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Kasar T, Erkut O, Tanidir İC, Şahin M, Topkarci MA, Guzeltas A. Balloon-expandable stents for native coarctation of the aorta in children and adolescents. Medicine (Baltimore) 2022; 101:e32332. [PMID: 36595787 PMCID: PMC9794334 DOI: 10.1097/md.0000000000032332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although balloon-expandable stent implantation for native aortic coarctation is a preferred method in the adolescent age group, there are insufficient data about indications for and the efficacy of the procedure in a younger age group. The aim of this study was to compare and evaluate the data of young pediatric and adolescent patients who underwent balloon-expandable stent implantation because of native aortic coarctation. The retrospective analysis included the demographic characteristics and data related to the procedure and follow-up of patients who underwent stent implantation for native aortic coarctation between August 2010 and November 2017. Patients with re-coarctation were excluded from the study. The patients were separated into 2 groups as the adolescent group (Group I: 10-18 years) and the pediatric group (Group II: ≤ 9.9 years). Group-I comprised of 18 patients and Group-II, 32 patients. Covered stent was implanted to 32 (73%) patients and uncovered stent to 12 (27%) patients. The procedural success rate was 100%. Following stent implantation, peak systolic gradient decreased significantly in both groups (P < .0001) (Group-I: from 35.9 ± 16.6 mm Hg-2.2 ± 3.4 mm Hg, Group II: from 34 ± 13.3 mm Hg-3 ± 4.09 mm Hg). Complications developed in 3 patients, and all in Group I. Femoral hematoma developed in 1 patient, balloon rupture occurred during the procedure in 1 patient, and there was temporary loss of pulse in 1 patient. All the complications were treated successfully. All the patients were taking anti-hypertensive drugs before intervention and during the mean 23-month follow-up period (range, 2-84 months), hypertension recovered in 35 (80%) patients and drugs were terminated. Stent implantation for aortic coarctation in the pediatric age group may provide pleasing results, reducing the coarctation gradient, providing effective dilatation in the lesion area and eliminating hypertension.
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Affiliation(s)
- Taner Kasar
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
- * Correspondence: Taner kasar, Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyon Mah.Turgut Ozal Bulvari No:11 Kucukcekmece, Istanbul 34303, Turkey (e-mail: )
| | - Ozturk Erkut
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - İ. Cansaran Tanidir
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Murat Şahin
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - M. Akin Topkarci
- Department of Anesthesia, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Salcher M, Naci H, Law TJ, Kuehne T, Schubert S, Kelm M, Kuehne T, Hennemuth A, Manset D, Mcguire A, Plank G, Ecabert O, Pongiglione G, Muthurangu V. Balloon Dilatation and Stenting for Aortic Coarctation: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003153. [PMID: 27296199 DOI: 10.1161/circinterventions.115.003153] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/29/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no systematic assessment of available evidence on effectiveness and comparative effectiveness of balloon dilatation and stenting for aortic coarctation. METHODS AND RESULTS We systematically searched 4 online databases to identify and select relevant studies of balloon dilatation and stenting for aortic coarctation based on a priori criteria (PROSPERO 2014:CRD42014014418). We quantitatively synthesized results for each intervention from single-arm studies and obtained pooled estimates for relative effectiveness from pairwise and network meta-analysis of comparative studies. Our primary analysis included 15 stenting (423 participants) and 12 balloon dilatation studies (361 participants), including patients ≥10 years of age. Post-treatment blood pressure gradient reduction to ≤20 and ≤10 mm Hg was achieved in 89.5% (95% confidence interval, 83.7-95.3) and 66.5% (44.1-88.9%) of patients undergoing balloon dilatation, and in 99.5% (97.5-100.0%) and 93.8% (88.5-99.1%) of patients undergoing stenting, respectively. Odds of achieving ≤20 mm Hg were lower with balloon dilatation as compared with stenting (odds ratio, 0.105 [0.010-0.886]). Thirty-day survival rates were comparable. Numerically more patients undergoing balloon dilatation experienced severe complications during admission (6.4% [2.6-10.2%]) compared with stenting (2.6% [0.5-4.7%]). This was supported by meta-analysis of head-to-head studies (odds ratio, 9.617 [2.654-34.845]) and network meta-analysis (odds ratio, 16.23, 95% credible interval: 4.27-62.77) in a secondary analysis in patients ≥1 month of age, including 57 stenting (3397 participants) and 62 balloon dilatation studies (4331 participants). CONCLUSIONS Despite the limitations of the evidence base consisting predominantly of single-arm studies, our review indicates that stenting achieves superior immediate relief of a relevant pressure gradient compared with balloon dilatation.
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Affiliation(s)
- Maximilian Salcher
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Huseyin Naci
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Tyler J Law
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Titus Kuehne
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Stephan Schubert
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | - Marcus Kelm
- From LSE Health, London School of Economics and Political Science, United Kingdom (M.S., H.N., T.J.L.); Department of Anesthesia, University of Toronto, Ontario, Canada (T.J.L.); and Department of Paediatric Cardiology and Congenital Heart Diseases, Deutsches Herzzentrum Berlin, Germany (T.K., S.S., M.K.).Lynkeus, Rome, ItalyDeutsches Herzzentrum Berlin, Berlin, GermanyFraunhofer MEVIS, Bremen, Germanygnúbila, Argonay, FranceLondon School of Economics and Political Science, London, United KingdomMedizinische Universität Graz, Graz, AustriaSiemens AG, Munich, GermanyOspedale Pediatrico Bambino Gesù, Rome, ItalyUniversity College London, London, United Kingdom
| | | | | | | | | | - Alistair Mcguire
- London School of Economics and Political Science, London, United Kingdom
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Ringel RE, Vincent J, Jenkins KJ, Gauvreau K, Moses H, Lofgren K, Usmani K. Acute outcome of stent therapy for coarctation of the aorta: Results of the coarctation of the aorta stent trial. Catheter Cardiovasc Interv 2013; 82:503-10. [DOI: 10.1002/ccd.24949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/01/2013] [Accepted: 04/07/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Richard E. Ringel
- Division of Pediatric Cardiology; Department of Pediatrics; Johns Hopkins University School of Medicine; Baltimore; MD
| | - Julie Vincent
- Division of Pediatric Cardiology; Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian; New York; New York
| | - Kathy J. Jenkins
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | | | - Heidi Moses
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | - Kimberly Lofgren
- Department of Cardiology; Boston Children's Hospital; Boston; MA
| | - Kudret Usmani
- Department of Cardiology; Boston Children's Hospital; Boston; MA
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4
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Abstract
Untreated thoracic aortic coarctation leads to early death predominantly because of hypertension and its cardiovascular sequelae. Surgical treatment has been available for > 50 years and has improved hypertension and survival. More recently, endovascular techniques have offered a minimally invasive alternative to traditional open repair. Early and intermediate results suggest angioplasty and stenting have an important role in the management of aortic coarctation, particularly in adults and older children.
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Affiliation(s)
- D R Turner
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
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5
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Beevers DG, Lip GY. Aortic coarctation and twin pregnancy. J Paediatr Child Health 2011; 47:316. [PMID: 21599787 DOI: 10.1111/j.1440-1754.2011.02092.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Walhout R, Suttorp M, Mackaij G, Ernst J, Plokker H. Long-term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue? Catheter Cardiovasc Interv 2009; 73:549-56. [DOI: 10.1002/ccd.21842] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Martucci G, Mullen M, Landzberg MJ. Care for Adults with Congenital Heart Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Coarctation of the aorta is an important, treatable cause of secondary hypertension. Its prevalence varies from 5% to 8% of all congenital heart defects. This condition is most often detected because of a murmur or hypertension found on routine examination. Delayed or absent femoral pulses and an arm/leg systolic blood pressure difference of 20 mm Hg or more in favor of the arms may be considered as evidence for aortic coarctation. The coarctation may be demonstrated on a suprasternal notch two-dimensional echocardiographic view along with increased Doppler flow velocities across the coarctation site. Cardiac catheterization reveals significant systolic pressure gradient (> 20 mm Hg) across the coarctation and angiography demonstrates the degree and type of aortic narrowing. Aortic obstruction may be relieved by surgery or by transcatheter techniques; the latter include balloon angioplasty and stent implantation. In the past, surgery has been used exclusively, but because of morbidity and complications associated with surgery, catheter techniques are increasingly used in the management of aortic coarctation. Balloon angioplasty in children and stents in adolescents and adults are becoming initial therapeutic options for management of coarctation. Studies evaluating long-term follow-up results of the interventional techniques are needed.
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Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, The University of Texas/Houston Medical School, 6431 Fannin, MSB 3.130, Houston, TX 77030, USA.
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Pedra CAC, Fontes VF, Esteves CA, Pilla CB, Braga SLN, Pedra SRF, Santana MVT, Silva MAP, Almeida T, Sousa JEMR. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv 2005; 64:495-506. [PMID: 15789379 DOI: 10.1002/ccd.20311] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 +/- 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 +/- 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% +/- 2% vs. 87% +/- 17%; P = 0.015), residual gradients lower (0.4 +/- 1.4 vs. 5.9 +/- 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% +/- 172% vs. 190% +/- 104%; P = 0.007), and CoA diameter larger (16.9 +/- 2.9 vs. 12.9 +/- 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 +/- 2.9 vs. 14.6 +/- 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood pressure was similar in both groups at follow-up (126 +/- 12/81 +/- 11 for G1 vs. 120 +/- 15/80 +/- 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic wall abnormalities.
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10
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Carr JA, Amato JJ, Higgins RSD. Long-Term Results of Surgical Coarctectomy in the Adolescent and Young Adult With 18-Year Follow-Up. Ann Thorac Surg 2005; 79:1950-5; discussion 1955-6. [PMID: 15919290 DOI: 10.1016/j.athoracsur.2005.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2004] [Revised: 12/30/2004] [Accepted: 01/03/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is no consensus in the literature regarding the optimal method for repair of coarctation of the aorta in the adolescent and young adult. METHODS We retrospectively reviewed operations in 45 patients treated between 1978 and 2003. RESULTS From 1978 to 2001, there were 45 adolescents or adults between the ages of 11 and 53 years (mean 21, SD +/- 10) who underwent surgical correction. The perioperative mortality rate was 0% and the morbidity rate was 18%. All patients had improved blood pressure before discharge after a mean of 7 days, which ranged from 160/90 mm Hg to 90/50 mm Hg (mean 128/73 mm Hg, SD +/- 17/12 mm Hg). This was an average improvement of 35 mm Hg (SD +/- 26) compared with the preoperative pressure (p < 0.0005). Long-term results (defined as 5 years or more) were documented for 30 (71%) with a mean follow-up of 18.2 years (range, 67 to 293 months; SD +/- 70 months). At the time of last follow-up, the blood pressure was documented and averaged 122/73 mm Hg (SD +/- 11/10 mm Hg), which was a decrease of 36 mm Hg (SD +/- 29) compared with the preoperative pressure (p < 0.0005). Seventy-six percent of patients were on no medications for hypertension. None of the 30 patients available for long-term follow-up has required a second operation for recurrence. CONCLUSIONS Surgical repair of coarctation in the adolescent and adult is safe and durable, with a high success rate in curing patients of hypertension and making them medication-free for life. The recurrence rate is low, and most patients will not require any further intervention.
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Affiliation(s)
- John Alfred Carr
- Department of Cardiothoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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11
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Vriend JWJ, Mulder BJM. Late complications in patients after repair of aortic coarctation: implications for management. Int J Cardiol 2005; 101:399-406. [PMID: 15907407 DOI: 10.1016/j.ijcard.2004.03.056] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2003] [Revised: 12/18/2003] [Accepted: 03/05/2004] [Indexed: 12/29/2022]
Abstract
Survival of patients with aortic coarctation has dramatically improved after surgical repair became available and the number of patients who were operated and reach adulthood is steadily increasing. However, life expectancy is still not as normal as in unaffected peers. Cardiovascular complications are frequent and require indefinite follow-up. Concern falls chiefly in seven categories: recoarctation, aortic aneurysm formation or aortic dissection, coexisting bicuspid aortic valve, endocarditis, premature coronary atherosclerosis, cerebrovascular accidents and systemic hypertension. In this review, these complications, with particular reference to late hypertension, are discussed and strategies for the clinical management of post-coarctectomy patients are described.
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Affiliation(s)
- Joris W J Vriend
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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12
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Tyagi S, Singh S, Mukhopadhyay S, Kaul UA. Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults. Am Heart J 2003; 146:920-8. [PMID: 14597945 DOI: 10.1016/s0002-8703(03)00434-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Balloon angioplasty for native coarctation of the aorta (CoA) in adults, though promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few studies available have reported on use of balloon-expandable stents in such a situation. We evaluated the use of self- and balloon-expandable stents in patients with suboptimal response to balloon angioplasty (BA). METHODS Twenty-one hypertensive patients (age, 18 to 61 years; mean, 28.6 +/- 11.2 years) with native CoA and in whom results of BA were suboptimal (ie, residual peak systolic gradient [PSG] >20 mm Hg) underwent stent implantation. Balloon-expandable Palmaz stents were implanted in 5 patients (group A) and self-expandable nitinol aortic stents in the remaining 16 patients (group B). RESULTS In group A, PSG decreased from 62.8 +/- 10.6 (53 to 80) mm Hg to 28.1 +/- 6.3 (22 to 39) mm Hg after BA. Systolic gradient further decreased to 8.3 +/- 3.9 (2 to 16) mm Hg (P <.001) after implantation of the balloon-expandable Palmaz stent. In group B, PSG decreased from 70.2 +/- 24.6 (40 to 110) mm Hg to 28.4 +/- 9.8 (22 to 42) mm Hg after BA and further reduced to 9.0 +/- 5.5 (4 to 16) mm Hg (P <.001). One of these patients had a nitinol self-expandable stent implanted after a Palmaz stent embolized immediately after deployment. Nitinol stents were easier to deploy and conformed better to aortic anatomy compared with balloon-expandable stents. In group A, the diameter of the coarcted segment increased from 3.8 +/- 0.8 mm to 13.3 +/- 0.8 mm (P <.001) after stent implantation and in group B it increased from 4.5 +/- 1.1 mm to 14.1 +/- 2.1 mm (P <.001). There was no significant difference between the two groups in the PSG and diameter of the coarcted segment before and after stent implantation. With the exception of one case, in which a Palmaz stent embolized, there was no other complication in our series. On follow-up of 12 to 71 months (mean, 40.7 +/- 5.8 months) all the implanted stents remained in their original position and none showed evidence of fracture. Improvement in hypertension was seen in 20 of 21(95.2%) of the patients. On recatheterization and angiography 1.2 +/- 0.6 years after implantation in 19 patients, one patient showed an increase in PSG to 27 mm Hg across the nitinol stent and underwent successful redilation. No increase in gradient was seen in other patients. Beneficial late remodeling was seen in 10 of 14(71.4%) of patients restudied after implantation of self-expandable stent. None of the patients showed aneurysm formation. CONCLUSIONS Stent implantation is safe and effective in improving suboptimal results after BA for CoA. Self-expandable stents were easier to implant, adapted better to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation as balloon-expandable stents.
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Affiliation(s)
- Sanjay Tyagi
- Department of Cardiology, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
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13
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Moore J, Doyle TP. Interventional catheter therapy in adults with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2003. [DOI: 10.1016/s1058-9813(03)00013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Walhout RJ, Lekkerkerker JC, Ernst SMPG, Hutter PA, Plokker THWM, Meijboom EJ. Angioplasty for coarctation in different aged patients. Am Heart J 2002; 144:180-6. [PMID: 12094206 DOI: 10.1067/mhj.2002.123109] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Differences in the indication and outcome of balloon angioplasty for coarctation in children and adults have not been elucidated sufficiently. The results of balloon angioplasty for coarctation are compared between pediatric and adult age groups. METHODS Balloon angioplasty for coarctation of the aorta was performed in 85 patients who were classified according to age and native coarctation/recoarctation. Groups A (patients aged <16 years, n = 32) and B (patients aged > or =16 years, n = 17) included patients with native coarctations. Groups rCoA A (patients aged <16 years, n = 33) and rCoA B (patients aged > or =16 years, n = 3) included patients with recoarctations. Follow-up included 2-dimensional Doppler scanning echocardiography and additional angiography or magnetic resonance imaging. Gradient reductions in groups were compared by use of the independent-samples t test. Kaplan-Meier and log-rank analyses were performed as a means of comparing long-term outcome. RESULTS No mortality occurred. Immediate success was equal in groups A, B, and rCoA A (94%). Dilatation was unsuccessful in 2 patients in group rCoA B. Pressure gradients decreased 23 mm Hg in group A, 31 mm Hg in group B, 18 mm Hg in group rCoA A, and 11 mm Hg in group rCoA B. Pressure gradient drops, compared between groups A and B, showed a significant difference (P <.001). The length of hospital stay ranged from 12 to 48 hours. The period of follow-up ranged from 6 months to 12 years (mean, 4.9 years). Kaplan-Meier curves of groups A and B are not different, as determined by means of log-rank analysis. No aneurysm formation was encountered. CONCLUSIONS The results of balloon angioplasty for native coarctation in both selected children and adults are excellent. In recoarctation, we recommend balloon angioplasty in the pediatric patients.
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Affiliation(s)
- Ronald J Walhout
- Heart Lung Center, University Medical Center Utrecht, The Netherlands
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Abstract
The standard treatment of coarctation of the aorta is surgical. In the last 2 decades, however, treatment by catheter intervention has become more widespread, using either balloon angioplasty or primary stent implantation. Balloon angioplasty was originally used for recurrent coarctation after surgical repair but has now been shown equally effective for unoperated coarctation. The procedure produces a satisfactory gradient reduction in approximately 80% of patients, with transverse arch hypoplasia the main predictor of poorer outcome. Rates of restenosis and aneurysm formation are less than 10%. Primary stent implantation has been suggested as an option potentially superior to angioplasty alone. Stent implantation limits elastic recoil and potentially reduces aneurysm formation by reducing the amount of balloon stretch required. The incidence of suboptimal gradient reduction is low, probably 5% or less, as is the rate of restenosis. Aneurysm formation, vascular complications, and stent migration also occur in less than 5%. Catheter interventions are now an established treatment strategy for coarctation, with a good success rate and safety profile. The outcome for native and recurrent coarctation appears similar. The authors believe that for most adult patients with coarctation of the aorta, catheter intervention should be offered as initial therapy.
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Affiliation(s)
- T S Hornung
- Division of Cardiology, Green Lane Hospital, Auckland, New Zealand
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Affiliation(s)
- S A Saeed
- Department of Medicine, Walsall Manor Hospital, Walsall, West Midlands WS2 9PS, UK
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Affiliation(s)
- C Duke
- Department of Congenital Heart Disease, Guy's Hospital, St. Thomas Street, London SE1 9RT, United Kingdom
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Sánchez M, García-Robles R, Morán E, Leiva A, Teijelo A, Jiménez-Martín F, Tejerizo-García A, Corredera F, Pérez-Escanilla J, Tejerizo-López L. Coartación aórtica diagnosticada después de un embarazo que cursó con hipertensión. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2001. [DOI: 10.1016/s0210-573x(01)77085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schmaltz AA, Neudorf U, Sack S, Galal O. [Interventions in congenital heart disease and their sequelae in adults]. Herz 1999; 24:293-306. [PMID: 10444708 DOI: 10.1007/bf03043880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The advancements of cardiac surgery over the last decades led to larger numbers of patients with operated congenital heart diseases surviving into adulthood. In Germany it is estimated that over 120,000 adults have operated congenital heart diseases. Five to 7% of them will need yearly hospital admissions. Interventional procedures are additional tools used to treat these patients with various sequelae or residua (Table 1). In the following review we concentrate on 2 different interventional procedures: dilatation and stent implantations for treatment of stenosis and the different devices used for the closure of shunt lesions. For congenital valvular pulmonary stenosis, balloon dilatation is the therapy of choice regardless the age of the patient. Stent implantation for the treatment of peripheral pulmonary stenosis (e.g., after previous systemic pulmonary shunts) can decrease the need for redo surgery, which is accompanied with increased risk. Stent implantations proved also to be useful to treat stenoses after Mustard patch in patients with transposition of the great arteries, after Fontan procedures or dealing with the rare pulmonary venous stenosis. In contrast, dilatation of bioprosthesis and conduit stenosis are not promising. Balloon dilatation of valvular aortic stenosis is an accepted therapy in childhood up to adolescents. Table 2 compares a surgical series including many infants with critical aortic stenosis with a series of balloon dilatation in children and another one in adults regarding lethality, complications, and results. Table 3 illustrates the immediate and late results of balloon dilatation of aortic coarctation in 3 different studies. The high recurrence rate in infants made clinicians refrain from taking this age group for balloon dilatation. In children and adult patients, good results are reported (75% reduction of gradients). The complication rate is low (2.3 to 3.3%) and aneurysm formation rate seldom (1 to 7%). Stenosed aorto-pulmonary collaterals will rarely need balloon dilatation. Surgical closure of atrial septal defect is a low risk procedure with a very low rate of residual shunts (2%). Of the 5 available devices for transcatheter closure of atrial septal defect Type II, only 2 occluders are in use in Germany, the Clamshell and the Amplatzer device. The largest clinical studies of the different systems, their efficacy, complications and residual shunt rate are presented in Table 4. For the deployment of these occluders a TEE is always needed. There are many more systems in clinical use to close the patent arterial duct (PDA) (Table 5). The Ivalon plug as well as the Rashkind device have probably only historical value. Different types of coils (Gianturco, Cook detachable, PFM) are now in use worldwide. The reason for their widespread use, besides their easy application, is the fact that most coils are relatively cheap and need only small sheaths for deployment. Their further evaluation identified a residual shunt rate of 5% as well as a number of complications (embolization, hemolysis, stenosis of the left pulmonary artery) in 0 to 6%. For the large PDA the Amplatzer device has recently been introduced. An additional indication for the use of the different occluding devices are aorto-pulmonary collaterals, venovenous fistulae, pulmonary or coronary artery fistulae. Aorto-pulmonary collaterals are often associated with complex cardiac lesions and occasionally appear after palliative procedures. An excellent cooperation between adult and pediatric cardiologists is needed in order to offer the group of adults with congenital heart diseases an adequate and comprehensive management.
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Affiliation(s)
- A A Schmaltz
- Abteilung für Pädiatrische Kardiologie, Zentrum für Kinder- und Jugendmedizin, Universität Essen, Deutschland.
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Abstract
Coarctation of the aorta is an unusual cause of hypertension in pregnancy because the disorder in adults is often unrecognized by obstetricians or general practitioners managing antenatal clinics. We report 3 women with adult coarctation of the aorta that was diagnosed in the hypertension clinic after hypertensive pregnancies where the diagnosis had been missed.
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Affiliation(s)
- G Y Lip
- University Department of Medicine, City Hospital, Birmingham, United Kingdom
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BENSON LEEN, OVAERT CAROLINE, NYKANEN DAVID, FREEDOM ROBERTM. Nonsurgical Management of Coarctation of the Aorta. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00137.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Affiliation(s)
- A Rothman
- Division of Pediatric Cardiology, University of California-San Diego, USA
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Poplausky MR, Rozenbilt G, Pavlis M, Rundback JH. Balloon angioplasty for an unusual aortic coarctation. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:77-80. [PMID: 9473198 DOI: 10.1002/(sici)1097-0304(199801)43:1<77::aid-ccd23>3.0.co;2-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Percutaneous balloon angioplasty is an alternative therapy for the treatment of the typical type of coarctation. Its associated morbidity and mortality compares favorably when compared to the standard treatment surgery. While atypical coarctations are rare, the described cases have been treated surgically. We present a case of unusually located aortic coarctation successfully treated with percutaneous balloon angioplasty.
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Affiliation(s)
- M R Poplausky
- Department of Radiology, New York Medical College, Valhalla, USA
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