortic Pathologies: Review of Clinical Applications and Imaging Protocols. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 36910554 PMCID: PMC10000327 DOI: 10.14797/mdcvj.1172] [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: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 03/09/2023] Open
Abstract
The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions.
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Affiliation(s)
- Peter Osztrogonacz
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Marton Berczeli
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Ponraj Chinnadurai
- Houston Methodist Hospital, Houston, Texas, US.,Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, US
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Lin H, Chang Y, Qian X, Yu C, Sun X. Outcomes of one-staged procedures to treat aortic coarctation complicated by cardiac anomalies. BMC Cardiovasc Disord 2022; 22:302. [PMID: 35786318 PMCID: PMC9250724 DOI: 10.1186/s12872-022-02739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent (hybrid). METHODS Between January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results. RESULTS All the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5 ± 14.0 years which was older than hybrid group (27.9 ± 8.5 years, P = 0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4 to 119.7 mmHg and 148.4 to 111.6 mmHg, the median peak systolic gradient decreased from 68.0 to 10 mmHg and 46.5 to 10 mmHg respectively (P = 0.09). And the mean upper-lower limbs gradient decreased from 21.7 to 5.9 mmHg and 21.0 to 2.7 mmHg respectively (P = 0.104). The mean follow-up time was 76.92 ± 18.7 in bypass group and 85.4 ± 20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups. CONCLUSIONS The bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.
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Affiliation(s)
- Hongyuan Lin
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Yi Chang
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Xiangyang Qian
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China.
| | - Cuntao Yu
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
| | - Xiaogang Sun
- Cardiac Surgery Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, North Lishi street, Xicheng District, Beijing, 100037, China
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Somers T, Nies HMJM, van Kimmenade RRJ, Bosboom DGH, Geuzebroek GSC, Morshuis WJ. Necessity of life-long follow-up after surgery for coarctation of the aorta: a case series of very late false aneurysm formation. Eur Heart J Case Rep 2022; 6:ytac073. [PMID: 35233500 PMCID: PMC8881378 DOI: 10.1093/ehjcr/ytac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/15/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Coarctation of the aorta accounts for 5-7% of congenital defects of the heart and great vessels. It requires treatment in the form of open surgical or percutaneous repair. Common long-term complications include re-stenosis and aneurysm formation. The formation of a false aneurysm is a complication with a significant morbidity and mortality. CASE SUMMARY We reviewed six cases of late false aneurysm after repair of a coarctation of the aorta. Our six cases developed a false aneurysm after an open surgical repair of a coarctation more than 30 years after initial surgical repair. All aneurysms were located at the aortic repair site. DISCUSSION The symptoms or risk factors in the described cases are not uniform and are difficult to include in a general follow-up protocol. Guidelines recommend frequent evaluation, but do not specify duration or intervals of imaging follow-up. Our cases support the necessity of life-long follow-up in patients with open aortic repairs irrespective of symptomatology.
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Affiliation(s)
- Tim Somers
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Hedwig M J M Nies
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Roland R J van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Dennis G H Bosboom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
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7
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Sampson B, Hammers J, Stram M. Forensic aspects of cardiovascular pathology. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00003-7] [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: 11/24/2022] Open
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8
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Abstract
Most children with congenital heart disease (CHD) survive to adulthood, owing largely to significant advances in the diagnosis and management of CHD over the past few decades. Primary care providers are essential partners in the recognition and management of these patients in our current medical environment. This article reviews the role of the primary care physician in detecting fetuses, infants, and children with possible CHD. Furthermore, this article discusses common primary care issues arising for patients with CHD, including growth and development, mental illness, dental care, and the transition to adult primary care.
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Affiliation(s)
- Michael Scott
- Department of Pediatrics, University of Louisville, Office of Medical Education, School of Medicine, 571 South Floyd, Suite 412, Louisville, KY 40202, USA
| | - Ashley E Neal
- Department of Pediatrics, University of Louisville School of Medicine and Norton Children's, 571 South Floyd Street, Suite 113, Louisville, KY 40202, USA.
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9
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Gu Y, Li Q, Lin R, Jiang W, Wang X, Zhou G, Su J, Fan X, Gao P, Jin M, Wang Y, Du J. Prognostic Model to Predict Postoperative Adverse Events in Pediatric Patients With Aortic Coarctation. Front Cardiovasc Med 2021; 8:672627. [PMID: 34095260 PMCID: PMC8175771 DOI: 10.3389/fcvm.2021.672627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Postoperative adverse events remain excessively high in surgical patients with coarctation of aorta (CoA). Currently, there is no generally accepted strategy to predict these patients' individual outcomes. Objective: This study aimed to develop a risk model for the prediction of postoperative risk in pediatric patients with CoA. Methods: In total, 514 patients with CoA at two centers were enrolled. Using daily clinical practice data, we developed a model to predict 30-day or in-hospital adverse events after the operation. The least absolute shrinkage and selection operator approach was applied to select predictor variables and logistic regression was used to develop the model. Model performance was estimated using the receiver-operating characteristic curve, the Hosmer–Lemeshow test and the calibration plot. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) compared with existing risk strategies were assessed. Results: Postoperative adverse events occurred in 195 (37.9%) patients in the overall population. Nine predictive variables were identified, including incision of left thoracotomy, preoperative ventilation, concomitant ventricular septal defect, preoperative cardiac dysfunction, severe pulmonary hypertension, height, weight-for-age z-score, left ventricular ejection fraction and left ventricular posterior wall thickness. A multivariable logistic model [area under the curve = 0.8195 (95% CI: 0.7514–0.8876)] with adequate calibration was developed. Model performance was significantly improved compared with the existing Aristotle Basic Complexity (ABC) score (NRI = 47.3%, IDI = 11.5%) and the Risk Adjustment for Congenital Heart Surgery (RACHS-1) (NRI = 75.0%, IDI = 14.9%) in the validation set. Conclusion: Using daily clinical variables, we generated and validated an easy-to-apply postoperative risk model for patients with CoA. This model exhibited a remarkable improvement over the ABC score and the RACHS-1 method.
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Affiliation(s)
- Yan Gu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Pediatric Heart Centre, Beijing, China
| | - Qianqian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Rui Lin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xue Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Gengxu Zhou
- Department of Pediatric Cardiology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Junwu Su
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Pediatric Heart Centre, Beijing, China
| | - Xiangming Fan
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Pediatric Heart Centre, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Peking University Clinical Research Institute, Peking University Health Science Center, Peking University, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Mei Jin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Pediatric Heart Centre, Beijing, China
| | - Yuan Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China.,Collaborative Innovation Centre for Cardiovascular Disorders, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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10
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McFarland CA, Truong DT, Pinto NM, Minich LL, Burch PT, Eckhauser AW, Lal AK, Molina KM, Ou Z, Presson AP, May LJ. Implications of Left Ventricular Dysfunction at Presentation for Infants with Coarctation of the Aorta. Pediatr Cardiol 2021; 42:72-77. [PMID: 33005984 PMCID: PMC7529086 DOI: 10.1007/s00246-020-02455-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
Abstract
Infants with aortic coarctation may present with left ventricular (LV) dysfunction which may complicate the postoperative course and lead to increased healthcare costs. We aimed to define the prevalence of moderate to severe left ventricular (LV) systolic dysfunction, evaluate time to recovery, and compare health care costs. Single-center retrospective cohort study at a tertiary care hospital was conducted. Infants < 6 months old at diagnosis with aortic coarctation were identified using surgical codes for coarctation repair between January 2010 and May 2018. Moderate to severe dysfunction was defined as ejection fraction (EF) < 40%. Of 160 infants studied, 18 (11%) had moderate to severe LV dysfunction at presentation. Compared to those with better LV function, infants with moderate to severe LV dysfunction were older at presentation (12 vs. 6 days, p = 0.004), had more postoperative cardiac intensive care unit (ICU) days (5 vs. 3, p < 0.001), and more ventilator days (3.5 vs. 1, p < 0.001). The median time to normal LV EF (≥ 55%) was 6 days postoperatively (range 1-230 days). Infants presenting with moderate to severe LV dysfunction had higher index hospitalization costs ($90,560 vs. $59,968, p = 0.02), but no difference in cost of medical follow-up for the first year following discharge ($3,078 vs. $2,568, p = 0.46). In the current era, > 10% of infants with coarctation present with moderate to severe LV dysfunction that typically recovers. Those with moderate to severe dysfunction had longer duration of mechanical ventilation and postoperative cardiac ICU stays, likely driving higher costs of index hospitalization.
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Affiliation(s)
- Carol A McFarland
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA.
| | - Dongngan T Truong
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
| | - Nelangi M Pinto
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
| | - L LuAnn Minich
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
| | - Phillip T Burch
- Department of Surgery, Pediatric Cardiothoracic Surgery, Cook Children's Hospital, Fort Worth, USA
| | - Aaron W Eckhauser
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ashwin K Lal
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
| | - Kimberly M Molina
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lindsay J May
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, 84113, USA
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11
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Şahinarslan A, Gazi E, Aktoz M, Özkan Ç, Okyay GU, Elalmış ÖU, Belen E, Bitigen A, Derici Ü, Tütüncü NB, Yıldırır A. Consensus paper on the evaluation and treatment of resistant hypertension by the Turkish Society of Cardiology. Anatol J Cardiol 2020; 24:137-152. [PMID: 32870176 PMCID: PMC7585974 DOI: 10.14744/anatoljcardiol.2020.74154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Asife Şahinarslan
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, 18 Mart University; Çanakkale-Turkey
| | - Meryem Aktoz
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Çiğdem Özkan
- Department of Endocrinology, İzmir Bozyaka Training and Research Hospital; İzmir-Turkey
| | - Gülay Ulusal Okyay
- Department of Nephrology, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital; Ankara-Turkey
| | | | - Erdal Belen
- Department of Cardiology, İstanbul Okmeydanı State Hospital; İstanbul-Turkey
| | - Atila Bitigen
- Department of Cardiology, Fatih Medical Park Hospital; İstanbul-Turkey
| | - Ülver Derici
- Department of Nephrology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | | | - Aylin Yıldırır
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
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12
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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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Ma S, Zheng J, Xu Y, Yang Z, Zhu Y, Su X, Mo X. Identified plasma proteins related to vascular structure are associated with coarctation of the aorta in children. Ital J Pediatr 2020; 46:63. [PMID: 32430056 PMCID: PMC7236479 DOI: 10.1186/s13052-020-00830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA), presenting with local stenosis of the aorta is involved in many cardiovascular processes. However, there has been little research on the mechanism of coarctation of the aorta. METHODS Altered proteins were identified by isobaric tag for relative and absolute quantitation (iTRAQ) technology in 8 participants, and further analysed by heatmap, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) and Search Tool for the Retrieval of Interacting Gene (STRING). Of these, two vascular structure-related proteins were further validated by using enzyme-linked immunosorbent assay (ELISA) in a new cohort of CoA patients. RESULTS 39 differentially expressed plasma proteins were first identified in patients with coarctation of the aorta by iTRAQ. Of these, fibulin-1 (FBLN1) and insulin-like growth factor-binding protein complex acid labile subunit (ALS) were considered candidates and further validation also showed that the level of FBLN1 in the CoA group (8.92 ± 2.36 μg/ml) was significantly higher compared with control group (6.13 ± 1.94 μg/ml), and the level of ALS in CoA children (348.08 ± 216.74 ng/ml) was significantly lower than the level in normal children (619.46 ± 274.08 ng/ml). CONCLUSIONS The differentially expressed proteins identified in the plasma from CoA patients indicated that they may play critical roles in CoA and that they could potentially be utilized as biomarkers for diagnosis. Altered vascular related proteins were associated with COA. These results provide a foundation for further understanding and studying the aetiology and pathogenesis of coarctation of the aorta.
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Affiliation(s)
- Siyu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Junqiang Zheng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Zhaocong Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yu Zhu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Xiaoqi Su
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
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Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2019-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.
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Pathirana D, Johnston B, Johnston P. The effect of including increased arterial stiffness in the upper body when modelling Coarctation of the Aorta. Comput Methods Biomech Biomed Engin 2019; 22:475-489. [PMID: 30714407 DOI: 10.1080/10255842.2018.1564821] [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: 10/27/2022]
Abstract
Coarctation of the Aorta is a congenital narrowing of the aorta and diagnosis can be difficult. Treatments result in idiopathic sequelae including hypertension. Untreated patients are known to develop increased arterial stiffness in the upper body, which worsens with time. We present results from simulations with a one-dimensional mathematical model, about the effect of stiffness, stenting, surgery and coarctation severity on blood pressure, Pulsatility and Resistivity Index. One conclusion is that increased stiffness may explain both hypertension in treated patients and why diagnosis can be difficult.
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Affiliation(s)
- Dilan Pathirana
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
| | - Barbara Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
| | - Peter Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
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17
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Abstract
Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6–8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.
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Affiliation(s)
- Arpan R Doshi
- Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Wichita, USA
| | - Sathish Chikkabyrappa
- Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, USA
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18
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Namazi MH, Safi M, Momenizadeh A, Khaheshi I, Memaryan M, Movahed MR. Mahaim fibers coexisting with coarctation of aorta and bicuspid aortic valve. Future Cardiol 2018; 14:483-489. [PMID: 30421621 DOI: 10.2217/fca-2017-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We found a coexistence of Mahaim fibers, coarctation of aorta and bicuspid valve in a young patient presenting with palpitations and subraventricular tachycardia. This rare combination of these three congenital cardiac abnormalities occurring in the same patient has not been reported previously. Detailed cardiac studies unmasked the patient's cardiac abnormalities. Furthermore, successful percutaneous intervention in treating coarctation and catheter-based ablation of Mahaim fibers were performed with resolution of symptoms. This case is discussed here in detail, alongside a review of the literature.
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Affiliation(s)
- Mohammad H Namazi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Safi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Momenizadeh
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Memaryan
- Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R Movahed
- Department of Medicine, University of Arizona, School of Medicine, Tucson, Arizona, USA.,Care More Health, 7901 E Speedway, Tucson, Arizona, AZ 85710, USA
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Pathirana D, Johnston B, Johnston P. The effects of tapering and artery wall stiffness on treatments for Coarctation of the Aorta. Comput Methods Biomech Biomed Engin 2017; 20:1512-1524. [PMID: 29119836 DOI: 10.1080/10255842.2017.1382483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Coarctation of the Aorta is a congenital narrowing of the aorta. Two commonly used treatments are resection and end-to-end anastomosis, and stent placements. We simulate blood flow through one-dimensional models of aortas. Different artery stiffnesses, due to treatments, are included in our model, and used to compare blood flow properties in the treated aortas. We expand our previously published model to include the natural tapering of aortas. We look at change in aorta wall radius, blood pressure and blood flow velocity, and find that, of the two treatments, the resection and end-to-end anastomosis treatment more closely matches healthy aortas.
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Affiliation(s)
- Dilan Pathirana
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre , Griffith University , Nathan , Australia
| | - Barbara Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre , Griffith University , Nathan , Australia
| | - Peter Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre , Griffith University , Nathan , Australia
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