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Ezzahi M, Bijbij A, Akammar A, El Bouardi N, Haloua M, Lamrani MYA, Boubbou M, Maaroufi M, Alami B. Incidental finding of undiagnosed aortic coarctation in an elderly patient with a rare association with thymic carcinoma: a case report with review of the literature. Radiol Case Rep 2023; 18:3317-3322. [PMID: 37483377 PMCID: PMC10362250 DOI: 10.1016/j.radcr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
Aortic coarctation is a congenital malformation that is relatively prevalent, occurring in approximately 5 out of every 1000 births. The narrowing typically happens at the aortic isthmus between the left subclavian artery and the arterial ligament. It is frequently associated with a bicuspid aortic valve. Generally, coarctation of the aorta is identified and treated during childhood or early adulthood. If left untreated, this condition can lead to a reduced life expectancy in individuals who have not received treatment. We present a case of a 52-year-old man who complained of chest pain, sputum, and hemoptysis persisting for approximately 2 years. Contrast-enhanced computed tomography (CT) scans revealed the presence of an anterior mediastinal mass, which was later confirmed to be a thymic carcinoma (on histological study). Additionally, an incidental finding of a thoracic aortic coarctation with a well-developed collateral circulation was observed. The discovery of aortic coarctation in adult patients as an incidental finding is rare and particularly uncommon in association with mediastinal or thoracic tumor pathology. Adult and elderly patients with uncorrected coarctation generally have a low survival rate, and the management strategies for such cases are controversial, especially when it is associated to other pathologies. Due to the complexity of therapeutic management and the limited literature available on postsurgical outcomes in these cases, making therapeutic decisions requires a multidisciplinary approach and personalized consideration for each individual case. This approach is necessary to evaluate the risk-benefit ratio and determine the most suitable therapeutic solution.
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2
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Colombo JN, Sawda CN, White SC. Cardiac Concerns in the Pediatric Athlete. Clin Sports Med 2022; 41:529-548. [PMID: 35710276 DOI: 10.1016/j.csm.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease remains the number one cause of death in Americans. It is no secret that exercise mitigates this risk. Exercise and regular physical activity are beneficial for physical health including aerobic conditioning, endurance, strength, mental health, and overall improved quality of life. Unfortunately, today many children and adolescents are sedentary, lacking the recommended daily amount of physical activity, leading to higher rates of obesity, cardiovascular disease, stroke, diabetes, anxiety, and depression. Given this rising concern, the World Health Organization launched a 12-year plan to improve physical activity in children and adolescents by reducing the inactivity rate by 15% in the world. How does this apply to children and adolescents with acquired or congenital heart disease?.
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Affiliation(s)
- Jamie N Colombo
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, 1 Childrens Place, St. Louis, MO 63110, USA
| | - Christine N Sawda
- Department of Pediatrics, Division of Cardiology, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Shelby C White
- Department of Pediatrics, Division of Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA.
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Zhang L, Liu L, Zhong Z, Jin H, Jia J, Meng L, Mo X, Shi X. The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants. BMC Anesthesiol 2021; 21:284. [PMID: 34781876 PMCID: PMC8591916 DOI: 10.1186/s12871-021-01498-0] [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: 05/26/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion. Methods
Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2). Results Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001). Conclusions
SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.
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Affiliation(s)
- Li Zhang
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China
| | - Lu Liu
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China
| | - Zhiqiu Zhong
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China
| | - Hengfang Jin
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China
| | - Jian Jia
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, 06520, New Haven, CT, USA.
| | - Xuming Mo
- Department of Cardiothoracic, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China.
| | - Xiaohua Shi
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, 210008, Nanjing, Jiangsu Province, China.
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Egbe AC, Miranda WR, Warnes CA, Bonnichsen C, Crestanello J, Anderson JH, Connolly HM. Persistent Hypertension and Left Ventricular Hypertrophy After Repair of Native Coarctation of Aorta in Adults. Hypertension 2021; 78:672-680. [PMID: 34247510 PMCID: PMC8363521 DOI: 10.1161/hypertensionaha.121.17515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine (A.C.E., W.R.M., C.A.W., C.B., H.M.C.), Mayo Clinic Rochester, MN
| | - William R Miranda
- Department of Cardiovascular Medicine (A.C.E., W.R.M., C.A.W., C.B., H.M.C.), Mayo Clinic Rochester, MN
| | - Carole A Warnes
- Department of Cardiovascular Medicine (A.C.E., W.R.M., C.A.W., C.B., H.M.C.), Mayo Clinic Rochester, MN
| | - Crystal Bonnichsen
- Department of Cardiovascular Medicine (A.C.E., W.R.M., C.A.W., C.B., H.M.C.), Mayo Clinic Rochester, MN
| | - Juan Crestanello
- Department of Cardiovascular Surgery (J.C.), Mayo Clinic Rochester, MN
| | - Jason H Anderson
- Division of Pediatric Cardiology (J.H.A.), Mayo Clinic Rochester, MN
| | - Heidi M Connolly
- Department of Cardiovascular Medicine (A.C.E., W.R.M., C.A.W., C.B., H.M.C.), Mayo Clinic Rochester, MN
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ALTINBAŞ Ö, MERCAN I, TABAN VB, TANYELİ Ö, EGE E. Two Staged Surgical Treatment of Aortic Coarctation Accompanied by Aortic Stenosis in a 63-Year-Old Patient. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.792989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schusterova I, Banovcinova A, Vachalcova M, Jakubova M, Artemiou P. Primary and secondary aortopathy associated with adult congenital heart disease - retrospective study. J Cardiothorac Surg 2020; 15:242. [PMID: 32912339 PMCID: PMC7488153 DOI: 10.1186/s13019-020-01283-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Primary and secondary aortopathy are frequently encountered in patients with congenital heart disease. The aim of this study is to present our experience and the incidence of primary and secondary adult CHD-associated aortopathy. Methods The cohort is comprised of adult patients with congenital heart disease from the registry of the Eastern Slovakia Institute of Cardiovascular Diseases. Data from the last follow-up examinations are included in this study. In the primary and secondary aortopathy groups were 35 and 12 patients respectively. As a control group were selected 64 patients with non aortopathy associated congenital heart disease (atrial and ventricular septal defect). Results Patients with primary and secondary aortopathy had larger ascending aorta/aortic root diameters than the control group (36.28 (26–49) mm vs 30.25 (21–41) mm p = 0.000113, 33.82 27–49) mm vs 29.03 (19–38)mm p = 0.000366 and 42.1 (30–50) mm vs 30.25 (21–41) mm, p = 0.000106, 35.67 (27–48) mm vs 29.03 (19–38) mm, p = 0.000119 respectively). Moreover, patients with secondary aortopathy had statistically significant larger ascending aorta diameter compared to the patients with primary aortopathy (42.1 (30–50) mm vs 36.28 (26–49) mm p = 0.030). During the follow-up period, were performed only in 2 patients (one from each group) operations on the aortic root and the ascending aorta due to aortic root or ascending aorta dilatation. Conclusion More patients with secondary aortopathy had dilated ascending aorta/ aortic root, as well as larger aortic diameters compare to the patients with primary aortopathy. Routine follow-up of these patients with attention to aortic diameter is necessary.
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Affiliation(s)
- Ingrid Schusterova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Alžbeta Banovcinova
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Marianna Vachalcova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Marta Jakubova
- 1th Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Pod krasnou horkou 1, 83101, Bratislava, Slovakia.
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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9
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Aortic elasticity after aortic coarctation relief: comparison of surgical and interventional therapy by cardiovascular magnetic resonance imaging. BMC Cardiovasc Disord 2019; 19:286. [PMID: 31830907 PMCID: PMC6907235 DOI: 10.1186/s12872-019-01270-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction. Our purpose was to assess aortic bioelasticity and LV properties in CoA patients who underwent endovascular stenting or surgery using cardiovascular magnetic resonance (CMR) imaging. Methods Fifty CoA patients (20.5 ± 9.5 years) were examined by 3-Tesla CMR. Eighteen patients had previous stent implantation and 32 had surgical repair. We performed volumetric analysis of both ventricles (LV, RV) and left atrium (LA) to measure biventricular volumes, ejection fractions, left atrial (LA) volumes, and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir). Aortic distensibility and pulse wave velocity (PWV) were assessed. Native T1 mapping was applied to examine LV tissue properties. In twelve patients post-contrast T1 mapping was performed. Results LV, RV and LA parameters did not differ between the surgical and stent group. There was also no significant difference for aortic distensibility, PWV and T1 relaxation times. Aortic root distensibility correlated negatively with age, BMI, BSA and weight (p < 0.001). Native T1 values correlated negatively with age, weight, BSA and BMI (p < 0.001). Lower post-contrast T1 values were associated with lower aortic arch distensibility and higher aortic arch PWV (p < 0.001). Conclusions CoA patients after surgery or stent implantation did not show significant difference of aortic elasticity. Thus, presumably other factors like intrinsic aortic abnormalities might have a greater impact on aortic elasticity than the approach of repair. Interestingly, our data suggest that native T1 values are influenced by demographic characteristics.
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10
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Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J 2019; 49:691-708. [PMID: 31347322 PMCID: PMC6675699 DOI: 10.4070/kcj.2019.0187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In adult congenital heart disease (ACHD), residua and sequellae after initial repair develop late complications such as cardiac failure, arrhythmias, thrombosis, aortopathy, pulmonary hypertension and others. Acquired lesions with aging such as hypertension, diabetes mellitus, obesity can be negative influence on original cardiovascular disease (CVD). Also, atherosclerosis may pose an additional health problem to ACHD when they grow older and reach the age at which atherosclerosis becomes clinically relevant. In spite of the theoretical risk of atherosclerosis in ACHD due to above mentioned factors, cyanotic ACHDs even after repair are noted to have minimal incidence of coronary artery disease (CAD). Acyanotic ACHD has similar prevalence of CAD as the general population. However, even in cyanotic ACHD, CAD can develop when they have several risk factors for CAD. The prevalence of risk factor is similar between ACHD and the general population. Risk of premature atherosclerotic CVD in ACHD is based, 3 principal mechanisms: lesions with coronary artery abnormalities, obstructive lesions of left ventricle and aorta such as coarctation of the aorta and aortopathy. Coronary artery abnormalities are directly affected or altered surgically, such as arterial switch in transposition patients, may confer greater risk for premature atherosclerotic CAD. Metabolic syndrome is more common among ACHD than in the general population, and possibly increases the incidence of atherosclerotic CAD even in ACHD in future. Thus, ACHD should be screened for metabolic syndrome and eliminating risk factors for atherosclerotic CAD.
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Affiliation(s)
- Koichiro Niwa
- Cardiovascular Center, Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
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11
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Li JD, Ma WG, Liu NN, Huang XY, Sun LZ. Surgical repair of graft aneurysm following ascending-to-abdominal aortic bypass. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:183-186. [PMID: 31193596 PMCID: PMC6536852 DOI: 10.1016/j.jvscit.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
Graft aneurysm after ascending aorta to abdominal aorta bypass is a rare complication of repair of coarctation of the aorta. We present a case of an aneurysm measuring 75 mm in diameter at the midportion of the prosthetic graft in a 33-year-old man. To prevent aneurysm rupture, redo ascending-to-abdominal aortic bypass was performed through an upper ministernotomy and upper midline laparotomy. No postoperative complications occurred. The patient was successfully discharged on postoperative day 6. Although ascending-to-abdominal aortic bypass can achieve long-term patency, the prosthetic graft still has the rare risk of aneurysm formation, as highlighted in this case. Early diagnosis and timely management of this rare complication are essential in preventing aneurysm rupture.
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Affiliation(s)
- Jin-Dong Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ning-Ning Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao-Yong Huang
- Department of Interventional Radiology, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
- Correspondence: Li-Zhong Sun, MD, Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Beijing 100029, PR China
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12
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Wahl L, Tubbs RS. A review of the clinical anatomy of hypertension. Clin Anat 2019; 32:678-681. [PMID: 30873636 DOI: 10.1002/ca.23369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 01/13/2023]
Abstract
Hypertension is defined as the persistent elevation of blood pressure above normal limits. It can be classified according to whether the contributing factors are genetics and environmental (primary hypertension) or underlying medical conditions and medications (secondary hypertension). The goal of this review is to increase recognition of the various anatomical etiologies of hypertension. Clin. Anat. 32:678-681, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lauren Wahl
- Seattle Science Foundation, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Pathirana D, Johnston B, Johnston P. The effect of including increased arterial stiffness in the upper body when modelling Coarctation of the Aorta. Comput Methods Biomech Biomed Engin 2019; 22:475-489. [PMID: 30714407 DOI: 10.1080/10255842.2018.1564821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Coarctation of the Aorta is a congenital narrowing of the aorta and diagnosis can be difficult. Treatments result in idiopathic sequelae including hypertension. Untreated patients are known to develop increased arterial stiffness in the upper body, which worsens with time. We present results from simulations with a one-dimensional mathematical model, about the effect of stiffness, stenting, surgery and coarctation severity on blood pressure, Pulsatility and Resistivity Index. One conclusion is that increased stiffness may explain both hypertension in treated patients and why diagnosis can be difficult.
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Affiliation(s)
- Dilan Pathirana
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
| | - Barbara Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
| | - Peter Johnston
- a School of Natural Sciences and Queensland Micro- and Nanotechnology Centre, Griffith University , Nathan 4111 , Australia
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14
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Carr M, Curtis S, Marek J. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Congenital left-sided heart obstruction. Echo Res Pract 2018; 5:R23-R36. [PMID: 29681546 PMCID: PMC5911774 DOI: 10.1530/erp-18-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 11/23/2022] Open
Abstract
Congenital obstruction of the left ventricular outflow tract remains a significant problem and multilevel obstruction can often coexist. Obstruction can take several morphological forms and may involve the subvalvar, valvar or supravalvar portion of the aortic valve complex. Congenital valvar stenosis presenting in the neonatal period represents a spectrum of disorders ranging from the hypoplastic left heart syndrome to almost normal hearts. Treatment options vary dependent on the severity of the left ventricular outflow tract obstruction (LVOTO) and the variable degree of left ventricular hypoplasia as well as the associated lesions such as arch hypoplasia and coarctation.
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Affiliation(s)
- Michelle Carr
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephanie Curtis
- Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Jan Marek
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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15
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Vigneswaran TV, Sinha MD, Valverde I, Simpson JM, Charakida M. Hypertension in Coarctation of the Aorta: Challenges in Diagnosis in Children. Pediatr Cardiol 2018; 39:1-10. [PMID: 29043396 DOI: 10.1007/s00246-017-1739-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
Evidence indicates that patients with coarctation of the aorta (COA) suffer from increased cardiovascular morbidity and mortality in later life despite successful repair of COA in childhood. Systolic arterial hypertension is common, presenting in up to one-third of patients, and is regarded as the main driver of premature cardiovascular events in this group of patients. In this review, we discuss the prevalence and pathophysiology of hypertension in children following successful COA repair with no residual arch obstruction. The challenges in accurate blood pressure assessment at this early phase are considered and non-invasive measures of central blood pressure are discussed. Although the pathways for investigations in adults are well defined, we highlight the need to address the issues of cardiovascular surveillance in children and describe techniques which can provide complementary information for cardiovascular assessment in this group of patients such that timely treatment can occur.
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Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, SE1 7EH, London, UK
| | - Israel Valverde
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK.,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK
| | - Marietta Charakida
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' Hospitals, London, SE1 7EH, UK. .,Division of Imaging Sciences, Kings College London British Heart Foundation Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
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16
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Poor blood pressure control in adults with repaired coarctation of the aorta and hypertension: a register-based study of associated factors. Cardiol Young 2017; 27:1708-1715. [PMID: 28703088 DOI: 10.1017/s1047951117001020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Arterial hypertension is common in adults with repaired coarctation of the aorta, and is associated with several severe complications. Aims This study aimed to investigate the prevalence of poorly controlled (⩾140/90 mmHg) blood pressure among patients with diagnosed hypertension and to identify associated factors. METHODS In the national register for CHD, adults with repaired coarctation of the aorta and diagnosed hypertension - defined as a registry diagnosis and/or use of anti-hypertensive prescription medication - were identified. Logistic regression analysis was used to identify variables associated with poorly controlled blood pressure. RESULTS Of the 243 included patients, 27.2% were female, the mean age was 45.4±15.3 years, and 52.3% had poorly controlled blood pressure at the last registration. In a multivariable model, age (years) (OR 1.03, CI 1.01-1.06, p=0.008) was independently associated with poorly controlled blood pressure and so was systolic arm-leg blood pressure gradient in the ranges [10, 20] mmHg (OR 4.92, CI 1.76-13.79, p=0.002) to >20 mmHg (OR 9.93, CI 2.99-33.02, p<0.001), in comparison with the reference interval [0, 10] mmHg. Patients with poorly controlled blood pressure had, on average, more types of anti-hypertensive medication classes prescribed (1.9 versus 1.5, p=0.003). CONCLUSIONS Poorly controlled blood pressure is common among patients with repaired coarctation of the aorta and diagnosed hypertension, despite what seems to be more intensive treatment. A systolic arm-leg blood pressure gradient is associated with poorly controlled blood pressure, even at low levels usually not considered for intervention, and may be an indicator of hypertension that is difficult to treat.
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Abstract
Coarctation of the aorta is an uncommon cause of treatment-resistant hypertension in adults. It is typically detected and treated in infancy or childhood with surgical or endovascular procedures. Most cases of recurrence of coarctation after repair occur in childhood or early adulthood; recurrence in older persons (>70 years) has rarely been reported. A 73-year-old woman was referred to us for the management of treatment-resistant hypertension accompanied by symptoms of claudication and headaches, which had resulted in multiple emergency room visits. Of note, 58 years earlier, a graft from the left subclavian artery had been used to bypass an aortic coarctation. During a hospitalization for severe hypertension accompanied by acute kidney injury and heart failure, diagnostic angiography revealed a complete thrombotic occlusion of the left subclavian-artery-to-descending-aorta bypass graft and a tight coarctation in the descending thoracic aorta. Balloon angioplasty and stenting across the coarctation was only transiently effective; subsequently, an ascending-to-descending graft was placed distal to the coarctation, and within a few days, the blood pressure levels and claudication improved markedly. This case demonstrates that hypertension specialists should suspect the possibility of recurrence of a coarctation in older patients who present with resistant hypertension and have a remote history of coarctation repair. Although such late recurrences are not common, as illustrated in our patient, surgical intervention may contribute to significant improvement in blood pressure control and prevent future complications.
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Caruana M, Grech V. Long-term outcomes after aortic coarctation repair in Maltese patients: A population-based study. CONGENIT HEART DIS 2017; 12:588-595. [DOI: 10.1111/chd.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 01/12/2023]
Affiliation(s)
| | - Victor Grech
- Department of Pediatrics; Mater Dei Hospital; Msida Malta
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Sato H, Kamiya CA, Sawada M, Horiuchi C, Tsuritani M, Iwanaga N, Ohuchi H, Shiraishi I, Ichikawa H, Yoshimatsu J. Changes in echocardiographic parameters and hypertensive disorders in pregnancies of women with aortic coarctation. Pregnancy Hypertens 2017; 10:46-50. [PMID: 29153689 DOI: 10.1016/j.preghy.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/14/2017] [Accepted: 05/27/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Pregnancy can be well tolerated after the repair of aortic coarctation. However, a higher incidence of hypertensive disorders during these pregnancies was reported. We analyzed the perinatal changes in echocardiographic parameters in women with aortic coarctation and investigated the risk factors of gestational hypertension (GH). METHODS We retrospectively identified 15 pregnancies in nine Japanese women with aortic coarctation between 1982 and 2015. We categorized the patients according to the presence/absence of GH as the group with GH(n=3) and that without GH(n=12). The echocardiographic parameters were compared between groups. RESULTS Our analysis revealed that a pre-pregnancy Doppler-measured pressure gradient≥20mmHg and a left ventricular mass index≥95g/m2 were significant risk factors for GH. The left ventricular end-diastolic diameters at the first and the third trimesters, the left ventricular end-systolic diameters at the first trimester, and the left ventricular ejection fraction at the third trimester were also significantly higher in the pregnancies with GH. All of these findings had been obtained before the patients' GH occurred. CONCLUSIONS Hypertrophy of the left ventricle with a lower ejection fraction and a high pressure gradient across the coarctation were risk factors for GH in the patients with aortic coarctation. Thus, serial measurements using echocardiography are important for predicting GH in women with aortic coarctation. However, further research investigating this finding with a larger sample size is needed.
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Affiliation(s)
- Hiroshi Sato
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
| | - Chizuko A Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Masami Sawada
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Chinami Horiuchi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Mitsuhiro Tsuritani
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Naoko Iwanaga
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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Survival and cardiovascular events after coarctation-repair in long-term follow-up (COAFU): Predictive value of clinical variables. Int J Cardiol 2017; 228:347-351. [DOI: 10.1016/j.ijcard.2016.11.164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/06/2016] [Indexed: 11/22/2022]
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21
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Chen SJ, Pu XB, An Q, Feng Y, Chen M. A two-stage hybrid approach for complex aortic coarctation combined with ascending-descending aorta dilatation and concomitant aortic valve regurgitation. J Card Surg 2017; 32:148-150. [PMID: 28110491 DOI: 10.1111/jocs.13089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a case of aortic coarctation combined with ascending-descending aorta dilatation and concomitant aortic valve regurgitation. The technique involved using endovascular stenting, a two-stage balloon dilation procedure post-stent implantation and a Bentall procedure.
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Affiliation(s)
- Shi-Jian Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Bo Pu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi An
- Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Rinnström D, Dellborg M, Thilén U, Sörensson P, Nielsen NE, Christersson C, Johansson B. Hypertension in adults with repaired coarctation of the aorta. Am Heart J 2016; 181:10-15. [PMID: 27823680 DOI: 10.1016/j.ahj.2016.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/22/2016] [Indexed: 11/15/2022]
Abstract
AIMS In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. METHODS AND RESULTS In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36.9±14.4years); 344 (52.7%) of them had HTN, defined as either an existing diagnosis or blood pressure (BP) ≥140/90mmHg at the clinical visit. In a multivariable model, age (years) (odds ratio [OR] 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68), and body mass index (kilograms per square meter) (OR 1.09, CI 1.03-1.16) were independently associated with having HTN, and so was systolic arm-leg BP gradient where an association with HTN was found at the ranges of (10, 20] and >20mmHg, in comparison to the interval ≤10mmHg (OR 3.58, CI 1.70-7.55, and OR 11.38, CI 4.03-32.11). This model remained valid when all patients who had increased BP (≥140/90mmHg) without having been diagnosed with HTN were excluded from the analyses. CONCLUSIONS Hypertension is common in patients with previously repaired CoA and is associated with increasing age, male sex, and elevated body mass index. There is also an association with arm-leg BP gradient, starting at relatively low levels that are usually not considered for intervention.
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Affiliation(s)
- Daniel Rinnström
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Thilén
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Niels-Erik Nielsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Bengt Johansson
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Kische S, D'Ancona G, Stoeckicht Y, Ortak J, Elsässer A, Ince H. Percutaneous treatment of adult isthmic aortic coarctation: acute and long-term clinical and imaging outcome with a self-expandable uncovered nitinol stent. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001799. [PMID: 25582143 DOI: 10.1161/circinterventions.114.001799] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To present perioperative and long-term results of percutaneous treatment of adult isthmic coarctation of the aorta by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany). METHODS AND RESULTS Preoperative, perioperative, and long-term clinical and computed tomographic angiography data were collected and analyzed prospectively. A total of 52 consecutive patients were treated with the Sinus-XL stent. Mean age was 36.6 (21-67) years, peak invasive trans-coarctation of the aorta gradient was 54.7 ± 9.9 mm Hg, and upper body hypertension unresponsive to medical treatment was present in all patients. Mean stent diameter and length were 24.2 mm (22-28 mm) and 70.4 mm (40-80 mm), respectively. Eight patients (15.4%) required coarctation of the aorta predilatation. All patients underwent poststent dilatation with a noncompliant balloon. Postoperative peak gradient (3.3 ± 2.5 mm Hg) was reduced significantly (P < 0.001) and minimal aortic diameter was increased significantly (4.6 ± 1.9 versus 18.6 ± 2.5 mm; P < 0.001). All patients were discharged home (mean hospitalization, 3.5 days). At follow-up (47.6 months; 12-84), 1 (1.9%) noncardiovascular mortality was reported. Aortic computed tomography confirmed the absence of stent collapse and secondary migration and documented stability in aortic diameter (18.3 ± 2.7 mm). Thirty patients (57.7%) were completely weaned-off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P < 0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P < 0.001). CONCLUSIONS Adult coarctation of the aorta treatment by means of a self-expandable uncovered stent is safe and durable. The peculiar stent design maintains adequate localized radial strength over time with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimization is immediate and persistent even at long-term follow-up.
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Affiliation(s)
- Stephan Kische
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Giuseppe D'Ancona
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
| | - Yannik Stoeckicht
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Jasmin Ortak
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Albrecht Elsässer
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Hüseyin Ince
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
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24
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Goldberg JF. Long-term Follow-up of "Simple" Lesions--Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta. CONGENIT HEART DIS 2015; 10:466-74. [PMID: 26365715 DOI: 10.1111/chd.12298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/10/2023]
Abstract
Surgery for congenital heart disease has advanced significantly in the past 50 years, such that repair of "simple" lesions, such as atrial septal defect, ventricular septal defect, and coarctation of the aorta carries minimal risk, with mortality risk much less than 1%. It was once thought successful repair of these lesions was definitively corrective. There is mounting evidence, however, that there are long-term complications after these repairs, prompting the need for continued follow-up. This review describes the current understanding of diagnosis, treatment, and long-term outcomes for these patients, with the goal of advocating for lifelong surveillance. As the perioperative care of these repairs has evolved significantly over time, so must the way in which we study these patients in the long-term.
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Affiliation(s)
- Jason F Goldberg
- Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex, USA
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25
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Lui GK, Fernandes S, McElhinney DB. Management of cardiovascular risk factors in adults with congenital heart disease. J Am Heart Assoc 2014; 3:e001076. [PMID: 25359401 PMCID: PMC4338694 DOI: 10.1161/jaha.114.001076] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/01/2014] [Indexed: 01/21/2023]
Affiliation(s)
- George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA (G.K.L., S.F.)
| | - Susan Fernandes
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA (G.K.L., S.F.)
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA (D.B.M.E.)
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26
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End-to-Side Repair for Aortic Arch Lesions Offers Excellent Chances to Reach Adulthood Without Reoperation. Ann Thorac Surg 2014; 98:1405-11. [DOI: 10.1016/j.athoracsur.2014.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/02/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022]
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27
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Luijendijk P, Lu H, Heynneman FB, Huijgen R, de Groot EE, Vriend JW, Vliegen HW, Groenink M, Bouma BJ, Mulder BJ. Increased carotid intima–media thickness predicts cardiovascular events in aortic coarctation. Int J Cardiol 2014; 176:776-81. [DOI: 10.1016/j.ijcard.2014.07.090] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/10/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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28
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Onohara D, Sato A, Tasaki Y, Yamada T. Co-existence of severe coarctation of the aorta and aortic valve stenosis in a 65-year-old woman: a case report. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:750-3. [PMID: 24492168 DOI: 10.5761/atcs.cr.13-00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coarctation of the aorta is usually diagnosed and corrected early in life. Survival to more than 60 years of age of a patient with unrepaired coarctation of the aorta is extremely unusual, and the optimal management strategies for such patients are controversial. We describe the case of a woman who was first diagnosed as having coarctation of the aorta and aortic valve stenosis at the age of 65 years and underwent successful aortic valve replacement.
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Affiliation(s)
- Daisuke Onohara
- Department of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Oita, Japan
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Hu ZP, Wang ZW, Dai XF, Zhan BT, Ren W, Li LC, Zhang H, Ren ZL. Outcomes of Surgical versus Balloon Angioplasty Treatment for Native Coarctation of the Aorta: A Meta-Analysis. Ann Vasc Surg 2014; 28:394-403. [DOI: 10.1016/j.avsg.2013.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/14/2013] [Accepted: 02/17/2013] [Indexed: 12/12/2022]
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30
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Luijendijk P, Bouma BJ, Groenink M, Boekholdt M, Hazekamp MG, Blom NA, Koolbergen DR, de Winter RJ, Mulder BJM. Surgical versus percutaneous treatment of aortic coarctation: new standards in an era of transcatheter repair. Expert Rev Cardiovasc Ther 2014; 10:1517-31. [DOI: 10.1586/erc.12.158] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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31
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Egan M, Holzer RJ. Comparing balloon angioplasty, stenting and surgery in the treatment of aortic coarctation. Expert Rev Cardiovasc Ther 2014; 7:1401-12. [DOI: 10.1586/erc.09.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Zhou L, Lui GK, Shenoy R, Taub CC. Coarctation of the aorta associated with Dandy-Walker variant. J Cardiovasc Dis Res 2014; 4:182-6. [PMID: 24396258 DOI: 10.1016/j.jcdr.2013.06.002] [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: 01/18/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022] Open
Abstract
This article reports a rare case of coarctation of the aorta associated with Dandy-Walker variant in a 17-year-old girl. Differential diagnoses of coarctation of the aorta and Dandy-Walker variant are extensively discussed. In addition, standard surgical treatment of coarctation as well as new approaches such as endovascular stenting are described in detail to provide therapeutic insights into her management. Although surgical or endovascular repair of coarctation results in significant improvement of systemic hypertension and is associated with better survival, cardiovascular complications are still very common. Thus, long-term follow-up after repair is required, and high-quality imaging studies such as echocardiography, CT and MRI are warranted.
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Affiliation(s)
- Li Zhou
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - George K Lui
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10461, USA ; Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Rajesh Shenoy
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Cynthia C Taub
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Sezer SS, Narin N, Ozyurt A, Onan SH, Pamukcu O, Argun M, Baykan A, Uzum K. Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting. J Hum Hypertens 2013; 28:372-7. [PMID: 24284383 DOI: 10.1038/jhh.2013.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/05/2013] [Accepted: 10/11/2013] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the echocardiographic, biochemical short- and mid-term effects of the stenting procedure on left ventricular function, aortic stiffness, elasticity and systemic hypertension in children with coarctation of the aorta (CoA). Fifteen patients with native or recurrent CoA and 30 healthy controls who were sex and age matched were included in the study. The blood pressure values, echocardiographic measurements, elastic functions of ascending aorta and serum N-Terminal ProBNP (NT-ProBNP) levels were recorded prospectively before and at the first and sixth month after stenting. The mean arterial pressure recorded before stenting was 134.4±16.3 mm Hg; at the sixth month it was 115.5±9.5 mm Hg and in the control group it was 107.3±9.4 mm Hg. Although blood pressure levels were lower compared with the pre-stenting measurements (P<0.05), they were still significantly higher compared with the control group (P<0.05). Although a significant reduction was detected in the LVMIz at the end of the sixth month (50.4±14.3 g m(-2.7)) compared with the baseline (66.6±17.9 g m(-2.7); P<0.05), it was still higher compared with the control group (35.7±6.2 g m(-2.7); P<0.05). The baseline aortic elasticity (6.4±3.4 cm(2) dyn(-1) 10(-6)) was lower compared with the control group (10.0±1.7 cm(2) dyn(-1) 10(-6); P<0.05), and prestenting aortic stiffness was higher than that of the control group (5.6±1.6 dyn(-1) 10(-6); 2.5±0.45 dyn(-1) 10(-6); P<0.05). A statistically significant negative correlation was detected between the pressure gradient at the lesion site and aortic elasticity (r: -0.53, P: 0.04). Although resolution of the coarctation by endovascular stenting led to a reduction in the arteriopathy that had already begun before treatment, it was demonstrated that these children did not completely return to normal.
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Affiliation(s)
- S S Sezer
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - N Narin
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - A Ozyurt
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - S H Onan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - O Pamukcu
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - M Argun
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - A Baykan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - K Uzum
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
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Luijendijk P, Stevens AW, de Bruin-Bon RH, Boekholdt SM, Vriend JW, Vliegen HW, Bouma BJ, Mulder BJ. Rates and determinants of progressive aortic valve dysfunction in aortic coarctation. Int J Cardiol 2013; 167:2841-5. [DOI: 10.1016/j.ijcard.2012.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/10/2012] [Accepted: 07/21/2012] [Indexed: 01/08/2023]
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Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, Oliver WC, Warnes CA, Schaff HV. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol 2013; 62:1020-5. [PMID: 23850909 DOI: 10.1016/j.jacc.2013.06.016] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/20/2013] [Accepted: 06/11/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The objective of our study was to review the long-term outcomes of patients undergoing surgical repair of aortic coarctation. BACKGROUND Surgical repair of aortic coarctation has been performed at the Mayo Clinic, Rochester, Minnesota, for over 60 years. METHODS Between 1946 and 2005, 819 patients with isolated coarctation of the aorta underwent primary operative repair. Medical records were reviewed and questionnaires mailed to the patients. RESULTS Mean age at repair was 17.2 ± 13.6 years. The majority (83%) had pre-operative hypertension. Operations included simple and extended end-to-end anastomosis (n = 632), patch angioplasty (n = 72), interposition grafting (n = 49), bypass grafting (n = 30), and subclavian flap or "other" (n = 35). Overall early mortality (<30 days) was 2.4%. In the previous 30 years (n = 225), there were no operative deaths. Mean follow-up was 17.4 ± 13.9 years, with a maximum of 59.3 years. Actuarial survival rates were 93.3%, 86.4%, and 73.5% at 10, 20, and 30 years, respectively. When compared to an age- and sex-matched population, long-term survival was decreased (p < 0.001). Older age at repair (>20 yrs) and pre-operative hypertension were associated with decreased survival (p < 0.001). Patients age <9 years age at repair had significantly less hypertension at 5 to 15 years of follow-up (p < 0.001). Rates of freedom from re-intervention on the descending aorta were 96.7%, 92.2%, and 89.4% at 10, 20, and 30 years, respectively. Younger age at time of repair (p < 0.001) and an end-to-end anastomosis technique (p < 0.001) were independently associated with lower rates of re-intervention on the descending aorta. CONCLUSIONS Primary repair of isolated coarctation of the aorta was performed with a low rate of mortality. However, long-term survival was reduced compared with that in an age- and sex-matched population, and many patients required further reoperation. These findings emphasize that patients with aortic coarctation need early recognition and intervention, as well as lifelong informed follow-up.
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Affiliation(s)
- Morgan L Brown
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Cuypers J, Leirgul E, Larsen TH, Berg A, Omdal TR, Greve G. Assessment of vascular reactivity in the peripheral and coronary arteries by Cine 3T-magnetic resonance imaging in young normotensive adults after surgery for coarctation of the aorta. Pediatr Cardiol 2013; 34:661-9. [PMID: 23064837 DOI: 10.1007/s00246-012-0522-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/11/2012] [Indexed: 01/22/2023]
Abstract
This study aimed to investigate whether coarctation of the aorta in infancy indicates an altered vascular reactivity in the peripheral and coronary arteries apart from the secondary effect of hypertension or other complications of the disease. Patients with repaired coarctation of the aorta have a high prevalence of premature cardiovascular complications. The etiology still is not fully understood, and the cause is most likely multifactorial. Endothelial function was assessed by peripheral flow mediated dilation (FMD) and coronary flow reserve (CFR) in a study of 10 control subjects and 10 patients with a successfully repaired coarctation of the aorta (mean age, 20.9 years; 20.5 years after repair). No one had re- or rest-coarctation of the aorta, hypertension, pathologic blood pressure response during exercise, or associated cardiac malformations such as bicuspid aortic valve. CFR was achieved by phase-contrast velocity encoding cine magnetic resonance imaging in the coronary sinus before and during infusion with adenosine (0.14 mg/kg/min). FMD was measured in the brachial artery before and after 5 min of arterial occlusion. A normal CFR and FMD was found in both groups. Most studies have been conducted with large, unselected groups. The current study group represented the best outcome of the coarctation spectrum (i.e., patients with no evidence of a residual gradient across the coarctation site or systemic hypertension). The findings reassuringly suggest that significant endothelial dysfunction and atherosclerotic changes were not present in this selected cohort.
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Affiliation(s)
- Jochem Cuypers
- Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway.
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Bocelli A, Favilli S, Pollini I, Bini RM, Ballo P, Chiappa E, Zuppiroli A. Prevalence and long-term predictors of left ventricular hypertrophy, late hypertension, and hypertensive response to exercise after successful aortic coarctation repair. Pediatr Cardiol 2013; 34:620-9. [PMID: 23052661 DOI: 10.1007/s00246-012-0508-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/26/2012] [Indexed: 01/06/2023]
Abstract
Controversial data exist about the long-term results of aortic coarctation (AC) repair. This study explored the prevalence and predictors of left ventricular (LV) hypertrophy, late hypertension, and hypertensive response to exercise in 48 subjects (age, 15.1 ± 9.7 years) currently followed in the authors' tertiary care hospital after successful AC repair. Data on medical history, clinical examination, rest and exercise echocardiography, and ambulatory blood pressure monitoring were collected. The time from AC repair to follow-up evaluation was 12.9 ± 9.2 years. The prevalence of LV hypertrophy ranged from 23 to 38 %, based on the criteria used to identify LV hypertrophy, and that of concentric geometry was 17 %. One sixth of the patients without residual hypertension experienced late-onset hypertension. One fourth of those who remained normotensive without medication showed a hypertensive response to exercise. Age at AC repair was the strongest independent predictor of LV hypertrophy, defined using indexation either for body surface area (odds ratio [OR], 1.03; p = 0.0090) or for height(2.7) (OR 1.02; p = 0.029), and it was the only predictor of late hypertension (OR 1.06; p = 0.0023) and hypertensive response to exercise (OR 1.09; p = 0.029). The risk of LV hypertrophy was 25 % for repair at the age of 3.4 years but rose to 50 and 75 % for repair at the ages of 5.9 and 8.4 years, respectively. Similar increases were found for the risk of late-onset hypertension and hypertensive response to exercise. A considerable risk of LV hypertrophy, late hypertension, and hypertensive response to exercise exists after successful AC repair. Older age at intervention is the most important predictor of these complications.
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Affiliation(s)
- Arianna Bocelli
- Pediatric Cardiology Unit, A. Meyer Hospital, Florence, Italy
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Hypertension after repair of aortic coarctation--a systematic review. Int J Cardiol 2012; 167:2456-61. [PMID: 23041096 DOI: 10.1016/j.ijcard.2012.09.084] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/14/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED Hypertension continues to be a common and potentially serious problem in patients who have undergone anatomically successful repair of aortic coarctation. OBJECTIVE To assess the prevalence of hypertension after aortic coarctation repair, the factors that affect the prevalence and the hypotheses behind hypertension in this cohort of patients. DESIGN A systematic review of all articles reporting on systolic blood pressure (SBP) in patients who have undergone aortic coarctation repair. DATA SOURCES An electronic search of all English articles using PUBMED and The Cochrane Controlled Trials Register was performed. A manual search of references lists of relevant studies and a search of conference abstracts were also conducted. INCLUSION CRITERIA We restricted inclusion to articles published between 1987 and 2012 that reported on SBP in patients who have undergone aortic coarctation repair. DATA EXTRACTION Independent extraction of articles was performed by two authors using predefined data fields. One author then proceeded to extract information of interest from these articles. RESULTS The first search yielded 12,914 articles. After screening titles, abstracts and full text articles 26 articles were included in this review article. In papers reporting the prevalence of hypertension late after anatomically satisfactory coarctation repair, the median prevalence was 32.5% (range 25-68%). CONCLUSION Hypertension remains a common complication following aortic coarctation repair. Factors that influence the reported prevalence of hypertension include the age at the time of surgery, age at follow up, the method used to measure blood pressure and the type of intervention performed.
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Vaseghi M, Ackerman MJ, Mandapati R. Restricting sports for athletes with heart disease: are we saving lives, avoiding lawsuits, or just promoting obesity and sedentary living? Pediatr Cardiol 2012; 33:407-16. [PMID: 22327180 DOI: 10.1007/s00246-012-0170-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 10/04/2011] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death in young competitive athletes is tragic and usually due to unsuspected cardiovascular disease. Screening programs for athletes remain debatable, and restriction of athletes from sports can have physical, emotional, and legal ramifications. In this article, we review the epidemiology of the more common inherited arrhythmias and congenital heart diseases that are of concern in a newly diagnosed athlete. A comparison of the current American Heart Association/American College of Cardiology and European Society guidelines, which are primarily based on expert opinion due to lack of randomized studies, is then undertaken. Furthermore, certain legal repercussions associated with both qualifying and restricting athletes from competitive sports are discussed. Lastly, we urge physicians to keep in mind that disqualifying an athlete from competitive sports does not mean restriction of all activities, and even patients with inherited arrhythmias and congenital heart disease can participate in low to moderate activity complementary with a healthy lifestyle.
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Affiliation(s)
- Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Trojnarska O, Szczepaniak-Chicheł L, Mizia-Stec K, Gabriel M, Bartczak A, Grajek S, Gąsior Z, Kramer L, Tykarski A. Vascular remodeling in adults after coarctation repair: impact of descending aorta stenosis and age at surgery. Clin Res Cardiol 2011; 100:447-55. [PMID: 21161708 PMCID: PMC3079825 DOI: 10.1007/s00392-010-0263-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/29/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients after successful repair of coarctation of aorta (CoAo) are at risk of hypertension at rest and associated end-organ damage. The aim of the study was to assess arterial stiffness and function in adults after coarctation repair in relation to descending aorta (AoD) residual coarctation and patient's age at operation. METHODS 85 patients after CoAo repair (53 males) aged 34.6 ± 10.3 years; median age at operation 0.9 ± 8.2 years. The control group-30 individuals (18 males) at mean age 33.6 ± 8.2 years. The following central parameters: augmentation pressure (AP) and augmentation index (AI) as well as peripheral vascular parameters: flow-mediated dilatation (FMD), nitroglycerin-mediated vasodilatation (NMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were measured. RESULTS 47 CoAo-repaired patients were normotensive, and compared to control, they presented higher values of central parameters AP (7.3 ± 4.6 vs. 4.4 ± 3.6 mmHg; p = 0.002) and AI (18.6 ± 10.4 vs. 13.5 ± 4.3%; p = 0.03); as well as the increased PWV (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), while IMT was comparable (0.53 ± 0.01 vs. 0.51 ± 0.01 mm; p = 0.06). The vasodilatation was impaired in the normotensive patients: FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001). The comparison of recoarctation (46, 54%) to non-recoarctation (39, 46%) patients did not reveal any significant differences in resting systolic and diastolic pressures, as well as the values of AI and the peripheral vascular parameters; the value of AP was higher in the recoarctation patients (10.5 ± 6.9 vs. 7.5 ± 4.1; p = 0.02) and correlated positively with the gradient across AoD (r = 0.295, p = 0.01). There was no significant linear correlation between age at the time of surgery and any of peripheral arterial parameters. CONCLUSIONS Residual stenosis in AoD does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. Early operation has no impact on peripheral vascular remodeling or central pressure which supports the claim that coarctation of the aorta is a systemic vascular disorder which leads to progressive vascular and end-organ damage despite early correction.
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Affiliation(s)
- Olga Trojnarska
- 1st Department of Cardiology, Poznań University of Medical Sciences, Poland, ul. Długa 1/2, 61-848, Poznań, Poland.
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Hemels MEW, Hoendermis ES, van Melle JP, Pieper PG. Therapy refractory hypertension in adults: aortic coarctation has to be ruled out. Neth Heart J 2011; 19:107-111. [PMID: 21475399 PMCID: PMC3047687 DOI: 10.1007/s12471-011-0074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In patients with unexplained hypertension, especially in combination with a cardiac murmur, the presence of an aortic coarctation should always be ruled out given the high morbidity and mortality. However, particularly patients with an isolated coarctation often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life. In the present article, we describe two patients with late detected coarctation to illustrate the clinical consequences, diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment. The key sign of an aortic coarctation, a difference in arterial blood pressure measured between the upper and lower extremities, should always be examined, followed by echocardiography. We conclude that even in case of a late detected severe coarctation, surgical or percutaneous repair has proven to be feasible and substantially effective, improving quality of life and lowering the risk of further hypertension-associated problems.
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Affiliation(s)
- M. E. W. Hemels
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - E. S. Hoendermis
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - J. P. van Melle
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - P. G. Pieper
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
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Tsai SF, Trivedi M, Boettner B, Daniels CJ. Usefulness of screening cardiovascular magnetic resonance imaging to detect aortic abnormalities after repair of coarctation of the aorta. Am J Cardiol 2011; 107:297-301. [PMID: 21211607 DOI: 10.1016/j.amjcard.2010.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 09/09/2010] [Accepted: 09/09/2010] [Indexed: 01/21/2023]
Abstract
Guidelines recommend screening cardiovascular magnetic resonance (Sc-CMR) imaging for all patients after coarctation of the aorta repair, although there are limited data verifying its clinical utility. Therefore, we sought to assess the value of Sc-CMR in detecting aortic complications and at-risk abnormalities after coarctation of the aorta repair and to identify significant risk factors. We reviewed 76 patients (mean age 31 ± 10 years), including 40 with symptomatically indicated CMR (Sx-CMR) and 36 with Sc-CMR studies. CMR angiograms were evaluated for aortic abnormalities. Recoarctation was defined as residual narrowing/descending aorta at the diaphragm ≤0.5 (at risk ≤0.75), ascending aorta aneurysm as maximum ascending cross-sectional area/height ≥10 (at risk ≥5), and descending aorta aneurysm as maximum descending diameter/descending aorta at the diaphragm ≥1.5 (at risk ≥1.25). Aortic complications or abnormalities were found in 45 patients (59%). No patient met criteria for recoarctation (at risk 10 Sx-CMR vs 5 Sc-CMR). Significant risk factors included heart failure symptoms and female gender (p <0.05). One patient (Sc-CMR) had ascending aneurysm (at risk 17 Sx-CMR vs 8 Sc-CMR). Time from repair was a significant predictor (p <0.05). There were 10 patients (6 Sx-CMR vs 4 Sc-CMR) with descending aneurysm (at risk 8 Sx-CMR vs 7 Sc-CMR). Cardiovascular symptoms, hypertension, and echocardiogram were not predictive. In conclusion, >50% of patients undergoing Sc-CMR had aortic abnormalities, which was not significantly different from those undergoing Sx-CMR. In particular, Sc-CMR identified descending aorta aneurysms that were not predicted by clinical parameters or echocardiogram.
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A case of severe asymptomatic aortic coarctation in an adult female. Case Rep Cardiol 2011; 2011:535463. [PMID: 24826221 PMCID: PMC4008515 DOI: 10.1155/2011/535463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/22/2011] [Indexed: 11/17/2022] Open
Abstract
Coarctation of the aorta is typically a disease of childhood and early adulthood,
and there is a reduced life expectancy in patients who have not undergone correction. Survival to
older age is rare, due to severe cardiovascular complications. We describe the case of a woman first
diagnosed with coarctation of aorta at an advanced age.
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Parameters of arterial function and structure in adult patients after coarctation repair. Heart Vessels 2010; 26:414-20. [PMID: 21110200 DOI: 10.1007/s00380-010-0063-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 05/21/2010] [Indexed: 02/03/2023]
Abstract
Regardless of a successful operation, patients with coarctation of aorta (CoAo) are exposed to the risk of hypertension and a propensity to vascular and end-organ damage. The aim of this study is to evaluate the influence of residual aorta stenosis as well as the age at the operation on the parameters of arterial function and structure in patients after CoAo repair. Eighty-five patients after CoAo repair (53 males; mean age: 34.6 ± 10.3 years, mean age at the repair: 10.9 ± 8.2 years) were enrolled in the study. The control group consisted of 30 healthy subjects (18 males; mean age: 33.6 ± 8.2 years). Indices of systemic arterial remodeling [flow-mediated dilatation (FMD), nitroglycerine-mediated vasodilatation (NMD), carotid intima-media thickness (IMT), pulse wave velocity (PWV)] were analyzed in all study patients. In normotensive patients after CoAo repair (47/55%), a significantly increased PWV was observed in comparison to the control group (6.8 ± 1.2 vs. 5.4 ± 0.9 m/s; p = 0.003), with no difference in IMT values (0.53 ± 0.1 vs. 0.51 ± 0.1 mm; p = 0.06). Mean FMD (4.8 ± 2.8 vs. 8.5 ± 2.3%; p = 0.00003) and NMD (11.3 ± 4.6 vs. 19.8 ± 7.2%; p = 0.00001) were lower than in the controls. In patients with a residual aorta stenosis (46/54%), defined as an arm-leg pressure gradient ≥ 20 mmHg, no differences were found within the scope of both systolic and diastolic blood pressure and of all of the examined vascular parameters. No significant correlations were revealed between the vascular parameters and the gradient across descending aorta as well as the age at the operation. Residual stenosis in the descending aorta does not affect the arterial vasodilatation nor stiffness in patients after CoAo repair. An early surgery does not influence the remodeling of the vessels, which supports the thesis that CoAo is a generalized vascular disease and that even an early operation cannot prevent the progressive and vascular changes and end-organ damage.
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Pereda D, Cartañá R, Sundt TM, Mestres CA. Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult. J Vasc Surg 2010; 52:1362-4. [PMID: 20674249 DOI: 10.1016/j.jvs.2010.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/02/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
Abstract
Anatomic repair of complex aortic coarctation is associated with significant mortality and morbidity, including paraplegia. Extra-anatomic bypass strategies have been developed to reduce these complications and allow the correction of any concomitant conditions during the same operation. We present the case of a woman with uncontrolled hypertension and preductal coarctation of the aorta diagnosed at age 22 who underwent an unsuccessful attempt at primary repair, followed by extra-anatomic bypass from the ascending-to-infrarenal aorta. The patient has remained normotensive, with no additional complications related to the disease or the procedure, during a follow-up of 17 years.
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Affiliation(s)
- Daniel Pereda
- Mayo Clinic, Division of Cardiovascular Surgery, Rochester, MN 55905, USA.
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Kenny D, Polson JW, Martin RP, Wilson DG, Caputo M, Cockcroft JR, Paton JF, Wolf AR. Surgical Approach for Aortic Coarctation Influences Arterial Compliance and Blood Pressure Control. Ann Thorac Surg 2010; 90:600-4. [DOI: 10.1016/j.athoracsur.2010.04.098] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/27/2010] [Accepted: 04/27/2010] [Indexed: 01/22/2023]
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Wiseman JE, Agange N, Milliken JC. Coarctation of the Aorta Presenting as Spontaneous Subarachnoid Haemorrhage in the Absence of Cerebral Aneurysm: A Report of a Rare Clinical Entity. Heart Lung Circ 2010; 19:432-4. [DOI: 10.1016/j.hlc.2009.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 11/10/2009] [Accepted: 12/13/2009] [Indexed: 11/15/2022]
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Abstract
Coarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.
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Florianczyk T, Werner B. Assessment of left ventricular systolic function using tissue Doppler imaging in children after successful repair of aortic coarctation. Clin Physiol Funct Imaging 2010; 30:1-5. [DOI: 10.1111/j.1475-097x.2009.00894.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Koletsis E, Ekonomidis S, Panagopoulos N, Tsaousis G, Crockett J, Panagiotou M. Two stage hybrid approach for complex aortic coarctation repair. J Cardiothorac Surg 2009; 4:10. [PMID: 19239693 PMCID: PMC2652448 DOI: 10.1186/1749-8090-4-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
Background Management of an adult patient with aortic coarctation and an associated cardiac pathology poses a great surgical challenge since there are no standard guidelines for the therapy of such complex pathology. Debate exists not only on which lesion should be corrected first, but also upon the type and timing of the procedure. Surgery can be one- or two-staged. Both of these strategies are accomplice with elevate morbidity and mortality. Case report In the face of such an extended surgical approach, balloon dilatation seems preferable for treatment of severe aortic coarctation. We present an adult male patient with aortic coarctation combined with ascending aorta aneurysm and concomitant aortic valve regurgitation. The aortic coarctation was corrected first, using percutaneous balloon dilatation; and in a second stage the aortic regurgitation and ascending aorta aneurysm was treated by Bentall procedure. The patients' postoperative period was uneventful. Three years after the operation he continues to do well.
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Affiliation(s)
- Efstratios Koletsis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Patras, Greece.
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