1
|
Sadeghipour P, Pouraliakbar HR, Farrashi M, Habibi Khorasani S, Mohebbi B, Iranian M, Babaei M, Forouzannia SM, Afrooghe A, Shafe O, Firouzi A, Hosseini F, Khalilipur E, Khajali Z, Saedi S, Abdi S, Moosavi J, Haulon S, Fraisse A. Balloon-expandable versus self-expanding stents in native coarctation of the aorta: three-year results of a randomised controlled trial. EUROINTERVENTION 2024; 20:613-615. [PMID: 38726718 PMCID: PMC11067719 DOI: 10.4244/eij-d-23-00846] [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] [Received: 10/05/2023] [Accepted: 02/16/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Parham Sadeghipour
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Melody Farrashi
- Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Habibi Khorasani
- Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Mohammadreza Iranian
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Mohammadreza Babaei
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Forouzannia
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Arya Afrooghe
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Faeghe Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular, Medical and Research Institute, Tehran, Iran
| | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
2
|
Pan M, Pericet C, González-Manzanares R, Díaz MA, Suárez de Lezo J, Hidalgo F, Alvarado M, Dueñas G, Gómez E, Espejo S, Perea J, Romero M, Ojeda S. Very long-term follow-up after aortic stenting for coarctation of the aorta. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:332-341. [PMID: 37981191 DOI: 10.1016/j.rec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.
Collapse
Affiliation(s)
- Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Cristina Pericet
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Manuel A Díaz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Javier Suárez de Lezo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Marco Alvarado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Guillermo Dueñas
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Elena Gómez
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Simona Espejo
- Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jorge Perea
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
| |
Collapse
|
3
|
Egbe AC, Miranda WR, Abozied O, Jain CC, Burchill LJ, Karnakoti S, Ahmed MH, Francois CJ, Connolly HM. Coarctation of Aorta With Tricuspid Aortic Valve Is Not Associated With Ascending Aortic Aneurysm. J Am Coll Cardiol 2024; 83:1136-1146. [PMID: 38508846 DOI: 10.1016/j.jacc.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Aortic aneurysm is common in patients with coarctation of aorta (COA), but it is unclear whether the risk of aortic aneurysms is due to COA or related to the presence of other risk factors such as bicuspid aortic valve (BAV) and hypertension. OBJECTIVES The purpose of this study was to assess the relationship among COA, BAV, and thoracic aortic aneurysms. METHODS A total of 867 patients with COA (COA group) were matched 1:1:1 to 867 patients with isolated BAV (BAV group) and 867 patients without structural heart disease (SHD) (no-SHD group). The COA group was further subdivided into a COA+BAV subgroup (n = 304 [35%]), and COA with tricuspid aortic valve (TAV) (COA+TAV subgroup [n = 563 (65%)]). Aortic dimensions were assessed at baseline and at 3, 5, and 7 years. RESULTS Compared with the no-SHD group, the COA+BAV subgroup had larger aortic root diameter (37 mm [Q1-Q3: 30-43 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001) and mid ascending aorta dimeter (34 mm [Q1-Q3: 29-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P = 0.008). Similarly, the BAV group had larger aortic root diameter (37 mm [Q1-Q3: 30-42 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001), and mid ascending aorta dimeter (35 mm [Q1-Q3: 30-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P < 0.001). Compared with the COA+TAV subgroup, the COA+BAV subgroup and BAV group were associated with larger aortic root and mid ascending aorta diameter at baseline and follow-up. The risk of acute aortic complications was low in all groups. CONCLUSIONS These findings suggest that BAV (and not COA) was associated with ascending thoracic aorta dimensions, and that patients with COA+TAV were not at a greater risk of developing ascending aortic aneurysms as compared with patients without SHD.
Collapse
Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA.
| | - William R Miranda
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abozied
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heidi M Connolly
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Qureshi F, Sivakumar K, Sagar P. Endoleak in covered CP stent causes procedural failure during transcatheter closure of sinus venosus defects. Catheter Cardiovasc Interv 2024; 103:317-321. [PMID: 38123891 DOI: 10.1002/ccd.30942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
Transcatheter sinus venosus defect closure uses a long covered stent of appropriate length and diameter across the cavoatrial junction after balloon interrogation. The fabric in the covered stent creates a roof for the right upper pulmonary vein that closes the interatrial communication and redirects the vein into the left atrium behind the stent. A fabric tear in the covered stent may cause endoleak that will result in residual flows across the struts of the covered stent, causing procedural failure. This report highlights the identification of fabric leak by angiography and transesophageal echocardiography and steps to overcome this complication by the placement of another overlapping covered stent.
Collapse
Affiliation(s)
- Farheen Qureshi
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| |
Collapse
|
5
|
Sagar P, Sivakumar K. Different mechanisms for persistent and residual left-to-right shunt after transcatheter sinus venosus defect closure and their management. Ann Pediatr Cardiol 2024; 17:45-51. [PMID: 38933051 PMCID: PMC11198930 DOI: 10.4103/apc.apc_190_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/06/2024] [Accepted: 04/06/2024] [Indexed: 06/28/2024] Open
Abstract
Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs.
Collapse
Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Colle A, Enciso SK, Brunee L, Sluysmans T, Kefer J, Astarci P, Lacroix V, Elens M. Aortic Coarctation Stenting in Adolescents and Adults: A Single-Center Experience. Vasc Endovascular Surg 2023; 57:863-868. [PMID: 37300455 DOI: 10.1177/15385744231183476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE/BACKGROUND The aim of this study was to evaluate the short and midterm results of aortic coarctation (AoCo) stenting in an adolescent and adult population. METHODS All patients with a AoCo older than 14 years treated by stent placement between December 2000 and November 2016 were included in this study. Twenty-eight patients with an invasive peak systolic pressure gradient >20 mmHg were identified. Number of redilations, non-invasive systolic blood pressure, peak systolic pressure gradient, antihypertensive medication intake, claudication status and complications were evaluated. RESULTS Twenty-two covered and 6 uncovered stents were successfully placed. Peak systolic pressure gradient decreased immediately after stenting from a mean of 32 mmHg to 0 mmHg (± 7 mmHg). Mean AoCo diameter increased from 8 tot 16 mm (± 4 mm). Peripheral arterial injury was seen in 2 patients (7.1%). The mean follow-up time was 60 ± 49 months. Redilation of the stent was required in 4 patients, 2 to accommodate for growth and 2 for restenosis. Six (35%) patients could stop all antihypertensive medication. All claudicants (6/28) became and remained asymptomatic after surgery and during their follow-up. No aneurysms, stent fractures or dissections were noticed. There were 2 stent migrations during the first procedure with only 1 needing additional stent placement. CONCLUSION Aortic coarctation stenting is a safe and effective treatment that significantly reduces the peak systolic pressure gradient. Antihypertensive medication can be reduced, and increase of walking distance in claudicants can be obtained. Younger patients may need more frequent reinterventions to accommodate for growth.
Collapse
Affiliation(s)
- Arnaud Colle
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Stéphane Kajingu Enciso
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Louise Brunee
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Thierry Sluysmans
- Department of Paediatrics, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Joëlle Kefer
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Parla Astarci
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Valerie Lacroix
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Maxime Elens
- Department of Cardiovascular Medicine, St Luc Hospital, Catholic University of Louvain, Brussels, Belgium
| |
Collapse
|
7
|
Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
|
8
|
Qureshi AM, Qureshi SA. Stenting of coarctation of the aorta-"Once and for all?". Catheter Cardiovasc Interv 2023; 102:966-967. [PMID: 37904668 DOI: 10.1002/ccd.30884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
Key Points
Long term hemodynamic benefit and survival are sustained in patients undergoing stenting of coarctation of the aorta with bare metal and covered Cheatham‐Platinum (CP) stents.
Reintervention and complication rates are similar with both bare metal and covered CP stents.
Routine advanced imaging should be performed periodically in the long‐term to assess for stent integrity and aortic wall injury, and to guide treatment/reintervention, when necessary.
Collapse
Affiliation(s)
- Athar M Qureshi
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shakeel A Qureshi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Mohammad Nijres B, Carr K, Aldoss O. A novel approach to place an adult-size stent to treat coarctation of the aorta using small introducers: "Nijres technique". Cardiol Young 2023; 33:2395-2401. [PMID: 37232082 DOI: 10.1017/s1047951123001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aortic arch stent placement in young children is a medical dilemma. This is attributed to the critical lack of commercially available stents that can be delivered through small sheaths and yet have the potential to be dilated to the adult-size aorta. Here in, we describe an innovative first-in-human technique that allows for overcoming the aforementioned challenges. A Palmaz Genesis XD stent was placed to treat coarctation of the aorta in two young children through small-bore sheaths.
Collapse
Affiliation(s)
- Bassel Mohammad Nijres
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Kaitlin Carr
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| | - Osamah Aldoss
- Pediatric Cardiology, Stead Family Children's Hospital, University of Iowa, Iowa City, USA
| |
Collapse
|
10
|
Raza S, Aggarwal S, Jenkins P, Kharabish A, Anwer S, Cullington D, Jones J, Dua J, Papaioannou V, Ashrafi R, Moharem-Elgamal S. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel) 2023; 13:2189. [PMID: 37443581 DOI: 10.3390/diagnostics13132189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Coarctation of the aorta (CoA) accounts for approximately 5-8% of all congenital heart defects. Depending on the severity of the CoA and the presence of associated cardiac lesions, the clinical presentation and age vary. Developments in diagnosis and management have improved outcomes in this patient population. Even after timely repair, it is important to regularly screen for hypertension. Patients with CoA require lifelong follow-up with a congenital heart disease specialist as these patients may develop recoarctation and complications at the repair site and remain at enhanced cardiovascular risk throughout their lifetime.
Collapse
Affiliation(s)
- Sadaf Raza
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Suneil Aggarwal
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Petra Jenkins
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Ahmed Kharabish
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Radiology Department, Al Kasr Al Aini, Old Cairo, Cairo 11562, Egypt
| | - Shehab Anwer
- Cardiology Department, University of Zurich, 8006 Zurich, Switzerland
| | - Damien Cullington
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Julia Jones
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Jaspal Dua
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Vasileios Papaioannou
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Reza Ashrafi
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
| | - Sarah Moharem-Elgamal
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Cardiology Department, National Heart Institute, Giza 11111, Egypt
| |
Collapse
|
11
|
Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults. Cardiol Young 2023; 33:354-361. [PMID: 36259152 DOI: 10.1017/s1047951122003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report our experience and early outcomes of using the BeGraft aortic stent in children, adolescents, and young adults. BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) requires a smaller long sheath compared to other covered stents, and it has a low profile and adequate radial power. With these features, it can overcome some limitations in the treatment of coarctation, especially in children. This is a single centre retrospective analysis of 11 implanted BeGraft aortic stents in coarctation of the aorta between July 2020 and November 2021. The eleven stents were successfully implanted in 11 patients (10 males). The median age of the patients was 13.7 years (interquartile range 12-16 years), and the median weight was 43 kg (interquartile range 35-62 kg). In five patients, after the stents were opened completely by the first balloon, they were exchanged with a Z-MED II™ balloon, 1-3 mm larger in diameter, and the stents were redilated. The median catheter-derived systolic peak-to-peak pressure gradient was 23 mm Hg (interquartile range 16-37 mmHg) before the procedure and 3 mm Hg (interquartile range 1-5 mm Hg) after the procedure. Except for the partial femoral artery thrombosis in two patients, no other procedural complications were observed in our study. The median follow-up duration was 5 months (interquartile range 2-12 months). During follow-up, only one patient (9%) had stent narrowing that required dilation. Our initial results and short-term follow-up showed that the BeGraft aortic stent implantation and redilation can be performed effectively, safely, and successfully in the treatment of coarctation of the aorta.
Collapse
|
12
|
Carminati M. Prime Time for Transcatheter Treatment of Coarctation of the Aorta. JACC Cardiovasc Interv 2023; 16:454-456. [PMID: 36858665 DOI: 10.1016/j.jcin.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 03/02/2023]
|
13
|
Eriksson P, Pihkala J, Jensen AS, Dohlen G, Liuba P, Wahlander H, Sjoberg G, Hlebowicz J, Furenas E, Leirgul E, Settergren M, Vithessonthi K, Nielsen NE, Christersson C, Sondergaard L, Sinisalo J, Nielsen-Kudsk JE, Dellborg M, Larsen SH. Transcatheter Intervention for Coarctation of the Aorta: A Nordic Population-Based Registry With Long-Term Follow-Up. JACC Cardiovasc Interv 2023; 16:444-453. [PMID: 36858664 DOI: 10.1016/j.jcin.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Coarctation of the aorta (CoA), a congenital narrowing of the proximal descending thoracic aorta, is a relatively common form of congenital heart disease. Untreated significant CoA has a major impact on morbidity and mortality. In the past 3 decades, transcatheter intervention (TCI) for CoA has evolved as an alternative to surgery. OBJECTIVES The authors report on all TCIs for CoA performed from 2000 to 2016 in 4 countries covering 25 million inhabitants, with a mean follow-up duration of 6.9 years. METHODS During the study period, 683 interventions were performed on 542 patients. RESULTS The procedural success rate was 88%, with 9% considered partly successful. Complications at the intervention site occurred in 3.5% of interventions and at the access site in 3.5%. There was no in-hospital mortality. During follow-up, TCI for CoA reduced the presence of hypertension significantly from 73% to 34%, but despite this, many patients remained hypertensive and in need of continuous antihypertensive treatment. Moreover, 8% to 9% of patients needed aortic and/or aortic valve surgery during follow-up. CONCLUSIONS TCI for CoA can be performed with a low risk for complications. Lifetime follow-up after TCI for CoA seems warranted.
Collapse
Affiliation(s)
- Peter Eriksson
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Jaana Pihkala
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | - Annette S Jensen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaute Dohlen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Hakan Wahlander
- University of Gothenburg, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gunnar Sjoberg
- Astrid Lindgren Children's Hospital and Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Furenas
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital and Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Lars Sondergaard
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Juha Sinisalo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | | | - Mikael Dellborg
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Signe H Larsen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
14
|
Bou-Chaaya RG, Zhu Z, Duarte VE, Lin CH. Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review. Methodist Debakey Cardiovasc J 2023; 19:78-90. [PMID: 37213883 PMCID: PMC10198245 DOI: 10.14797/mdcvj.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Structural interventions play a crucial role in the management of adult congenital heart disease (ACHD). In recent years, this field has seen significant advancements in catheter-based procedures despite limited investment from industry and lack of device development specific to this population. Because each patient is unique in their anatomy, pathophysiology, and surgical repair, many devices are used off-label with a "best fit" strategy. Therefore, continuous innovation is needed to adapt what is available to ACHD and to increase collaboration with industry and regulatory bodies to develop dedicated equipment. These innovations will further advance the field and offer this growing population less invasive options with fewer complications and faster recovery times. In this article, we summarize some of the contemporary structural interventions performed in adults with congenital defects and present cases performed at Houston Methodist to better illustrate them. We aim to offer a greater understanding of the field and stimulate interest in this rapidly growing specialty.
Collapse
Affiliation(s)
- Rody G. Bou-Chaaya
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Zhihao Zhu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Valeria E. Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| |
Collapse
|
15
|
Verheijen DBH, Stöger JL, van der Kley F, Schalij MJ, Jongbloed MRM, Vliegen HW, Kiès P, Egorova AD. A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview. Front Cardiovasc Med 2022; 9:1012147. [PMID: 36620635 PMCID: PMC9815109 DOI: 10.3389/fcvm.2022.1012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d'entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic "sawtooth" pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.
Collapse
Affiliation(s)
- D. B. H. Verheijen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J. Lauran Stöger
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - F. van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. J. Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. R. M. Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - H. W. Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - P. Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - A. D. Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: A. D. Egorova,
| |
Collapse
|
16
|
Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 358] [Impact Index Per Article: 179.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
| |
Collapse
|
17
|
Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Collapse
|
18
|
Bullock-Palmer RP, Bravo-Jaimes K, Mamas MA, Grines CL. Socioeconomic Factors and their Impact on Access and Use of Coronary and Structural Interventions. Eur Cardiol 2022; 17:e19. [PMID: 36643068 PMCID: PMC9820075 DOI: 10.15420/ecr.2022.23] [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: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023] Open
Abstract
In the past few decades, the accelerated improvement in technology has allowed the development of new and effective coronary and structural heart disease interventions. There has been inequitable patient access to these advanced therapies and significant disparities have affected patients from low socioeconomic positions. In the US, these disparities mostly affect women, black and hispanic communities who are overrepresented in low socioeconomic. Other adverse social determinants of health influenced by structural racism have also contributed to these disparities. In this article, we review the literature on disparities in access and use of coronary and structural interventions; delineate the possible reasons underlying these disparities; and highlight potential solutions at the government, healthcare system, community and individual levels.
Collapse
Affiliation(s)
| | - Katia Bravo-Jaimes
- Division of Cardiology, Department of Internal Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of CaliforniaLos Angeles, CA, US
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityKeele, UK
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Northside Cardiovascular Institute, Northside HospitalAtlanta, GA, US
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Pan J, Liu Y, He Y, Wang X, Tian L, Wang J, Fang X, Zhang H, Wu Z, Qiu C. Endovascular Treatments for Coarctation of the Aorta with Concurrent Poststenotic Aneurysms in Adults. Ann Vasc Surg 2022; 87:446-460. [PMID: 35688403 DOI: 10.1016/j.avsg.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coarctation of the aorta with poststenotic aneurysms is rare and complex. Here we report a relatively large group of endovascular treatments for the disease. MATERIALS AND METHODS Fifteen patients from two centers between 2006 and 2019 were included in the study. The patients were retrospectively divided into two groups. Patients in the complex group had insufficient proximal landing zone (<2 cm) or the zigzag shape of aorta. Their demographics, clinical manifestations, endovascular procedures, and follow-up results were analyzed. RESULTS There were 7 patients in the simple group and 8 patients in the complex group. Eleven patients were symptomatic. Despite the unfavorable anatomy in the complex group, technical success reached 100%. The diameter of coarctation increased from 8.6 mm to 16.7 mm with poststenotic aneurysms successfully excluded at the same time. In patients without sufficient proximal landing zone, left subclavian artery was covered by the stent grafts and then sacrificed (three patients) or revascularized (four patients). Other than one patient who suffered iliac artery rupture and received open repair, there was no other perioperative complications. Computed tomography angiography repeated at mean 42 months postoperation confirmed patency of stents and the exclusion of aneurysms with no aortic wall injury. Mild endoleaks occurred in two patients in the complex group and were left to observation. During 55.0 months follow-up, except for one patient who received secondary left subclavian artery fenestration, all other patients remained asymptomatic. CONCLUSIONS Endovascular treatments for coarctation of the aorta with poststenotic aneurysm showed a high technical success and could be an alternative solution for such disease.
Collapse
Affiliation(s)
- Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongchang Liu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jieqiong Wang
- Department of Operating room, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Fang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| |
Collapse
|
21
|
Homsi M, El Khoury M, Hmedeh C, Arabi M, El Rassi I, Bulbul Z, Sawaya F, Bitar F, Haddad F. Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 39:66-72. [PMID: 34916158 DOI: 10.1016/j.carrev.2021.10.010] [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: 06/15/2021] [Revised: 10/10/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks. MATERIALS/METHODS A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done. RESULTS 18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p < 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications. CONCLUSIONS Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.
Collapse
Affiliation(s)
- Mouafak Homsi
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Maya El Khoury
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Caroline Hmedeh
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Mariam Arabi
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Issam El Rassi
- American University of Beirut Medical Center, Department of surgery, Children Heart Center, Lebanon
| | - Ziad Bulbul
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fadi Sawaya
- American University of Beirut Medical Center, Department of Medicine, Lebanon
| | - Fadi Bitar
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fady Haddad
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon.
| |
Collapse
|
22
|
Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
Collapse
Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Bradley B. Keller
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
23
|
Schleiger A, Michel J, Kramer P, Buz S, Peters B, Photiadis J, Berger F, Nordmeyer J, Schubert S. Revascularization of Left Subclavian to Common Carotid Artery Prepares for Covered Stent Implantation in Patients With Complex Aortic Coarctation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:237-243. [PMID: 35616926 DOI: 10.1177/15569845221099298] [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: 01/28/2023]
Abstract
Seven adult patients underwent a two-stage treatment of complex coarctation (CoA), including surgical revascularization of the left subclavian artery (LSA) to left common carotid artery (LCCA), followed by transcatheter covered stent implantation. The majority of patients (5 of 7, 71%) received 1 covered stent (covered Cheatham Platinum stent: 8 zig/45 mm [n = 2], 10 zig/60 mm [n = 1], 10 zig/65 mm [n = 1]; BeGraft: 24/48 mm [n = 2]). In 1 patient (14%), the implantation of 2 covered stents (BeGraft 20/48 mm) was necessary. During a median follow-up of 2.4 years (interquartile range, 0.1 to 4.9 years), complications occurred in 3 of 7 patients (43%), including an asymptomatic but severe stenosis of the LSA bypass (n = 1), a recoarctation with a mild endoleak (n = 1), and a severe endoleak (n = 1). Surgical revascularization of the LSA to the LCCA can successfully prepare for covered stent implantation in complex CoA in adult patients. This two-stage approach was feasible and safe with complications occurring in 3 of 7 patients (43%). All complications were managed by catheter reintervention only.
Collapse
Affiliation(s)
- Anastasia Schleiger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology, and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Peter Kramer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Björn Peters
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Clinic of Ruhr University Bochum, Bad Oeynhausen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| |
Collapse
|
24
|
Fernández González L, Alcibar Villa J, Blanco Mata R, Arriola Meabe J, Galdeano Miranda JM. Unicentric experience in percutaneous stent treatment of aortic coarctation in children and teenagers. An Pediatr (Barc) 2022; 96:542-544. [DOI: 10.1016/j.anpede.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/02/2021] [Indexed: 10/18/2022] Open
|
25
|
Choi JH, Choi MS, Lee H. Emergency rescue stent grafting for a ruptured degenerated graft that bypassed coarctation of the aorta: a case report. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.21.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
26
|
Hascoët S, Karsenty C, Fraisse A. Efficacy of Self-Expandable Stents in Native Aortic Coarctation: A Single Flower Does Not Mean Spring (Persian Proverb). JACC Cardiovasc Interv 2022; 15:318-320. [PMID: 35144788 DOI: 10.1016/j.jcin.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sébastien Hascoët
- Marie Lannelongue Hospital, M3C Network, Groupe Hospitalier Paris Saint Joseph, School of Medicine, Paris-Saclay University, Inserm UMR S999, BME Lab, Le Plessis-Robinson, France; Department of Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom.
| | - Clément Karsenty
- Pediatric Cardiology Unit, Children's Hospital, CHU Toulouse, France; Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Alain Fraisse
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
27
|
Mingorance JDH, Pérez Bailón AM, Moreno Escobar JM, Salmerón Febres LM. Coarctation of the Aorta: An Atypical Case Treated with a Double Layer Technique. EJVES Vasc Forum 2022; 55:23-26. [PMID: 35299719 PMCID: PMC8920861 DOI: 10.1016/j.ejvsvf.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Coarctation of the aorta (CoA) is one of the more common congenital heart defects that usually manifests in adults as poorly controlled hypertension. When technically possible, the treatment of choice for adult CoA is an endovascular approach with covered stent placement. A case is presented with atypical clinical onset, treated endovascularly with a double layer stent technique. Report A 41 year old previously asymptomatic woman with an unremarkable past medical history presented with sudden dyspnoea, unstable blood pressure and pulse, and a radial femoral systolic pressure difference of 53 mmHg. A computed tomography scan showed coral reef aorta: aortic stenosis from a highly calcified lesion located distal to the origin of the left subclavian artery, compatible with CoA. Within a few hours, the patient went rapidly into cardiogenic shock with multiple organ failure requiring urgent intervention. Using a dual left iliac conduit and right brachial artery access, the lesion was pre-dilated with an 8 × 60 mm balloon. A double layer technique was then applied by coaxially deploying a BeGraft aortic stent (expanded to 18 mm) followed by a Conformable GORE® TAG® thoracic stent graft (26 × 26 × 100 mm). The patient's symptoms improved and the radial femoral systolic gradient decreased to 12 mmHg. Discussion Sudden onset CoA is a rare condition in adults that can lead to refractory cardiogenic shock and multiple organ failure. In anatomically complex cases, a double layer technique may be beneficial because it has high radial force and good wall apposition with lower risk of stent collapse than single stent deployment. Coarctation of the aorta can have a sudden presentation and lead to cardiogenic shock. The pathology can be caused by a very calcified aortic lesion (coral reef aorta). Endovascular treatment is the preferred approach in symptomatic adults. A dual layer technique may have a lower risk of stent collapse.
Collapse
|
28
|
Sherif NEE, Taggart NW. Covered Stents in the Management of Aortic Coarctation and Right Ventricular Outflow Tract Obstruction. Curr Cardiol Rep 2022; 24:51-58. [PMID: 35028814 DOI: 10.1007/s11886-021-01623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To review the use of covered stents in the treatment of coarctation of the aorta (CoA) and right ventricle to pulmonary artery (RV-PA) conduit obstruction. RECENT FINDINGS The only commercially available covered stent approved for treatment of CoA and dysfunctional RV-PA conduits is the covered Cheatham-Platinum stent (CCPS). Early outcomes have demonstrated its safety and have suggested its efficacy in treating or preventing aortic wall injury (AWI) or conduit disruption. A recent study of CCPS use for CoA reported a progressive risk of stent fracture over time and a risk of AWI despite the purported protection that the CCPS provides. The use of other covered stents has been reported, but large, systematic studies are lacking. CCPS use may reduce but does not eliminate the risk of conduit disruption or AWI. Structural limitations of the CCPS may predispose it to stent fracture. Access to a broad range of covered stents continues to be an unmet need in the field of congenital interventional cardiology.
Collapse
Affiliation(s)
- Nibras E El Sherif
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
29
|
Endovascular Repair of a Descending Thoracic Aortic Aneurysm in a Pediatric Patient with Tuberous Sclerosis: A Case Report and Review of the Literature. Pediatr Cardiol 2022; 43:238-243. [PMID: 34468774 DOI: 10.1007/s00246-021-02717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Aortic aneurysm in children is rare, but has been described in the tuberous sclerosis complex (TSC) population. While surgical repair has been utilized as the primary means of intervention, we present the first known case reporting exclusion of a descending thoracic aortic aneurysm with percutaneous covered stent implantation in a pediatric patient with TSC. A review of the literature is also included herein.
Collapse
|
30
|
Bruckheimer E, Birk E, Benson L, Butera G, Martin R, Roberts PA, Schneider MBE, Schubert S, Sievert H, Pedra CCA. Large Diameter Advanta V12 Covered Stent Trial for Coarctation of the Aorta: COARC Study. Circ Cardiovasc Interv 2021; 14:e010576. [PMID: 34749516 DOI: 10.1161/circinterventions.121.010576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Covered stent implantation for treatment of coarctation of the aorta (CoA) is effective and can prevent aortic wall injury. Prospective studies with long-term follow-up, including imaging, are lacking. We report the acute and long-term outcomes for use of the Large Diameter Advanta V12 covered stent for treatment of native and recurrent CoA. METHODS A prospective, multicenter, nonrandomized study was performed including 70 patients (43 male), median age 17 years, median weight 57.4 kg with CoA who underwent implantation of the Large Diameter Advanta V12 covered stent. Annual follow-up for 5 years included Doppler echocardiography to calculate diastolic velocity: systolic velocity ratio. RESULTS CoA diameter increased from 5.6±3.6 to 14.9±3.9 mm (P<0.0001) and the pressure gradient decreased from 35.8±16.2 to 5.6±7.9 mm Hg (P<0.0001). Preimplantation diastolic velocity:systolic velocity of 0.6±0.16 dropped to 0.34±0.13 (P<0.0001) and was maintained at 5 years. Computed tomography angiograms at 12 months postimplantation demonstrated the stent:transverse arch diameter to be similar, 0.91±0.09 to postprocedure 0.86±0.14. Major adverse vascular events at 30 days and 12 months were 1.4% and 4.3%, respectively. Significant adverse events included three patients who required stent implantation to treat infolding. There were no mortalities. CONCLUSIONS The Large Diameter Advanta V12 covered stent is safe and effective for the treatment of CoA with an immediate and sustained reduction of the pressure gradient over 12 months and 5 years as assessed by preimplantation and postimplantation Doppler echocardiography and 12-month computed tomography angiography. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00978952. URL: http://www.anzctr.org.au; Unique identifier: ACTRN12612000013864.
Collapse
Affiliation(s)
- Elchanan Bruckheimer
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel (E. Bruckheimer, E. Birk)
| | - Einat Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel (E. Bruckheimer, E. Birk)
| | - Lee Benson
- The Hospital for Sick Children, Toronto, Canada (L.B.)
| | | | - Robin Martin
- Bristol Royal Hospital for Children, United Kingdom (R.M.)
| | | | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin and Herz- und Diabeteszentrum Bad Oeynhausen, Germany (S.S.)
| | | | - Carlos C A Pedra
- Instituto Dante Pazzanese de Cardiologia, Sao Paolo, Brazil (C.C.A.P.)
| |
Collapse
|
31
|
Implantation of Covered Stent for Coarctation of the Aorta and Secondary Hypertension in Adolescents—Case Report. CHILDREN 2021; 8:children8111018. [PMID: 34828731 PMCID: PMC8623105 DOI: 10.3390/children8111018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta is a congenital cardiovascular anomaly with high morbidity and mortality rates. Arterial hypertension, heart failure, and aortic dissection are complications of this pathology, some of them being sometimes direct consequences of secondary hypertension. Periodic cardiology follow up after the procedure is mandatory to assess the hemodynamic response, to identify potential complications, and to stratify the cardiovascular risk.
Collapse
|
32
|
Fernández González L, Alcibar Villa J, Blanco Mata R, Arriola Meabe J, Galdeano Miranda JM. [Unicentric experience in percutaneous stent treatment of aortic coarctation in children and teenagers]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00252-6. [PMID: 34462229 DOI: 10.1016/j.anpedi.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Juan Alcibar Villa
- Cardiología Intervencionista, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Roberto Blanco Mata
- Cardiología Intervencionista, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Josune Arriola Meabe
- Cardiología Intervencionista, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | | |
Collapse
|
33
|
Stassen J, De Meester P, Troost E, Roggen L, Moons P, Gewillig M, Van De Bruaene A, Budts W. Covered stent placement for treatment of coarctation of the aorta: immediate and long-term results. Acta Cardiol 2021; 76:464-472. [PMID: 33108973 DOI: 10.1080/00015385.2020.1838126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to describe the safety and efficacy of covered stents in patients with coarctation of aorta (CoA) for immediate and long-term follow-up. BACKGROUND Covered stents are increasingly being used in (re)CoA, mainly to reduce the risk of aortic wall injuries (AWI). However, limited data are available on intermediate and long-term outcome. METHODS In 89 patients (67.4% male) with a mean age of 23.9 ± 15.8 (min max range 5.1-71.6) years were 102 covered stents implanted (January 2003 - December 2017). Short-term pre/post-implant hemodynamics and angiographic data were reported. Changes in blood pressure, the use of antihypertensive drugs and complications were recorded during follow-up. RESULTS The procedural success rate was 100%. The mean invasive ascending-to-descending aorta systolic gradient under general anaesthesia decreased from 25 ± 16 mmHg to 4 ± 7 mmHg (p < 0.001). After a mean follow-up time of 6.6 ± 3.7 years, there was a persistent improvement of the mean systolic blood pressure gradient between right arm and leg (-7 ± 18 vs 38 ± 24 mmHg; p < 0.001). A larger proportion of patients required antihypertensive medication (33.7% vs 50.0%, p = 0.017) and needed ≥ 2 drugs (20.2% vs 27.4%, p = 0.066) to control blood pressure. Long-term adverse events were found in 4.5% of patients [covered stent fracture (n = 3), aneurysm formation (n = 2)]. CONCLUSIONS Covered stent implantation for CoA is highly successful, safe and results in a persistent hemodynamic improvement in the immediate and long-term outcome. Lifelong follow-up with additional antihypertensive drug treatment is mandatory to maintain favourable hemodynamic results after stenting. CONDENSED ABSTRACT Long-term follow-up data on covered stents in patients with coarctation of the aorta are scarce. A cohort of 89 patients was reviewed. The procedural implantation success rate was 100%. The invasive gradient decreased from 25 ± 16 mmHg to 4 ± 7 mmHg (p < 0.001). After follow-up of 6.6 ± 3.7 years, there was a persistent improvement of the clinical systolic blood pressure gradient (-7 ± 18 vs 38 ± 24 mmHg; p < 0.001). However, a larger proportion of patients required antihypertensive medication (33.7% vs 50.0%, p = 0.017). Covered stent implantation results in favourable hemodynamic effects, but lifelong follow-up with additional antihypertensive drug treatment is mandatory to maintain these results.
Collapse
Affiliation(s)
- Jan Stassen
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Meester
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Els Troost
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Leen Roggen
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
34
|
Goldstein BH, Kreutzer J. Transcatheter Intervention for Congenital Defects Involving the Great Vessels: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:80-96. [PMID: 33413945 DOI: 10.1016/j.jacc.2020.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
Since the development of balloon angioplasty and balloon-expandable endovascular stent technology in the 1970s and 1980s, percutaneous transcatheter intervention has emerged as a mainstay of therapy for congenital heart disease (CHD) lesions throughout the systemic and pulmonary vascular beds. Congenital lesions of the great vessels, including the aorta, pulmonary arteries, and patent ductus arteriosus, are each amenable to transcatheter intervention throughout the lifespan, from neonate to adult. In many cases, on-label devices now exist to facilitate these therapies. In this review, we seek to describe the contemporary approach to and outcomes from transcatheter management of major CHD lesions of the great vessels, with a focus on coarctation of the aorta, single- or multiple-branch pulmonary artery stenoses, and persistent patent ductus arteriosus. We further comment on the future of transcatheter therapies for these CHD lesions.
Collapse
Affiliation(s)
- Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Kreutzer
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
35
|
Pu X, Wang M, Huang X, Zhang H, Huang L. Case report: a novel approach for the emergency repair of acute aortic rupture associated with congenital aortic Coarctation. J Cardiothorac Surg 2021; 16:170. [PMID: 34112233 PMCID: PMC8191040 DOI: 10.1186/s13019-021-01552-5] [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: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital aortic coarctation (CoA) associated with aortic rupture is a rare but extremely lethal condition. In pregnant patients, the condition becomes very risky. CASE PRESENTATION We presented a case of a pregnant (20 weeks gestation) patient with CoA associated with ruptured aortic pseudoaneurysm who was successfully rescued using a novel hybrid strategy. CONCLUSIONS This hybrid approach may be a life-saving bridging intervention in patients with CoA associated with devastating complications, such as ruptured aneurysms, especially with extremely narrowed access.
Collapse
Affiliation(s)
- Xin Pu
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyong Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
36
|
Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long-Term Outcomes of the Coarctation of the Aorta Stent Trials. Circ Cardiovasc Interv 2021; 14:e010308. [PMID: 34039015 DOI: 10.1161/circinterventions.120.010308] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Ralf J Holzer
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, NY (R.J.H.)
| | | | - Kerry McEnaney
- Department of Cardiology (K.M.), Boston Children's Hospital, MA
| | | | | |
Collapse
|
37
|
Affiliation(s)
- Gregory T Adamson
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Kyong-Jin Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
38
|
Rajan P, Kaur N, Barwad P, Revaiah PC, Rohit M. Coarctation of aorta intervention: When covered stents should have been first choice? Ann Pediatr Cardiol 2021; 14:204-207. [PMID: 34103861 PMCID: PMC8174632 DOI: 10.4103/apc.apc_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 02/14/2021] [Indexed: 11/08/2022] Open
Abstract
Coarctation of aorta (CoA) is one of the common congenital heart diseases. The two approaches for intervention in CoA include surgical and transcatheter (TC). Out of the two TC interventions available, stenting has been proved better than balloon angioplasty. We have two types of stents; the conventional ones – balloon expandable and the covered stent grafts. The elective covered stent implantation in all CoA has not offered any advantage. However, there are peculiar situations, apart from acute aortic complications, when they should be considered the first choice. We describe our experience of three cases of coarctation stenting, in which covered stenting should have been the preferred choice. A 32-year-old female with Turner's syndrome and severe CoA developed dissection after balloon angioplasty which was successfully managed with a covered stent. A 27-year-old female with near atresia of aorta was managed with balloon expandable stent which remained underexpanded despite post dilatation. A 17-year-old girl with severe CoA and patent ductus arteriosus (PDA) was managed with balloon angioplasty for the CoA and Amplatzer Duct Occluder I for the PDA. However, she developed re-coarctation in 6 months which was managed with a covered stent. Not all CoA requires the covered stents, but there are certain “high risk” CoA which require covered stent as first choice.
Collapse
Affiliation(s)
- Palanivel Rajan
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navjyot Kaur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parag Barwad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pruthvi C Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
39
|
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
40
|
YIN XIAOWEN, HU XIAOMIN, LI TONG, MA JIAYAO. A NEW RING STENT WITH GRADED GEOMETRY FOR TREATING COARCTATION OF CURVED AORTA ARTERIES. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ring stent implantation has been widely used to treat coarctation of the aorta (CoA) as an alternative to surgery. Currently adopted stents with uniform geometry may cause uneven stress distribution and high stress concentration in curved vessels, leading to in-stent restenosis (ISR). Inspired by functional graded material, here we propose a new ring-and-link stent, which has graded geometry in order to achieve a reduced peak stress when deployed in curved arteries. Numerical simulation of a single ring of the graded stent indicated that by varying the circumferential spacing of wave crest, the maximum stress exerted on the artery was reduced by as much as 27.86% in comparison with the uniform one. The effects of stent geometric parameters and artery curvature were also obtained through a parametric study. Finally, a whole stent was studied to verify the design, and a maximum stress reduction by 31.96% was achieved. In summary, the proposed graded ring stent shows great potential in clinical applications to reduce the risk of ISR.
Collapse
Affiliation(s)
- XIAOWEN YIN
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin 300350, P. R. China
| | - XIAOMIN HU
- Tianjin Third Central Hospital, 83 Jintang Road, Tianjin 300170, P. R. China
| | - TONG LI
- Tianjin Third Central Hospital, 83 Jintang Road, Tianjin 300170, P. R. China
| | - JIAYAO MA
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin 300350, P. R. China
| |
Collapse
|
41
|
Blais B, Carr K, Sinha SP, Salem MM, Levi DS. Mechanical properties of low-diameter balloon expandable covered stents. Catheter Cardiovasc Interv 2021; 97:451-458. [PMID: 33283447 DOI: 10.1002/ccd.29421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/12/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine over-dilation potential of commercially available covered stents. BACKGROUND Covered stents including the Atrium iCast, Gore VBX, and Lifestream stents (LS) can treat ruptures, dissections, and aneurysms in small vessels. Especially in growing patients, stents often require serial dilations beyond their implant or nominal diameters. Tolerance of serial dilations is clinically important information for interventionalists. METHODS Serial dilations of 5-12 mm iCast, VBX, and LS covered stents were performed in 1-2 mm increments (up to 20 mm). With each dilation, foreshortening and recoil were measured, and stent strut and covering integrity were assessed. High-pressure balloons were used to expand the stents until they fractured or could not be further expanded. RESULTS The 5-8 mm LS tolerated dilation to 14.5-16 mm. The 10-12 mm LS stents tolerated dilation to 18 mm and fractured on the 20 mm balloon. LS stents foreshortened 35%-45% on average after 8 mm of over-dilation and had 5%-10% recoil on <6 mm over-dilation. All iCast stents tolerated dilation to 12-13 mm and required fracture for dilation to >14 mm. ICast stents foreshortened 19%-29% at maximum dilation, with 3-6% recoil on <2 mm over-dilation, and < 3% thereafter. VBX stents over-dilated to 2.9-4.7 mm above nominal, foreshortening 40%-50% after 4-6 mm of over-dilation before collapsing into a ring. VBX stent recoil was <2.5% on all dilations. CONCLUSIONS LS stents had the greatest over-dilation potential. VBX stents had the least recoil but tended to foreshorten significantly 3-4 mm above nominal. Regardless of nominal size, all iCast stents (including the 5 mm) tolerated dilation to a maximum of 12-13 mm.
Collapse
Affiliation(s)
- Benjamin Blais
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Karen Carr
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Sanjay P Sinha
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA.,2UCI/CS CHOC Children's Hospital
| | - Morris M Salem
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA
| |
Collapse
|
42
|
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 839] [Impact Index Per Article: 279.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
43
|
Initial experience with a novel ePTFE-covered balloon expandable stent in patients with near-atretic or severe aortic coarctation and small femoral arterial access. Cardiol Young 2021; 31:224-228. [PMID: 33172512 DOI: 10.1017/s1047951120003728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We report our experience of using the Bentley BeGraft Aortic stent in patients with severe or near-atretic aortic coarctation and small femoral arterial access. BACKGROUND Use of covered stent is recommended in some settings such as aortic coarctation with associated aneurysm, Turner syndrome, and coarctation with aortic atresia. However, currently available covered stents need larger sheaths that may limit their use in children and patients with smaller arterial access. Newer stents may overcome this limitation. METHODS Single-centre retrospective study of patients with severe or near-atretic aortic coarctation and small femoral arterial access. RESULTS Between July and October, 2019, five patients (median age 15 years) with near-atretic or severe coarctation were treated with a Bentley BeGraft Aortic stent. Long sheaths between 9 and 11 Fr were used to implant stents, which were dilated up to 12-16 mm. None of the patients had residual coarctation (gradient >20 mm of mercury) after stenting. None of the patients developed acute vascular injuries or local access related complications at the end of the procedure or during follow-up (range 6-10 months). CONCLUSIONS Bentley BeGraft aortic stents are important to consider in patients with severe coarctation and provided acute procedural success in patients with small femoral arterial access and widen the applicability in this patient population.
Collapse
|
44
|
Hatoum I, Haddad RN, Saliba Z, Abdel Massih T. Endovascular stent implantation for aortic coarctation: parameters affecting clinical outcomes. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 10:528-537. [PMID: 33489455 PMCID: PMC7811920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/30/2020] [Indexed: 09/28/2022]
Abstract
OBJECTIVE To evaluate safety and efficacy of endovascular stenting for aortic coarctation (AC) and to explore the effect of clinical parameters and stent characteristics on outcomes. MATERIAL AND METHODS Clinical data of all patients with AC who had attempted transcatheter stenting between 2004 and 2019 were retrospectively reviewed. Eligible patients had native or recurrent AC with systemic arterial hypertension and resting arm-leg pressure gradient > 20 mmHg. Exclusions included distance between takeoff of cervical arteries and stenotic aortic lesion < 10 mm, contraindication to antithrombotic therapy, bodyweight < 25 kg, and secondary hypertension. RESULTS A total of 20 patients (75.0% with native lesions) were included with a mean age of 18.4 years and a mean bodyweight of 59.2 kg. Procedure was successful in 90.0% of cases with an immediate drop in the invasive pressure gradient across lesions. On a median follow-up of 12 months (range, 8 to 144.9 months), coarctation reoccurred in five patients, but four of them required intervention after a median of 104.4 months with successful outcomes. Cheatham Platinum stents were significantly associated with lower rates of recoarctations and reinterventions. At the latest follow-up, three out of six patients with persistent hypertension had no recoarctation. Analysis showed that the need for antihypertensive therapy was not influenced by clinical parameters, aortic arch geometry, or stent characteristics. CONCLUSION Treating AC with stent implantation is a safe and successful procedure. Using Cheatham Platinum stents appears to be associated with better outcomes. The persistence of arterial hypertension despite successful stenting remains a complex and challenging phenomenon.
Collapse
Affiliation(s)
- Ibrahim Hatoum
- Department of Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University Beirut, Lebanon
| | - Raymond N Haddad
- Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University Beirut, Lebanon
| | - Zakhia Saliba
- Department of Pediatric Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University Beirut, Lebanon
| | - Toni Abdel Massih
- Department of Cardiology, Hotel Dieu de France University Medical Center, Saint Joseph University Beirut, Lebanon
| |
Collapse
|
45
|
Abdominal pain after stenting for aortic coarctation. J Vasc Surg Cases Innov Tech 2020; 6:678-680. [PMID: 33251396 PMCID: PMC7680694 DOI: 10.1016/j.jvscit.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
A 56-year-old man underwent stenting for treatment of coarctation of the aorta. He subsequently developed severe abdominal pain and paradoxical postoperative hypertension. Abdominal computed tomography revealed two long mesenteric artery lesions. After potent antihypertensive therapy, he did not develop intestinal necrosis, and he was discharged with no recurrent abdominal pain. Although postcoarctectomy syndrome is rare in the current era of nonsurgical intervention for coarctation of the aorta, it can still occur and should be carefully managed to prevent intestinal necrosis.
Collapse
|
46
|
Fujii T, Tomita H, Kobayashi T, Kato H, Sugiyama H, Mizukami A, Ueda H. Clinical trial of the CP stent for pulmonary artery stenosis: the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan. Heart Vessels 2020; 36:291-296. [PMID: 32889644 DOI: 10.1007/s00380-020-01691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022]
Abstract
Stenting is an important treatment option for pulmonary artery stenosis (PS) associated with congenital heart disease (CHD). However, no stent has been approved for this indication in Japan, despite negotiation between academia and the regulatory bodies for longer than 20 years. To evaluate efficacy and safety of the CP stent, we performed the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan. This trial was designed as a single-arm, prospective, clinical trial. Patients who had postoperative PS associated with CHD were included. Stenting was attempted in 24 cases and succeeded in 22 cases. The median age of the patients was 11 years (3-36 years) and weight was 38 kg (12-69 kg), while follow-up for 12 months was completed. In all 22 cases, stenting was successful, with a 50% increase in the minimum lumen diameter (MLD) in 86.4% of patients (90% confidence interval, 68.4-96.2%). The mean percent change in MLD was 119.3 ± 52.5%. In two-ventricle repair, the mean percent change in systolic right ventricular/aortic pressure was - 8.5 ± 16.1%, while that of pressure gradient was - 55.9 ± 41.7%. In single-ventricle repair, the percent change in the mean pressure gradient was - 100.0 ± 0%, while that of SaO2 was 1.4 ± 1.7%. No serious adverse events or significant restenosis was reported. The CP stent is highly effective and safe for PS associated with CHD. This study has significant importance in not only scientific but also social considerations.
Collapse
Affiliation(s)
- Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan.
| | - Hideshi Tomita
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hitoshi Kato
- Department of Pediatric Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ayumi Mizukami
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| |
Collapse
|
47
|
Abstract
This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance.
Collapse
|
48
|
Marcus BS, Rubio A, Deen JF. Transcatheter relief of coarctation of the aorta in a persistent fifth aortic arch anatomy. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101200] [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: 10/25/2022]
|
49
|
Abstract
Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and lifelong surveillance to identify long-term complications.
Collapse
Affiliation(s)
- Yuli Y Kim
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Lauren Andrade
- Philadelphia Adult Congenital Heart Center, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine and Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen C Cook
- Adult Congenital Heart Disease Program, Congenital Heart Center, Helen DeVos Children's Hospital, Frederik Meijer Heart & Vascular Institute, Pediatrics and Human Development, Michigan State University, 25 Michigan Street NE Suite 4200, Grand Rapids, MI 49503, USA
| |
Collapse
|
50
|
Pan M, Ojeda S, Hidalgo F, Suárez de Lezo J, Lostalo A, Mazuelos F, Segura J, Pericet C, Luque A, González R, Fernández A, Gomez E, Romero M. Percutaneous reintervention on aortic coarctation stenting. EUROINTERVENTION 2020; 15:1464-1470. [DOI: 10.4244/eij-d-18-00923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|