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Long-term observation of adults after successful repair of aortic coarctation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 15:455-464. [PMID: 31933662 PMCID: PMC6956463 DOI: 10.5114/aic.2019.90220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Despite successful repair of aortic coarctation, cardiovascular complications occur. Aim To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair. Material and methods Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed. Results The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO2/kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, p < 0.001, VE/VCO2 peak higher 28.18 ±4.69 vs. 26.78 ±3.13, p = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, p < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, p < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, r = 0.29, p = 0.025, wall thickness, r = 0.31, p = 0.039. Age at operation was related to left ventricle wall thickness, r = 0.27, p = 0.041, and carotid intima-media thickness, r = 0.26, p = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results. Conclusions Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.
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Meijs TA, Warmerdam EG, Slieker MG, Krings GJ, Molenschot MMC, Meijboom FJ, Sieswerda GT, Doevendans PA, Bouma BJ, de Winter RJ, Mulder BJM, Voskuil M. Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis. Heart 2019; 105:1464-1470. [PMID: 31315937 DOI: 10.1136/heartjnl-2019-314965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Long-term prognosis of patients with coarctation of the aorta (CoA) is impaired due to the high prevalence of hypertension and consequent cardiovascular complications. Although stent implantation results in acute anatomical and haemodynamic benefit, limited evidence exists regarding the late clinical outcome. In this meta-analysis, we aimed to evaluate the medium-term effect of stent placement for CoA on systemic blood pressure (BP). METHODS PubMed, EMBASE and Cochrane databases were searched for non-randomised cohort studies addressing systemic BP ≥12 months following CoA stenting. Meta-analysis was performed on the change in BP from baseline to last follow-up using a random-effects model. Subgroup analyses and meta-regression were conducted to identify sources of heterogeneity between studies. RESULTS Twenty-six studies with a total of 1157 patients and a median follow-up of 26 months were included for final analysis. Meta-analysis showed a 20.3 mm Hg (95% CI 16.4 to 24.1 mm Hg; p<0.00001) reduction in systolic BP and an 8.2 mm Hg (12 studies; 95% CI 5.2 to 11.3 mm Hg; p<0.00001) reduction in diastolic BP. A concomitant decrease in the use of antihypertensive medication was observed. High systolic BP and peak systolic gradient at baseline and stenting of native CoA were associated with a greater reduction in systolic BP at follow-up. CONCLUSIONS Stent implantation for CoA is associated with a significant decline in systolic and diastolic BP during medium-term follow-up. The degree of BP reduction appears to be dependent on baseline systolic BP, baseline peak systolic gradient, and whether stenting is performed for native or recurrent CoA.
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Affiliation(s)
- Timion A Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mirella M C Molenschot
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gertjan T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Hartman EMJ, Groenendijk IM, Heuvelman HM, Roos-Hesselink JW, Takkenberg JJM, Witsenburg M. The effectiveness of stenting of coarctation of the aorta: a systematic review. EUROINTERVENTION 2016; 11:660-8. [PMID: 26499220 DOI: 10.4244/eijv11i6a133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually reported in small retrospective case series. This systematic review provides an overview of clinical experience with stenting for CoA. METHODS AND RESULTS A systematic review of the reports published between January 1990 and December 2014 after stenting a CoA was performed with a focus on relief of obstruction and lowering of blood pressure. Study and patient characteristics were extracted, as well as pre- and post-stenting aortic diameter in mm, systolic pressure gradient (SPG) and pre- and post-stenting systolic blood pressure (mmHg), periprocedural and follow-up complications. Forty-five articles met the inclusion criteria. Three outcomes were extracted from the articles - aortic diameter, systolic pressure gradient and blood pressure. Diameter increased from 6.4 mm (5.6, 7.3) to 15.1 mm (14.5, 15.7), pressure gradients decreased from 40 mmHg (35, 42) to 4 mmHg (3, 5) and systolic blood pressure decreased from 153 mmHg (148, 158) to 132 mmHg (127, 136). Stent migration was the most common periprocedural complication (2.4%), and mortality was low (0.4%). CONCLUSIONS Stenting is an effective treatment with regard to immediate relief of obstruction and direct lowering effect on blood pressure. However, there is a lack of evidence regarding late effectiveness concerning durable blood pressure lowering, and limited information on periprocedural and late complications. This observation calls for a systematic and longer prospective follow-up of patients after CoA stenting.
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Affiliation(s)
- Eline M J Hartman
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kische S, D'Ancona G, Stoeckicht Y, Ortak J, Elsässer A, Ince H. Percutaneous treatment of adult isthmic aortic coarctation: acute and long-term clinical and imaging outcome with a self-expandable uncovered nitinol stent. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001799. [PMID: 25582143 DOI: 10.1161/circinterventions.114.001799] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To present perioperative and long-term results of percutaneous treatment of adult isthmic coarctation of the aorta by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany). METHODS AND RESULTS Preoperative, perioperative, and long-term clinical and computed tomographic angiography data were collected and analyzed prospectively. A total of 52 consecutive patients were treated with the Sinus-XL stent. Mean age was 36.6 (21-67) years, peak invasive trans-coarctation of the aorta gradient was 54.7 ± 9.9 mm Hg, and upper body hypertension unresponsive to medical treatment was present in all patients. Mean stent diameter and length were 24.2 mm (22-28 mm) and 70.4 mm (40-80 mm), respectively. Eight patients (15.4%) required coarctation of the aorta predilatation. All patients underwent poststent dilatation with a noncompliant balloon. Postoperative peak gradient (3.3 ± 2.5 mm Hg) was reduced significantly (P < 0.001) and minimal aortic diameter was increased significantly (4.6 ± 1.9 versus 18.6 ± 2.5 mm; P < 0.001). All patients were discharged home (mean hospitalization, 3.5 days). At follow-up (47.6 months; 12-84), 1 (1.9%) noncardiovascular mortality was reported. Aortic computed tomography confirmed the absence of stent collapse and secondary migration and documented stability in aortic diameter (18.3 ± 2.7 mm). Thirty patients (57.7%) were completely weaned-off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P < 0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P < 0.001). CONCLUSIONS Adult coarctation of the aorta treatment by means of a self-expandable uncovered stent is safe and durable. The peculiar stent design maintains adequate localized radial strength over time with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimization is immediate and persistent even at long-term follow-up.
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Affiliation(s)
- Stephan Kische
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Giuseppe D'Ancona
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
| | - Yannik Stoeckicht
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Jasmin Ortak
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Albrecht Elsässer
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Hüseyin Ince
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
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Lara-Rojas CM, Bernal-Lopez MR, Lopez-Carmona MD, Gomez-Huelgas R. Familial aortic coarctation: a rare cause of refractory hypertension in the elderly: a case report. Medicine (Baltimore) 2015; 94:e467. [PMID: 25634191 PMCID: PMC4602944 DOI: 10.1097/md.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report the first case of late presentation of familial aortic coarctation, a rare cause of hypertension. Diagnosis of familial aortic coarctation in the elderly is exceptional, given that in the absence of endovascular or surgical repair patients do not usually survive beyond 50 years of age. Our case concerns a 72-year-old woman with hypertension of long evolution, control of which improved markedly after endovascular repair of the coarctation. Her son had undergone surgery for repair of aortic coarctation at the age of 23 years.
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Affiliation(s)
- Carmen M Lara-Rojas
- From the Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Spain (CML-R, MDL-C, G-H); Ciber Fisiopatología de la Obesidad y Nutrición (CB06/003) Instituto de Salud Carlos III, Madrid, Spain (MRB-L, RG-H); and Biomedical Research Laboratory, Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), Regional University Hospital of Malaga, Spain (MRB-L)
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Ang HL, Lim CW, Hia C, Yip J, Quek SC. Coarctation of the aorta: nonsurgical treatment using stent implantation. Singapore Med J 2014; 55:302-4. [PMID: 25017404 DOI: 10.11622/smedj.2014080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Coarctation of the aorta (CoA) accounts for 5%-8% of all congenital heart defects. If left untreated, most patients with significant CoA will have varying degrees of morbidity (e.g. hypertension, stroke, collateral formation and ventricular hypertrophy), possibly even mortality. Traditionally, treatment for this condition is surgical. Herein, we report stenting during catheterisation as an alternative nonsurgical treatment option for patients with CoA, and present the treatment outcomes of patients who underwent this treatment option. METHODS We retrospectively reviewed four patients (2 men and 2 women; age range 20-41 years) who underwent CoA stenting under general anaesthesia for the treatment of native CoA or restenosis of CoA at our institution. Three patients had a 40-mm Palmaz stent inserted, while one had a 39-mm Cheatham-Platinum covered stent inserted. Angiography and measurement of pressure gradients were performed before and after stent implantation to ensure good treatment outcomes. RESULTS The patients' treatment outcomes were good, with a significant reduction in pressure gradients across the narrowed segments. Angiography showed relief of CoA. The patients were followed up for 1-3 years, during which no complications were noted. CONCLUSION This is the first reported series in Singapore on the nonsurgical treatment of CoAs in adult patients using stents during interventional cardiac catheterisation. This less invasive procedure may lead to a new paradigm shift with regard to the treatment of CoA.
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Affiliation(s)
| | | | | | | | - S C Quek
- Division of Cardiology, Department of Paediatrics, National University of Singapore, Lower Kent Ridge Road, Singapore. swee _chye
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Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation: immediate and intermediate-term results. JACC Cardiovasc Interv 2014; 7:416-23. [PMID: 24630880 DOI: 10.1016/j.jcin.2013.11.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 11/11/2013] [Accepted: 11/21/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to evaluate the outcomes of endovascular treatment with covered versus bare Cheatham-platinum stents (NuMed, Hopkinton, New York) in coarctation of aorta (CoA) patients. BACKGROUND Covered stenting has been newly recognized as a useful therapeutic method for patients with native CoA, but there has been no study comparing the use of covered stents with bare stents for treating CoA. METHODS In this randomized clinical trial, 120 patients with a mean age of 23.60 ± 10.99 years (range 12 to 58 years, 79 men), with post-ductal, short-segment, severe native CoA underwent implantation of bare Cheatham-Platinum (bCP) (n = 60) or covered Cheatham-Platinum (cCP) (n = 60) stents. Patients were followed clinically at 1, 3, 6, and 12 months after the stenting and yearly thereafter. During follow-up, multislice computed tomography (64 slices) was scheduled to assess any complications. RESULTS The procedural success rate was 100% in both groups. Patients were followed for 31.1 ± 19.2 months. Although recoarctation was seen only in the bCP group during follow-up, the difference between groups did not reach statistical significance (6.7% vs. 0%; p = NS). Two cases of pseudoaneurysm (3.3%) occurred in the cCP group, but none was observed in the bCP group (p = NS). Normotensive status significantly increased during follow-up in both groups (from 15% to 73.3% in the bCP group and 16.7% to 78.3% in the cCP group, p < 0.001 for each group and not significant between groups). CONCLUSIONS Implanting bCP and cCP stents have very high success rates with remarkable hemodynamic effects in severe native CoA patients. Patients undergoing cCP stent implantation experienced a nonsignificantly lower recoarctation rate and a higher occurrence of pseudoaneurysm formation with respect to bCP stenting during follow-up. These findings indicate that CoA stenting is a safe procedure. (Endovascular Stenting With Covered CP Stent Compared With Bare CP Stent for Adult Patients With Coarctation: The Initial and Intermediate-Term Follow-Up Results; IRCT201012045311N1).
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Morbi A, Gohel MS, Hamady M, Cheshire NJ, Bicknell CD. Lower-Limb Ischemia in the Young Patient: Management Strategies in an Endovascular Era. Ann Vasc Surg 2012; 26:591-9. [DOI: 10.1016/j.avsg.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/22/2022]
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Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP. Congenital Heart Defects in Adults : A Field Guide for Cardiologists. ACTA ACUST UNITED AC 2012. [PMID: 24294540 DOI: 10.4172/2155-9880.s8-007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advances in cardiology and cardiac surgery allow a large proportion of patients with congenital heart defects to survive into adulthood. These patients frequently develop complications characteristic of the defect or its treatment. Consequently, adult cardiologists participating in the care of these patients need a working knowledge of the more common defects. Occasionally, patients with congenital heart defects such as atrial septal defect, Ebstein anomaly or physiologically corrected transposition of the great arteries present for the first time in adulthood. More often patients previously treated in pediatric cardiology centers have transitioned to adult congenital heart disease centers for ongoing care. Some of the more important defects in this category are tetralogy of Fallot, transposition of the great arteries, functionally single ventricle defects, and coarctation. Through this field guide, we provide an overview of the anatomy of selected defects commonly seen in an adult congenital practice using pathology specimens and clinical imaging studies. In addition, we describe the physiology, clinical presentation to the adult cardiologist, possible complications, treatment options, and outcomes.
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Affiliation(s)
- Anitra Romfh
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA ; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Open surgical repair and endovascular treatment in adult coarctation of the aorta. Ann Vasc Surg 2011; 24:1068-74. [PMID: 21035699 DOI: 10.1016/j.avsg.2010.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 04/03/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to compare the results of endovascular therapy (covered stenting) with surgical technique to repair aortic coarctation in adults. METHODS A prospective study of 11 patients who were treated during the past 10 years was carried out. Of these, five patients underwent endoprosthesis (group A) and six an open surgical repair (group B). Follow-up comprised monitoring of the blood pressure, echocardiography, and computed tomography and magnetic resonance angiographic studies. RESULTS The mean age of the patients was 46 years (range: 17-67 years) and the mean follow-up was 52.6 months (range: 1-117 months; 32.3 for group A vs. 69.7 for group B; p = 0.01). Two cases in group A were recoarctations after child angioplasty. The rate of postoperative complications was 27.7% (one hemothorax for group A vs. one pneumothorax and one hemothorax for group B); however, mortality did not occur. The success rate of the endovascular technique was 80%. The stay in the intensive care unit was 2.3 days with significant differences (one group A vs. three group B; p = 0.01), whereas length of hospital stay was 11 days (7.8 group A vs. 11.83 group B; p = 0.17). The pressure gradient across the stenosis decreased by 21.9 ± 3.7 mm Hg (24.5 ± 4.3 group A vs. 33 ± 3.2 group B). Six patients (54.5%) showed persistent hypertension (80% group A vs. 33% group B), with a mean residual pressure gradient of 23.4 ± 4.3 mm Hg (22.5 ± 5.4 group A vs. 22 ± 2.1 group B; p = 0.58). CONCLUSIONS Short- and medium-term results of the endovascular therapy are similar, with shorter stay in the intensive care unit and higher necessity of antihypertensive treatment. Echocardiography and Doppler aortic coarctation gradients slightly higher than 20 mm Hg are usual during follow-up.
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Moltzer E, Roos-Hesselink J, Yap S, Cuypers J, Bogers A, de Jaegere P, Witsenburg M. Endovascular stenting for aortic (re)coarctation in adults. Neth Heart J 2010; 18:430-6. [PMID: 20862238 PMCID: PMC2941129 DOI: 10.1007/bf03091810] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives. Stenting for native and recurrent coarctation (COA) in adults has become an important therapeutic strategy. In this prospective observational study we evaluated the intermediate-term outcome of stent implantation for either native or recurrent (re)COA in adults.Methods. All adults who underwent stent implantation in our institution between January 2003 and December 2008 were included. Diagnosis of (re)COA was based upon a combination of clinical signs, noninvasive imaging or invasive gradient measurements. NuMED stents were implanted under general anaesthesia.Results. Twenty-four patients (50% male) underwent stent implantation for native (n=6) or reCOA (n=18) at a median age of 36 (18 to 60) years. There was significant improvement in pre- versus post-stent invasive systolic gradient (19 vs. 0 mmHg, p<0.001) and COA diameter (10 vs. 16 mm, p<0.001). Acute complications (12.5%) included death due to aortic rupture despite immediate successful coverage with a covered stent (n=1) and groin haematoma (n=2). During a median follow-up period of 33 (8 to 77) months (n=22), late complications occurred in three patients (13.6%): stent migration to the ascending aorta (n=1), pseudoaneurysm at the site of the initial stent (n=1), and occluded external iliac artery (n=1). Stent implantation did not reduce the need for antihypertensive medication or blood pressure at last follow-up. Conclusion. COA stenting results in a significant gradient decrease and increase in vessel diameter. However, serious complications do occur and hypertension remains in the majority of patients. (Neth Heart J 2010;18:430-6.).
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Affiliation(s)
- E. Moltzer
- Department of Cardiology, Thoraxcenter and Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - J.W. Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - S.C. Yap
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - J.A.A.E. Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - A.J.J.C. Bogers
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - P.P.T. de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - M. Witsenburg
- Department of Cardiology, Thoraxcenter and Division of Paediatric Cardiology, Departments of Paediatrics, Erasmus MC, Rotterdam, the Netherlands
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Kische S, Schneider H, Akin I, Ortak J, Rehders TC, Chatterjee T, Nienaber CA, Ince H. Technique of interventional repair in adult aortic coarctation. J Vasc Surg 2010; 51:1550-9. [DOI: 10.1016/j.jvs.2009.12.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW Coarctation of the aorta is the discrete narrowing of the proximal descending aorta and is the sixth most common lesion in congenital heart disease. Repair of the coarctation can relieve the obstruction, but recurrent coarctation and future aneurysm formation can occur, and a heightened risk of vascular disease is present. This review focuses on advances in the management of native and previously treated coarctation and provides insights into future vascular risk. RECENT FINDINGS Coarctation of the aorta is associated with other left heart obstructive lesions, and advances in the genetic basis of these conditions have been made. Recurrent coarctation and aneurysm formation are common after surgical and endovascular repair of coarctation of the aorta. Endovascular treatment is an acceptable alternative to surgical repair of native and recurrent coarctation. Covered stents and stent grafts can be used to treat arch complications with a low risk of complications. In spite of repair of the obstruction, hypertension persists and appears to be multifactorial due to a variety of factors, including endothelial dysfunction, aortic stiffness, altered arch morphology and increased ventricular stiffness. SUMMARY People with previously repaired coarctation of the aorta require long-term surveillance for local complications with aortic imaging and surveillance and management of hypertension to prevent vascular disease.
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