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Meloro B, Gigioli J, Kovach R, Domer G. Vertebrobasilar insufficiency after subclavian flap aortoplasty for aortic coarctation. J Vasc Surg Cases Innov Tech 2024; 10:101409. [PMID: 38357655 PMCID: PMC10864848 DOI: 10.1016/j.jvscit.2023.101409] [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: 09/18/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
The mainstay of treatment of pediatric aortic coarctation is open surgery. One option for repair includes subclavian flap aortoplasty, first described by Waldhausen and Nahrwold in 1966. Within this technique, several modifications have been made over the years as long-term follow-up data became available. Early outcomes revealed little concern for left upper extremity limb ischemia or subclavian steal syndrome. These complications are rare but can have a significantly delayed presentation years after coarctation repair. We present a case of subclavian steal syndrome with lifestyle-limiting vertebrobasilar symptoms experienced by a patient 36 years after subclavian flap aortoplasty for aortic coarctation.
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Affiliation(s)
- Beth Meloro
- Department of Vascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ
| | - John Gigioli
- Department of Vascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ
| | - Richard Kovach
- Department of Interventional Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ
| | - Gregory Domer
- Department of Vascular Surgery, Deborah Heart and Lung Center, Browns Mills, NJ
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2
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Talwar S, Chandra D, Choudhary SK, Airan B. Repair of coarctation of aorta with preservation of blood supply to upper limb. Indian Heart J 2015; 67:368-70. [PMID: 26304571 DOI: 10.1016/j.ihj.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/10/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022] Open
Abstract
In this report, we present a modified technique of extended resection and end-to-end anastomosis of aorta for repair of coarctation of aorta. The advantages of this technique are a larger tension free anastomosis without compromising the blood supply into the left subclavian artery.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India; Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Dinesh Chandra
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Balram Airan
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
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Giamberti A, Pomé G, Butera G, Rosti L, Agnetti A, Frigiola A. Extended end-to-end anastomosis with modified reverse subclavian flap angioplasty. Ann Thorac Surg 2001; 72:951-2. [PMID: 11565701 DOI: 10.1016/s0003-4975(01)02843-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a surgical treatment for neonatal aortic coarctatin associated with distal aortic arch hypoplasia. This technique offers the possibility for augmentation of the aortic arch without sacrificing the subclavian artery or using prosthetic patch material. The procedure was successfully performed in 5 patients.
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Affiliation(s)
- A Giamberti
- Division of Cardiac Surgery, Hospital San Donato, San Donato Milanese, Italy.
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Amato JJ, Douglas WI, James T, Desai U. Coarctation of the aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 3:125-141. [PMID: 11486191 DOI: 10.1053/tc.2000.6028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Controversy still exists in the literature regarding definitive therapy for repair of coarctation of the aorta. Major factors involve not only the timing of repair, but also the method of repair, whether surgical or by percutaneous transluminal balloon dilatation. Results and complications of coarctation repair using various methods of classification present a diversity of results. This report will focus on these issues and attempt to dispel the statement that either one method or the other is the "choice method" of repair for any and all types of coarctation. Also presented is a proposed classification we believe will assist in clarifying the choice of therapy and perhaps improve not only the reporting of results, but also the results themselves. Methods of repair are discussed to provide the surgeon with a complete armamentarium of operations that the surgeon would tailor to the individual anatomicopathological patterns of the patient who presents at the time of surgery. Copyright 2000 by W.B. Saunders Company
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Affiliation(s)
- Joseph J. Amato
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL
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Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg 2000; 69:S298-307. [PMID: 10798436 DOI: 10.1016/s0003-4975(99)01280-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The extant nomenclature for patent ductus arteriosus (PDA), coarctation of the aorta (CoAo), and interrupted aortic arch (IAA) is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. PDA is subclassified by origin, insertion, and patient weight. CoAo is subclassified into isolated CoAo, CoAo with ventricular septal defect, and CoAo with complex intracardiac anomalies. IAA is subclassified into anatomic types A, B, and C based on the location of the interruption. A comprehensive database set is presented which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented which will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.
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Affiliation(s)
- C L Backer
- Department of Surgery, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
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Affiliation(s)
- A Rothman
- Division of Pediatric Cardiology, University of California-San Diego, USA
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Sarsam MA. Coarctation in teenagers: two new surgical modifications. J Card Surg 1997; 12:41-5. [PMID: 9169368 DOI: 10.1111/j.1540-8191.1997.tb00087.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Definitive surgical procedure for correction of aortic coarctation presenting initially in teenagers, remains an issue. Classic subclavian angioplasty as described by Waldhausen is not recommended after the age 1 or 2 years. Prosthetic patch angioplasty has been associated with an unacceptable incidence of aneurysm formation and resection with end to end anastomosis is not always easy, owing to the development of friable collaterals. METHODS In the last 4 years, we have utilized two surgical modifications for the treatment of primary isolated coarctation in teenagers. The first is aortoplasty, which relies on minimal resection of the coarctation segment and a plastic procedure of creating four identical flaps from the proximal and distal aorta, the interlocking of which will restore aortic lumen. The second modification is the use of a classic subclavian flap aortoplasty with the addition of a Gore-Tex graft, anastomosed between the upper lateral opening in the suture line and the distal left subclavian artery. Additionally, for the treatment of recurrent coarctation associated with cardiac anomalies, we have utilized the use of adult sized extra-anatomical conduit interposed between the ascending and the descending aorta. RESULTS AND CONCLUSIONS All three procedures have yielded gratifying results and we believe will increase the options available for the surgeon treating teenagers' coarctation.
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Affiliation(s)
- M A Sarsam
- Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, Northern Ireland
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8
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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]
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9
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Waldhausen JA. Invited commentary. Ann Thorac Surg 1992. [DOI: 10.1016/0003-4975(92)91161-2] [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: 10/19/2022]
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Sharma BK, Calderon M, Ott DA. Coarctation repair in neonates with subclavian-sparing advancement flap. Ann Thorac Surg 1992; 54:137-40; discussion 140-1. [PMID: 1610225 DOI: 10.1016/0003-4975(92)91160-b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A modification of the technique of using the subclavian-sparing advancement flap for severe coarctation of the aorta was successfully used in 7 neonates ranging in age from 3 to 30 days (mean age, 12 days). Four of the 7 patients had associated cardiac defects with congestive heart failure. The procedure was performed through a left thoracotomy incision, and the coarctation repair was performed by advancing the origin of the left subclavian artery as a flap while preserving flow to the left arm. No deaths occurred, and there was patency of the repair in all patients at follow-up ranging from 1 1/2 to 2 1/4 years (mean, 2 years). In 7 of the 8 patients there was no clinically significant gradient either by examination or Doppler echocardiography at follow-up. One patient underwent balloon angioplasty at the time of catheterization to evaluate other cardiac defects 1 year postoperatively, at which time he was noted to have a peak systolic gradient of 30 mm Hg across the repair site. The technique of subclavian-sparing advancement is a reasonable addition to the surgical armamentarium for coarctation repair in neonates. It provides the advantages of subclavian flap aortoplasty without sacrificing the blood supply to the left arm. Because of the unique anatomic variations associated with coarctation of the aorta, we suggest that the choice of repair be individualized for patients with this condition.
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Affiliation(s)
- B K Sharma
- Department of Cardiovascular Surgery, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston 77225-0345
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Amato JJ, Galdieri RJ, Cotroneo JV. Role of extended aortoplasty related to the definition of coarctation of the aorta. Ann Thorac Surg 1991; 52:615-20. [PMID: 1898165 DOI: 10.1016/0003-4975(91)90960-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One hundred thirty-nine patients underwent operation for coarctation of the aorta. Age ranged from 1 day to 21 years and weight, from 1.5 to 70.4 kg. Numerous methods of repair were used. The operative mortality was low (1.3%), and 17 patients (11.3%) died late. Recoarctation occurred in 13 patients (9.4%). We attempted to correlate mortality and recoarctation with the surgical procedure. A review of the literature revealed no classifications of coarctation that applied to the anatomical and pathological variations we found at the time of operation. Therefore, we devised a surgical classification to separate the various entities in the spectrum of coarctation: type I = primary coarctation; type II = coarctation with isthmus hypoplasia; and type III = coarctation with tubular hypoplasia involving the isthmus and segment between the left carotid and left subclavian arteries. Each of these types has subtypes: A = with ventricular septal defect and B = with other major cardiac defects. We believe that rather than labeling one procedure as "the procedure of choice," providing this classification will allow the surgeon to use a method of repair that is suited to the anatomical variation.
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Affiliation(s)
- J J Amato
- Pediatric Cardiothoracic Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Messmer BJ, Minale C, Mühler E, von Bernuth G. Surgical correction of coarctation in early infancy: does surgical technique influence the result? Ann Thorac Surg 1991; 52:594-600; discussion 601-3. [PMID: 1898162 DOI: 10.1016/0003-4975(91)90954-o] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.9 month. Four different surgical techniques were used: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty (Meier-Mendonca technique). Hospital mortality was 7.5% and was limited to patients with additional complex intracardiac defects. Neither age nor surgical technique had an influence on the operative risk. Follow-up averaged 15 to 43 months for the four different groups. Restenosis developed in 9 (19%) of 47 patients regularly followed up, 5 (11%) of whom have had reoperation. Age at operation was not a predictor for restenosis, which occurred in 17.4% of patients less than 1 month and 20.8% of those greater than 1 month of age at operation. Patch enlargement and the subclavian displacement technique demonstrated the highest restenosis rates (42% and 43%, respectively). However, patients who underwent patch enlargement had less favorable pathological conditions. It is concluded that results of coarctation repair in early infancy do not depend as much on the operative method itself as on the specific pathological aspect, which largely determines the method of treatment. Some reservation must be made in regard to the subclavian displacement technique.
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Affiliation(s)
- B J Messmer
- Department of Thoracic Surgery, University Hospital, Aachen, Germany
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Fontes VF, Esteves CA, Braga SL, da Silva MV, E Silva MA, Sousa JE, de Souza JA. It is valid to dilate native aortic coarctation with a balloon catheter. Int J Cardiol 1990; 27:311-6; discussion 317-8. [PMID: 2141007 DOI: 10.1016/0167-5273(90)90286-e] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report our experience in 37 patients with aortic coarctation who underwent balloon aortoplasty. Of the 37, the lesion was native in 34 cases. Clinical re-evaluation was possible in 22 patients, with a mean follow-up period of 13 months and, of these, 21 patients were asymptomatic. Haemodynamic and angiographic studies were performed in 13 patients, with a mean period of follow-up of 12 months, showing excellent results in 11 patients. Aneurysmal formation had occurred in one and recoarctation in the other patient. Our experience has proved that balloon aortoplasty is an effective method for treating patients with aortic coarctation. Adequate selection in terms of the morphology of the coarctation and the size of the balloon catheter are crucial factors in the success of the procedure.
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Affiliation(s)
- V F Fontes
- Division of Pediatric Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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14
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Ladusans EJ, Campalani G, Parsons JM, Qureshi SA, Opie J, Baker EJ, Tynan M, Deverall PB. Recurrence of aortic coarctation following repair by re-implantation of the subclavian artery. Int J Cardiol 1989; 23:321-5. [PMID: 2737776 DOI: 10.1016/0167-5273(89)90191-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Four patients mean age six months, range 11 days to 2 years, underwent repair of aortic coarctation by the technique of reimplantation of the subclavian artery (Mendonca repair). All developed re-coarctation within six months of an initially successful repair.
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Affiliation(s)
- E J Ladusans
- Department of Paediatric Cardiology, Guy's Hospital, London, U.K
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Nawa S, Nakayama Y, Teramoto S, Mori K, Dohi T. Coarctation restenosis after isthmosubclavioplasty. A consideration on operative procedure and intraluminal balloon angioplasty. Chest 1989; 95:247-50. [PMID: 2521203 DOI: 10.1378/chest.95.1.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We describe a case of a six-month-old boy in whom an aortic coarctation restenosis had developed three months after isthmosubclavioplasty. The restenosis was successfully relieved by means of intraluminal balloon angioplasty. At the isthmosubclavioplasty operation, extensive mobilization of the aorta to facilitate the anastomosis should be avoided. From anatomic and operative viewpoints, coarctation restenosis after the isthmosubclavioplasty operation was considered to be amenable to the intraluminal balloon angioplasty.
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Affiliation(s)
- S Nawa
- Second Department of Surgery, Okayama University Medical School, Japan
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Brawn WJ, Menahem S, Mee RB. Cerebellar infarction secondary to subclavian aortoplasty repair for coarctation of the aorta. Int J Cardiol 1987; 17:336-8. [PMID: 3679614 DOI: 10.1016/0167-5273(87)90086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A five-year-old boy developed a left cerebellar infarction following repair of coarctation of the aorta by subclavian aortoplasty. At operation a large left vertebral artery had been ligated. If a large vertebral artery is encountered at repair of coarctation of the aorta then consideration should be given to a method of repair which does not sacrifice this vessel.
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Affiliation(s)
- W J Brawn
- Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Melbourne, Australia
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