1
|
Kottayil BP, Bayya PR, Baquero L, Sen AC, Kumar RK. Modified technique for uncommon coarctation of the aorta with arch hypoplasia. Ann Pediatr Cardiol 2018; 11:275-277. [PMID: 30271017 PMCID: PMC6146853 DOI: 10.4103/apc.apc_34_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A true presubclavian coarctation of the aorta with arch hypoplasia without major intracardiac anomaly can result in a surgical dilemma. Theoretically, one can avoid repair through median sternotomy using selective cerebral perfusion and its sequelae since no major intracardiac repair is needed. Repair through thoracotomy is technically challenging if arch reconstruction is required and precise surgical planning is required to avoid spinal hypoperfusion and to maintain cerebral perfusion. Moreover, inadequate repair often has resulted in hypoplastic aortic arch or residual coarctation on follow-up requiring future intervention. We have employed a modified surgical repair through thoracotomy avoiding cardiopulmonary bypass to address presubclavian coarctation of the aorta with diffuse arch hypoplasia with theoretically less chance for future stenosis.
Collapse
Affiliation(s)
- Brijesh Parayaru Kottayil
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Praveen R Bayya
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Luis Baquero
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Amitabh C Sen
- Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Raman K Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| |
Collapse
|
2
|
Wood AE, Javadpour H, Duff D, Oslizlok P, Walsh K. Is extended arch aortoplasty the operation of choice for infant aortic coarctation? Results of 15 years' experience in 181 patients. Ann Thorac Surg 2004; 77:1353-7; discussion 1357-8. [PMID: 15063265 DOI: 10.1016/j.athoracsur.2003.07.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recurrent coarctation is an ever-present complication of surgical treatment of coarctation of aorta (CoA) among infants. No single operation appears to have a clear superiority. METHODS From January 1, 1986, to June 30, 2002, a consecutive series of 181 patients less than 1 year of age (range 1 to 300 days, median 13.5 days) were referred for CoA repair. Neonates accounted for 135 patients, and hypoplastic arch (less than 1 mm/kg plus 1) was present in 107 infants. Coarctation of aorta was simple (group 1) in 71 patients; complicated by ventricular septal defect (group 2) in 62; and complicated by complex congenital heart disease (group 3) in 48. All patients were assessed by right arm/left leg Dynamap pressures and routine follow-up was performed by the cardiologists. Follow-up was complete in all patients (range 6 months to 16 years, median 7.5 years). RESULTS The overall hospital/30-day mortality was 0.5% (group 1 = 0, group 2 = 0, group 3 = 1 [2.0%]). Complications other than recoarctation occurred in 5 patients (2.7%). Late mortality occurred in 15 (11 at intracardiac repair). Recoarctation, ie, a gradient of more than 20 mm Hg, occurred in 4 patients (2.2%). All 4 patients were noted to have a gradient of more than 10 mm Hg (right arm/left leg) postoperatively and as such had residual coarctation. All 4 were successfully treated by balloon aortoplasty. CONCLUSIONS Extended arch aortoplasty in association with ductal and coarctation excision provides excellent coarctation repair with a low incidence of recoarctation. Recoarctation occurred only in proximal aortic arch hypoplasia or low birth weight. Balloon aortoplasty easily and effectively relieved the recoarctation in all cases.
Collapse
Affiliation(s)
- Alfred E Wood
- Department of Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
| | | | | | | | | |
Collapse
|
3
|
Abstract
BACKGROUND Management of hypoplastic aortic arch associated with coarctation in infancy can be challenging. Reverse subclavian flap aortoplasty plus coarctation resection offers simplicity without needing foreign material or cardiopulmonary bypass. METHODS Since 1988, 46 of 162 infants less than 3 months undergoing coarctation repair had hypoplastic arch enlargement with reverse subclavian flap aortoplasty. Median age was 11 days; mean weight was 3.2 kg. Thirty-seven patients (80%) had associated cardiac defects including single or multiple ventricular septal defects (14 infants), transposition of the great arteries (7), aortic or mitral stenosis (5), and complete atrioventricular septal defect (5 infants). Twenty-eight patients had pulmonary artery banding; 2 had an arterial switch operation through a separate median sternotomy. RESULTS There were two hospital deaths: one 4 months postoperatively in a patient requiring a Norwood procedure the next day for underestimated left ventricular hypoplasia; the other of sepsis more than 1 month postoperatively. On follow-up from 1 to 129 months (mean, 38 months), there were five recurrent obstructions: three at the coarctation site treated with balloon dilatation and two at the arch site. Twenty-six children had their heart defects corrected with 29 subsequent operations including an arterial switch operation for transposition of the great arteries/ ventricular septal defect (3 infants), relief of aortic or mitral stenosis +/- ventricular septal defect closure (5), multiple ventricular septal defect closure (3), a bidirectional Glenn (2), complete atrioventricular septal defect (2), and anomalous left coronary with ventricular septal defect repair (1 infant). Four children await debanding and ventricular septal defect closure or Glenn anastomosis. There have been two late deaths (overall survival, 91%). CONCLUSIONS Reverse subclavian flap aortoplasty is excellent for relief of arch hypoplasia and coarctation in infants with low recurrence rates and acceptable operative and intermediate survival.
Collapse
Affiliation(s)
- K R Kanter
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
| | | | | |
Collapse
|
4
|
Brouwer RM, Cromme-Dijkhuis AH, Erasmus ME, Contant C, Bogers AJ, Elzenga NJ, Ebels T, Eijgelaar A. Decision making for the surgical management of aortic coarctation associated with ventricular septal defect. J Thorac Cardiovasc Surg 1996; 111:168-75. [PMID: 8551762 DOI: 10.1016/s0022-5223(96)70413-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Coarctation of the aorta and associated ventricular septal defect may be repaired simultaneously or by initial coarctation repair with or without banding of the pulmonary artery. The question is whether specific preoperative criteria can enable the surgeon to choose the optimal surgical management. Between 1980 and 1993, 80 infants younger than 3 months with coarctation and ventricular septal defect were treated surgically. In 64 infants (multistage group), simple coarctation repair was performed through a posterolateral approach, with concomitant banding of the pulmonary artery in 10 infants. Twenty ventricular septal defects were closed as a secondary procedure and four were closed as a tertiary procedure. Sixteen infants (single-stage group) underwent one-stage repair through an anterior midline approach. The total in-hospital mortality rate was 7.5%. Freedom from recoarctation after 5 years was 91.3% in the multistage group versus 60.0% in the single-stage group (p = 0.018). Freedom from secondary ventricular septal defect treatment in the multistage group after 5 years was 40.7%, versus 100% in the single-stage group (p = 0.016). Thirty-seven ventricular septal defects (47.8%) closed spontaneously. In particular, the preoperative left-to-right shunt and extension of the perimembranous VSD into the inlet or outlet were risk factors for the need for eventual surgical ventricular septal defect closure after initial coarctation repair. On the basis of these two risk factors, the probability of the need for eventual surgical treatment of ventricular septal defect after initial coarctation repair can be calculated. This policy offers a well-considered choice between single-stage and multistage repair, weighing the risk of secondary ventricular septal defect treatment versus the risk of recoarctation. Finally, the number of surgical procedures per infant will be as low as possible.
Collapse
Affiliation(s)
- R M Brouwer
- Division of Cardiothoracic Surgery, University Hospital Groningen, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Aortic obstructions in infants and children. PROGRESS IN PEDIATRIC CARDIOLOGY 1994. [DOI: 10.1016/1058-9813(94)90026-4] [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: 11/20/2022]
|
6
|
Kimball TR, Witt SA, Pisters EM, Schroder CA, Meyer RA. Coarctation of the aorta and partial anomalous pulmonary venous return: a unique anatomic and physiologic presentation as seen by echocardiography. J Am Soc Echocardiogr 1994; 7:190-3. [PMID: 8185967 DOI: 10.1016/s0894-7317(14)80128-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- T R Kimball
- Children's Hospital Medical Center, Cincinnati, OH 45229
| | | | | | | | | |
Collapse
|
7
|
Aortic obstructions in infants and children: Surgery for simple aortic coarctation. PROGRESS IN PEDIATRIC CARDIOLOGY 1994. [DOI: 10.1016/s1058-9813(05)80009-8] [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: 11/15/2022]
|
8
|
Graham TP, Burger J, Boucek RJ, Johns JA, Moreau GA, Hammon JW, Bender HW. Absence of left ventricular volume loading in infants with coarctation of the aorta and a large ventricular septal defect. J Am Coll Cardiol 1989; 14:1545-52. [PMID: 2530263 DOI: 10.1016/0735-1097(89)90396-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Clinical characteristics and angiographic ventricular volume data were obtained in 25 infants aged 1 to 66 days who presented with coarctation of the aorta, ventricular septal defect and congestive heart failure to determine if left ventricular volume loading was present and if there were hemodynamic or volumetric variables that were predictive of operative mortality in this group. Pulmonary to systemic flow ratio averaged 2.8 +/- 0.8 and right ventricular/left ventricular peak pressure ratio was 0.96 +/- 0.12. Left ventricular end-diastolic volume averaged 116 +/- 49% of normal and was less than the investigators' lower limit of normal in 5 (20%) of 25 patients. In contrast, right ventricular end-diastolic volume, measured in eight patients, averaged 173 +/- 47% of normal and was greater than the investigators' upper limit of normal in seven (88%) of eight. Left ventricular ejection fraction averaged 0.47 +/- 0.17 and was below normal (less than 0.55) in 14 (58%) of 24 patients. Preoperative volume and ejection fraction data did not differ in infants with coarctation plus ventricular septal defect and a similar group of 19 infants with isolated coarctation. Abnormal left ventricular operative volume distensibility was inferred by normal or decreased left ventricular end-diastolic volume and increased left ventricular end-diastolic pressure (greater than 12 mm Hg) in 12 (55%) of 24 patients. Early plus late mortality was related to left ventricular size: 3 of 5 patients with a small left ventricular end-diastolic volume died, compared with only 4 of 20 with a normal or increased volume (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- T P Graham
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2572
| | | | | | | | | | | | | |
Collapse
|
9
|
Yee ES, Soifer SJ, Turley K, Verrier ED, Fishman NH, Ebert PA. Infant coarctation: a spectrum in clinical presentation and treatment. Ann Thorac Surg 1986; 42:488-93. [PMID: 3777999 DOI: 10.1016/s0003-4975(10)60569-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Between 1975 and 1985, 125 infants 2 to 365 days old (majority, 30 days old or less) with coarctation of the aorta underwent surgical repair. Forty-seven patients (38%) had severe congestive heart failure (CHF), metabolic acidosis, and poor systemic perfusion. The predominant operative technique was synthetic patch aortoplasty (100 patients); the remaining 25 had an end-to-end anastomosis. There were no operative deaths. Perioperative complications were minimized with the synthetic patch technique (less than 15%). For patients surviving at least 3 months after repair, the arm-leg systolic blood pressure gradient was relieved in 82% (71/87) of the patients having patch aortoplasty versus 65% (15/23) of the patients with end-to-end anastomosis. Although the rate of reoperation between the two groups was similar (patch, 5 [6%]; end-to-end, 3 [13%], two of the reoperations in the patch group were for preexisting hypoplastic transverse aortic arch. Late deaths (20 patients, 16%) were due to other major associated cardiac anomalies. Patch aneurysms have not occurred. Expedient use of synthetic patch aortoplasty has decreased perioperative complications, relieved coarctation gradients for CHF, increased early survival even in the presence of complex or associated cardiac anomalies, and has an acceptable rate of recurrent coarctation (6 to 13%).
Collapse
|
10
|
Bharati S, Lev M. The surgical anatomy of the heart in tubular hypoplasia of the transverse aorta (preductal coarctation). J Thorac Cardiovasc Surg 1986. [DOI: 10.1016/s0022-5223(19)38484-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Carpenter MA, Dammann JF, Watson DD, Jedeikin R, Tompkins DG, Beller GA. Left ventricular hyperkinesia at rest and during exercise in normotensive patients 2 to 27 years after coarctation repair. J Am Coll Cardiol 1985; 6:879-86. [PMID: 4031303 DOI: 10.1016/s0735-1097(85)80498-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The short- and long-term results of effective surgical repair of coarctation of the aorta on left ventricular mass and function in 48 patients were evaluated using echocardiography and stress-gated radionuclide angiography. Thirty-two of the 48 patients who had no additional cardiac problems and had technically adequate radionuclide angiograms form the basis for this report. Among these, three had mild systolic hypertension and none had significant aortic valve dysfunction. Age at the time of study ranged from 6.5 to 59 years (mean 27). Age at the time of surgery ranged from 3 months to 34 years (mean 12 years). Duration from surgery to the time of noninvasive study ranged from 2 to 29 years (mean 15). In the 32 patients, left ventricular mass was 120 +/- 20 g/m2, compared with a control value of 87 +/- 10 g/m2. Mean left ventricular ejection fraction was elevated to 69.2 +/- 1.6% at rest (control 60 +/- 1.3%) and 78.8 +/- 1.3% during exercise (control 70 +/- 1.7%) (p less than 0.01). The systolic ejection rate was significantly increased (p less than 0.01) and end-systolic volume significantly decreased (p less than 0.01) compared with values in control patients. There was no correlation between ejection fraction and either age at the time of surgery or years since surgery. These findings of hyperdynamic left ventricular function and increased left ventricular mass without apparent cause many years after coarctation repair raise important questions as to mechanisms, extension to other forms of afterload stress that have been surgically or medically relieved and long-term outcome.
Collapse
|
12
|
Brown JW, Fiore AC, King H. Isthmus flap aortoplasty: an alternative to subclavian flap aortoplasty for long-segment coarctation of the aorta in infants. Ann Thorac Surg 1985; 40:274-9. [PMID: 3899030 DOI: 10.1016/s0003-4975(10)60041-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The ideal operation for infants with coarctation of the aorta remains controversial. Subclavian flap aortoplasty is the most popular technique for this age group. The 5 to 20% recurrence rate is attributed to regrowth of the coarctation web or inadequate length of the subclavian flap, particularly when the aortic isthmus is long and narrow. Severe arm ischemia following subclavian flap aortoplasty, although rare, is a disturbing complication. The purpose of this study is to report the results with a new technique we call isthmus flap aortoplasty for coarctation of a long segment of the aorta in infants. This technique avoids the limitations of subclavian flap aortoplasty. A short segment of aorta, including the ductal entrance and coarctation web, was resected in 4 infants (mean age, 35.5 days) with long-segment coarctation. The posterior wall of the long isthmus was opened longitudinally to the level of the transverse aortic arch. The descending aorta was mobilized and advanced to the level of the aortic arch where the posterior half was sutured. The anterior flap of attached isthmus was then sewn into a longitudinal incision made in the anterior wall of the descending aorta. All infants survived this procedure and had no gradient at completion of the repair. The mean transconduit gradient at rest was zero and rose to 7.0 +/- 0.93 mm Hg after angiography at a mean follow-up of 42 months. Aortograms demonstrated that the reconstructed area had grown in girth and attained a normal caliber in each child.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
13
|
Pennington DG, Dennis HM, Swartz MT, Nouri S, Chen SC, Azzam F, Schweiss JF. Repair of aortic coarctation in infants: experience with an intraluminal shunt. Ann Thorac Surg 1985; 40:35-40. [PMID: 3893339 DOI: 10.1016/s0003-4975(10)61166-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
From 1962 to mid-1984, 63 infants underwent coarctation repair. Cardiac defects were present in 46 (73%). Repair was by subclavian aortoplasty in 35 patients, resection and end-to-end anastomosis in 19, and other techniques in 6. Three patients died before the repair was completed. In 15 patients, an intraluminal shunt was used during subclavian aortoplasty. Prostaglandin E1 (PGE1) was infused in 9 patients. Early (thirty-day) mortality was 16% (10 patients): 4 patients who underwent end-to-end anastomosis; 3 during attempted end-to-end anastomosis; 2 who received bypass grafts; and 1 who had subclavian aortoplasty without a shunt. None of the 15 patients who had subclavian aortoplasty with a shunt died. There were no early deaths among the last 25 patients seen. One patient who underwent subclavian aortoplasty without a shunt is paraplegic. There were 10 late deaths among the 53 patients followed from 1 month to 12 years (mean, 3 years). Arm-leg pressure gradients of 20 mm Hg or greater were found in 4 of the patients who had end-to-end anastomosis but not in any of the patients who had subclavian aortoplasty. Improved results of coarctation repair in infants in this study were attributed to PGE1, subclavian aortoplasty, and use of an intraluminal shunt.
Collapse
|
14
|
Hammon JW, Graham TP, Boucek RJ, Bender HW. Operative repair of coarctation of the aorta in infancy: results with and without ventricular septal defect. Am J Cardiol 1985; 55:1555-9. [PMID: 4003298 DOI: 10.1016/0002-9149(85)90972-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coarctation of the aorta (CA) presenting in infancy is a life-threatening condition, especially if associated with intracardiac left-to-right shunts. Between 1971 and 1980, 51 infants with symptomatic CA have been diagnosed and treated. Ventricular septal defect (VSD) was present in 18 patients and patent ductus arteriosus in 24. End-to-end repair was performed in 20 patients, 17 (85%) of whom were long-term survivors. Subclavian flap angioplasty repair was used in 28 patients, of whom 25 (89%) were long-term survivors. During long-term follow-up 6 patients (35%) who underwent end-to-end repair had recurrent CA, whereas only 3 patients (12%) who underwent subclavian flap angioplasty had recurrent CA (p less than 0.05). The mortality rate in patients with associated VSD was higher (4 of 18, 22%). Pulmonary trunk banding with subsequent VSD repair was associated with a better survival (13 of 14 patients, 90%) than when banding was not performed (2 of 5 patients) (p less than 0.05). These results suggest subclavian flap angioplasty is the preferred treatment for symptomatic CA occurring in infancy. Concomitant pulmonary trunk banding in patients with VSD can be performed with the expectation of a lower mortality at subsequent VSD repair.
Collapse
|
15
|
Metzdorff MT, Cobanoglu A, Grunkemeier GL, Sunderland CO, Starr A. Influence of age at operation on late results with subclavian flap aortoplasty. J Thorac Cardiovasc Surg 1985. [DOI: 10.1016/s0022-5223(19)38818-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
16
|
Yee ES, Turley K, Soifer S, Ebert PA. Synthetic patch aortoplasty. A simplified approach for coarctation in repairs during early infancy and thereafter. Am J Surg 1984; 148:240-3. [PMID: 6380324 DOI: 10.1016/0002-9610(84)90229-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Synthetic patch aortoplasty is an expedient, safe technique for coarctation repairs during early infancy and thereafter for reoperation since it affords both an immediate hemodynamic result and potential for late growth while avoiding sacrifice of a major arch vessel. The surgical advantages include minimization of the total cross-clamp time (10 minutes in infants and 12 minutes in older patients) and elimination of the need to sacrifice collateral vessels and the need for extensive dissection for proximal and distal control. Hence, this technique has minimized the associated severe complications of coarctation repair, even in emergency cases. In our study, there were no operative deaths, spinal cord injuries or recoarctation, and intraoperative cardiac arrest occurred in only 3 percent of the patients.
Collapse
|
17
|
Penkoske PA, Williams WG, Olley PM, LeBlanc J, Trusler GA, Moes C, Judakin R, Rowe RD. Subclavian arterioplasty. J Thorac Cardiovasc Surg 1984. [DOI: 10.1016/s0022-5223(19)38419-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
18
|
Mace SE, Hirschfeld SS, Riggs TW. Echocardiographic and hemodynamic findings in isolated symptomatic coarctation of the aorta in infancy. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1983; 9:363-72. [PMID: 6226361 DOI: 10.1002/ccd.1810090407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Echocardiographic findings and cardiac catheterization data were evaluated in 18 infants less than 1 year old in order to define anatomical or pathophysiological features that were associated with early cardiac decompensation. The infants could be divided into three groups: Group I (10 patients) had left ventricular dilatation and depressed contractility in response to the severe systemic hypertension. Group II (3 patients) had marked myocardial hypertrophy In response to the systemic hypertension. Group III (5 patients) were the youngest patients and had findings of right ventricular volume overload and pulmonary hypertension. This study demonstrates that, in early infancy, the ventricular response to simple coarctation of the aorta is variable in infants in a state of cardiac decompensation. The different echocardiographic and hemodynamic findings may be a consequence of the lesion exerting its influence at various stages of the patients' intrauterine or postnatal life. In most patients, resection of the coarctation results in rapid normalization of the echocardiographic findings.
Collapse
|
19
|
Lerberg DB, Hardesty RL, Siewers RD, Zuberbuhler JR, Bahnson HT. Coarctation of the aorta in infants and children: 25 years of experience. Ann Thorac Surg 1982; 33:159-70. [PMID: 7065775 DOI: 10.1016/s0003-4975(10)61903-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Repair of coarctation of the aorta was performed in 334 patients ranging from less than a year to 16 years of age at Children's Hospital of Pittsburgh from 1953 to 1977. Resection and end-to-end anastomosis were performed in 310, interposition grafts in 7, and other procedures in 17. There were 41 operative deaths among the 95 infants less than 1 year old (43% mortality); all of these infants had associated cardiac anomalies. Only 1 operative death occurred in patients older than a year (0.4% mortality). No hospital deaths occurred in patients with isolated coarctation of the aorta. Eleven late deaths were due to associated anomalies (7) and unrelated or unknown causes (4). Postoperatively, hemorrhage occurred in 7, paradoxical or persistent hypertension in 128, postcoarctectomy syndrome in 32, neurological problems in 14, pulmonary complications in 53, and infections in 12 patients. Restenosis occurred in 26 patients (8%); only 10 have required reoperation. Residual hypertension was present in 28 of 264 patients (11%). Mortality from coarctation resection remains high in infants, but is minimal in children older than 1 year. Based on minimizing the risk of restenosis and residual hypertension, elective repair of coarctation is recommended when the patient is about 6 years of age.
Collapse
|
20
|
|
21
|
Brown JW, King H. Cardiac surgery in the critically ill infant during the first three months of life. Surg Clin North Am 1981; 61:1063-78. [PMID: 6171897 DOI: 10.1016/s0039-6109(16)42531-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Major advances have been made in the treatment of congenital heart disease in the past 10 years. Management of the 20 per cent of children who become critically ill during the first 3 months of life remains a major challenge because they represent the most extreme anatomic and physiologic derangements. A review of the recent data accumulated in the NERICP showed an overall mortality of 54 per cent in infants presenting for surgery in the first 2 months of life. We have reviewed our experience with over 400 procedures during the past 5 years in infants less than three months of age, and our overall mortality is 19 per cent. Primary repair remains our goal, but a disappointingly high mortality with primary repair in this group, by us and others, has caused us to perform palliative procedures when palliation in our experience offers an overall lower mortality.
Collapse
|
22
|
Moulton AL. Repair of coarctation in the neonate. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)39308-0] [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: 11/28/2022]
|
23
|
DeLeon SY, Idriss FS, Ilbawi MN, Tin N, Berry T. Transmediastinal repair of complex coarctation and interrupted aortic arch. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)39394-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
|
25
|
Kamau P, Miles V, Toews W, Kelminson L, Friesen R, Lockhart C, Butterfield J, Hernandez J, Hawes C, Pappas G. Surgical repair of coarctation of the aorta in infants less than six months of age. J Thorac Cardiovasc Surg 1981. [DOI: 10.1016/s0022-5223(19)37623-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
26
|
Campbell J, Delorenzi R, Brown J, Girod D, Hurwitz R, Caldwell R, King H. Improved results in newborns undergoing coarctation repair. Ann Thorac Surg 1980; 30:273-80. [PMID: 7425706 DOI: 10.1016/s0003-4975(10)61257-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Among 172 children who underwent repair of coarctation of the thoracic aorta from June 1, 1967, to June 1, 1979, there were 50 who were less than 6 weeks old. A review was undertaken to assess mortality and postoperative residual hypertension in this newborn age group. Forty-five (90%) had one or more associated congenital cardiac lesions, which were repaired or paliated at the time of coarctation repair. The three most common associated lesions were patent ductus arteriosus (74%), atrial septal defect (74%), and ventricular septal defect (62%). Thirty-one newborns underwent resection with parimary end-to-end repair with 8 deaths (26%), and 18 underwent Dacron patch angioplasty and 1 underwent subclavian angioplasty with 4 deaths (21%). Of the 38 survivors, 36 (95%) had good pedal pulses on postoperative clinical examination 3 months to eleven years postoperatively. Seventeen (45%) had upper and lower extremity blood pressure measured; 2 (5%) showed residual upper extremity hypertension (greater than 2 standard deviations above the mean and a gradient less than 20 mm Hg). One of these 2 patients has undergone repeat repair. Based on this low mortality and infrequent need for repeat repair, we advocate aggressive early operation and judicious use of palliative procedures in newborns, when indicated, for associated defects.
Collapse
|
27
|
|
28
|
Williams WG, Shindo G, Trusler GA, Dische MR, Olley PM. Results of repair of coarctation of the aorta during infancy. J Thorac Cardiovasc Surg 1980. [DOI: 10.1016/s0022-5223(19)37927-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
Sade RM, Taylor AB, Chariker EP. Aortoplasty compared with resection for coarctation of the aorta in young children. Ann Thorac Surg 1979; 28:346-53. [PMID: 507980 DOI: 10.1016/s0003-4975(10)63132-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We repaired coarctation of the aorta in a group of 18 children less than 3 years old, using either resection with end-to-end anastomosis (8 patients, Group 1) or patch graft aortoplasty (10 patients, Group 2). The two groups were similar preoperatively in age, pressure difference between proximal and distal aorta (delta PA0), and severity of aortic arch hypoplasia. Three patients, all less than 2 months old, died early postoperatively. Among the survivors, the right brachial artery systolic pressure was significantly higher in Group 1 (133.1 +/- 7.0 mm Hg) (mean +/- standard error of the mean) than in Group 2 (102.5 +/- 7.2 mm Hg) (p less than 0.05). The delta PA0 was significantly higher in Group 1 (33.0 +/- 7.5 mm Hg) than in Group 2 (5.1 +/- 2.3 mm Hg) (p less than 0.01). Three patients in Group 1 required reoperation and were treated with patch graft aortoplasty; relief of delta PO0 was complete in 2. Patch graft aortoplasty is more effective than resection in reducing proximal aortic systolic pressure and in relieving delta PA0 in infants and small children with coarctation of the aorta.
Collapse
|
30
|
|
31
|
Liberthson RR, Pennington DG, Jacobs ML, Daggett WM. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol 1979; 43:835-40. [PMID: 425922 DOI: 10.1016/0002-9149(79)90086-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|