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Eicken A, Kaemmerer H. Aortenisthmusstenose – eine lebenslange Systemerkrankung. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1493-6462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungKoarktation der Aorta (CoA) ist eine Systemerkrankung aller prästenotischen Arterien.
Während im Säuglingsalter die chirurgische Behandlung im Vordergrund steht, werden erwachsene
Patienten mit CoA oder Re-CoA nach chirurgischer Initialbehandlung, heute überwiegend mit
Stents behandelt, wenn dies technisch möglich ist. Trotz erfolgreicher Beseitigung der
aortalen Enge bleiben viele Patienten hypertensiv. Die Ursache des arteriellen Hypertonus ist
multifaktoriell. Erwachsene CoA-Patienten müssen zum einen regelmäßig in einem EMAH-Zentrum
evaluiert werden und benötigen zum anderen häufig eine permanente antihypertensive
medikamentöse Therapie.
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Affiliation(s)
- Andreas Eicken
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Harald Kaemmerer
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
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Bambul Heck P, Fayed M, Hager A, Cesna S, Georgiev S, Tanase D, Hörer J, Ewert P, Eicken A. Sequential dilation strategy in stent therapy of the aortic coarctation: A single centre experience. Int J Cardiol 2021; 331:82-87. [PMID: 33548378 DOI: 10.1016/j.ijcard.2021.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 12/01/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In our study, we sought to analyse the mid-term results after interventional aortic coarctation (CoA) stenting with sequential dilation of the stent. METHODS The data of all 218 patients, who are above the age of 6 years and underwent CoA-stent implantation in our hospital, were retrospectively analysed on the rate of re-interventions, complications and arterial hypertension at a follow-up time of 31 months. To avoid any aortic complications, stents were deployed primarily not in full size and a second cardiac catheterisation for further dilatation was scheduled within 6-12 months after the stent implantation. RESULTS The median peak invasive systolic pressure gradient declined significantly from 26.2 mmHg to 2.7 mmHg after stenting. There was one procedure related death due to an aortic rupture after stent implantation. There were in total 33 (15.1%) procedure-related complications including femoral artery complications, stent fracture and stent dislocation (in 9, 9 and 7 patients, respectively). In 85 patients a re-dilatation and in 25 patients a second stent-implantation was necessary at the first re-intervention. The systolic blood pressure declined significantly from 144 mmHg to 131 mmHg after stenting. The number of patients being normotensive changed from 18% before stenting to 78.5% after stenting with adjusted antihypertensive medication. CONCLUSION Aortic stenting is an effective means for CoA treatment. With sequential dilation of the stent, a very low rate of life-threatening procedural complications and mortality can be achieved. CoA stenting with proper antihypertensive medications results in better control of blood pressure.
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Affiliation(s)
- Pinar Bambul Heck
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany.
| | - Mohamed Fayed
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany; Department of Paediatrics, Faculty of Medicine, Zagazig University, Egypt
| | - Alfred Hager
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany
| | - Sigitas Cesna
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany; Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania
| | - Stanimir Georgiev
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany
| | - Daniel Tanase
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany
| | - Jürgen Hörer
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany; Division of Paediatric and Congenital Heart Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Peter Ewert
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany
| | - Andreas Eicken
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (DHM), Technische Universität München (TUM), Germany
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Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience. Int J Cardiol 2018; 263:34-39. [DOI: 10.1016/j.ijcard.2018.02.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/13/2018] [Indexed: 11/20/2022]
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Coarctation of the aorta-stenting via Glidesheath Slender in a newborn with recoarctation early after a Norwood operation. Cardiol Young 2018; 28:347-350. [PMID: 29081324 DOI: 10.1017/s1047951117001883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this article, we report on a newborn with hypoplastic left heart syndrome in whom recoarctation of the aorta was treated with a bare metal stent (Cook Formula 414 Stent) in the early postoperative period after a Norwood procedure. To reduce the risk for scarring and occluding the femoral artery the stent was implanted via 5F Glidesheath Slender sheath.
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Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults. Arch Cardiovasc Dis 2015; 108:626-33. [PMID: 26522073 DOI: 10.1016/j.acvd.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/17/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults. METHODS Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months. RESULTS There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P<0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 ± 18 mmHg vs. 137 ± 17 mmHg vs. 142 ± 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 ± 14 mmHg vs. 132 ± 16 mmHg vs. 131 ± 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG >25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96). CONCLUSION Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups.
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Ascending-to-descending aortic bypass: a simple solution to a complex problem. Ann Thorac Surg 2014; 97:2041-7; discussion 2047-8. [PMID: 24725830 DOI: 10.1016/j.athoracsur.2014.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/16/2014] [Accepted: 02/04/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical correction of complex aortic coarctation can be associated with significant risks. Extraanatomic bypass may represent a safer alternative. METHODS Between January 1985 and December 2012, 80 consecutive patients with complex coarctation underwent ascending-to-descending aortic bypass through a median sternotomy. Patients were a median age of 42 years (range, 15 to 75 years), and 51 (64%) were males. Recurrent coarctation was present in 52 patients (65%), with 6 (8%) having undergone balloon dilatation. Uncontrolled hypertension was present in 63 patients (79%). The most common concomitant pathology was aortic valve stenosis in 21 patients (26%), subaortic stenosis in 10 (13%), and Shone complex in 4 (5%). RESULTS There were no early deaths. The most common concomitant procedures were aortic valve replacement, coronary artery bypass grafting, and resection of subaortic stenosis. The mean aortic cross-clamp and cardiopulmonary bypass times were 33 ± 40 and 106 ± 54 minutes, respectively. Morbidity included atrial fibrillation in 17 patients (21%) and reexploration for bleeding in 6 (8%). There was no paraplegia or stroke. Upper extremity blood pressure significantly improved (p < 0.001). Mean systolic blood pressure decreased from 153 ± 26 mm Hg preoperatively to 123 ± 15 mm Hg postoperatively. Mean follow-up was 7 ± 6 years (maximum, 22 years). Late deaths occurred in 5 patients (6%) and were not graft-related. Three patients (4%) required reoperation for repair of periprosthetic regurgitation in 2 and mitral valve replacement in 1. CONCLUSIONS The ascending-to-descending aortic bypass can be performed with low morbidity and mortality. It is an effective solution to complex aortic coarctation and represents a safe single-stage approach for patients with concomitant cardiac pathology.
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Cleuziou J, Kasnar-Samprec J, Hörer J, Eicken A, Lange R, Schreiber C. Recoarctation after the norwood I procedure for hypoplastic left heart syndrome: incidence, risk factors, and treatment options. Ann Thorac Surg 2013; 95:935-40. [PMID: 23337070 DOI: 10.1016/j.athoracsur.2012.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/30/2012] [Accepted: 11/06/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early survival after the Norwood I procedure has improved over the years, but subsequent morbidity is not yet well assessed. The aim of this study was to review the incidence of recoarctation, evaluate risk factors, and analyze treatment options. METHODS We reviewed the medical records of 124 consecutive patients with hypoplastic left heart syndrome (HLHS) who underwent the Norwood I procedure. Reconstruction of the aortic arch was performed in a standardized manner, removing all visible ductal tissue and enlarging the distal anastomosis with a Y incision into the descending aorta. Angiographic assessment with measurement of the peak gradient across the aortic arch was performed before the second stage was performed. RESULTS Recoarctation of the aorta was documented in 13 patients (13.4%) at a mean time of 6.4 ± 5 months after the Norwood procedure. One patient died before the recoarctation could be treated. Right ventricular function was good in all except 1 patient at the time of diagnosis. Ten patients underwent 16 percutaneous balloon angioplasties, and 2 patients underwent operative enlargement of the neoaorta. The pretreatment peak gradient of 24.1 ± 16 mm Hg (10-64 mm Hg) across the aortic arch was significantly reduced to 6.3 ± 4 mm Hg (0-14 mm Hg) after angioplasty or operation (p = 0.003). There were no procedure-related deaths. No risk factor for recoarctation could be identified. CONCLUSIONS A standardized surgical technique for reconstruction of the aorta leads to a low recoarctation rate. Balloon angioplasty can be performed in the majority of patients before the second-stage procedure.
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Affiliation(s)
- Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
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Krasemann T, Bano M, Rosenthal E, Qureshi SA. Results of stent implantation for native and recurrent coarctation of the aorta-follow-up of up to 13 years. Catheter Cardiovasc Interv 2011; 78:405-12. [PMID: 21748842 DOI: 10.1002/ccd.23023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate the mid and long-term prognosis after stenting of native or recurrent CoA, we studied the cardiovascular parameters in the follow-up period up to 13 years. METHODS AND RESULTS Between 1993 and 2006, 68 patients underwent stent implantation for aortic coarctation (average age 25.5 years, range 5.7-65 years, average weight 65.5 kg, range 32-122 kg). Forty-six (68%) patients were aged >17 years. Stenting was performed for native coarctation in 41 and for recurrent coarctation in 27 patients, in 23 (34%) patients with a covered stent. Redilation was carried out in 26 (38%) patients. The invasive systolic gradient decreased from mean (±SD) 25 (±15) mm Hg to 5 (±5) mm Hg (P < 0.0005). The descending aorta pressure increased from 80 (±15) mm Hg to 101 (±18) mm Hg. The systolic right arm blood pressure decreased from a mean of 153 (±24) mm Hg to 129 (±18) mm Hg (P < 0.0005). Complications like small dissections were rare. Follow-up (6 days to 13 years, mean 41 months) was available in 66 patients, in 23 after reintervention at a mean of 71 months, range of 8 months to 10.3 years. Fifty-one percent remained clinically hypertensive. CONCLUSIONS Stenting of aortic coarctation gives good medium-term results. Frequent reintervention relate to deliberately under-dilating stents during the initial procedure. The reintervention rate has reduced since the introduction of covered stents.
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Affiliation(s)
- Thomas Krasemann
- Department of Paediatric Cardiology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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Hill SJ, Zarroug AE, Ricketts RR, Veeraswamy R. Bedside placement of an aortic occlusion balloon to control a ruptured aorto-esophageal fistula in a small child. Ann Vasc Surg 2010; 24:822.e7-9. [PMID: 20471216 DOI: 10.1016/j.avsg.2009.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/19/2009] [Indexed: 11/27/2022]
Abstract
A child had a percutaneous endoscopic gastrostomy tube removed by transecting it at skin level. The internal portion ("the bolster") was allowed to pass in the GI tract. She subsequently had odynophagia. Magnetic resonance imaging identified a foreign body within the lower thoracic esophagus. During esophagoscopy, the bolster was removed. The following morning, she had massive hematemesis with cardiovascular collapse. As an emergent maneuver, an intra-aortic balloon was percutaneously deployed at the bedside without fluoroscopic guidance. This temporized the exsanguination. Subsequent intraoperative aortography confirmed an aortoesophageal fistula. A stent-graft was deployed with immediate hemodynamic stabilization. She later underwent esophageal resection and recovered well.
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Affiliation(s)
- Sarah J Hill
- Department of Surgery, Emory University, Atlanta, GA, USA
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The causes, diagnosis and management of recoarctation of the aorta following coarctation of the aorta surgery at neonatal age. COR ET VASA 2006. [DOI: 10.33678/cor.2006.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Villalba Nogales J, Fernández-Pineda L, Herráiz Sarachaga JI, Bermúdez-Cañete Fernández R, Maitre Azcárate MJ, Quero Jiménez M. Tratamiento no quirúrgico de la coartación y recoartación de aorta. An Pediatr (Barc) 2004; 60:537-43. [PMID: 15207165 DOI: 10.1016/s1695-4033(04)78323-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: 10/27/2022] Open
Abstract
OBJECTIVES To analyze the results of nonsurgical treatment of aortic coarctation and recoarctation by evaluating the results of each technique, and its complications and outcome. PATIENTS AND METHODS The results were as follows: 51 children underwent balloon dilatation due to recoarctation (86.5 %); two underwent dilation of a native coarctation (3.3 %) and six underwent stent implantation for recoarctation (10 %). Age ranged from 2 to 236 months (109 +/- 63.45 months) with a follow-up of between 1 and 156 months (38.87 +/-32.96 months). RESULTS The mean predilatation gradient in children with recoarctation was 34 +/- 11.62 mmHg, which decreased to 11 +/- 5.38 mm Hg (p < 0.0001). In 12 patients (20.3 %) effective dilatation was not achieved. The size of the stenosis was 6.7 +/- 2.35 mm predilatation, which increased to 9.3 +/- 3.10 mm (p < 0.0001) after dilatation with a percentage increase of 50.97. There were very few complications. Six children required subsequent redilatation. The experience with stent showed a mean gradient of 32.83 +/- 10.62 mm Hg, which decreased to 7.3 +/- 3.8 mm Hg (p < 0.0001) with a balloon/stenosis ratio of 1.94. CONCLUSIONS We conclude that the interventionist technique is highly effective in both native coarctation and recoarctation in the short term, as well as subsequently, with very few complications. The stent technique produces equally good results in older children, which is promising for the future.
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Affiliation(s)
- J Villalba Nogales
- Servicio de Cardiología Pediátrica, Hospital Ramón y Cajal, 28400 Madrid, Spain
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Corno AF, Botta U, Hurni M, Payot M, Sekarski N, Tozzi P, von Segesser LK. Surgery for aortic coarctation: a 30 years experience. Eur J Cardiothorac Surg 2001; 20:1202-6. [PMID: 11717029 DOI: 10.1016/s1010-7940(01)00996-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A retrospective study to review the experience of a single center with surgery for aortic coarctation over a period of 30 years (1970-1999). METHODS Criteria for inclusion: (a) aortic coarctation, isolated or associated with congenital heart defect; (b) surgery between 1970 and 1999. Data recorded: (1) date of surgery; (2) age at surgery; (3) associated lesions; (4) surgical technique; (5) simultaneous surgical procedures; (6) early and late surgical results in term of: (a) deaths; (b) need for reoperation because of re-coarctation or other cardiac lesion; (c) residual/recurrent pressure gradient, evaluated at cuff/Doppler at rest; (d) systemic hypertension, requiring medical treatment. RESULTS One hundred and forty-one patients underwent surgery for aortic coarctation: 30 neonates, 29 infants, 45 children and 37 adults. Associated lesions were found in 8/37 (=21.6%) adults and in 73/104 (=70.1%) pediatric patients. There were no hospital deaths. During the follow-up there were one late death in the adults group (1/37=2.7%) and three late deaths in the pediatric group (3/104=2.9%), all unrelated with aortic coarctation. Re-operation because of re-coarctation occurred only in ten late survivors of the pediatric group (10/101=9.9%), 9/10 operated on before 1980 (P<0.00001). End-to-end anastomosis, enlarged to the aortic arch in neonates, was associated with the lowest incidence of re-coarctation (P<0.005). A significant (>20 mmHg at rest) pressure gradient was found in none of the adults, and in seven of the 91 pediatric patients (7/91=7.7%) late survivors. Three adults (3/36=8.3%) late survivors are on medical treatment to control systemic hypertension. CONCLUSIONS The long-term results of our retrospective study confirm that surgery has to be considered the gold standard for the treatment of aortic coarctation. The interventional angioplasty techniques have to provide long-term outcome at least similar to the results obtained with surgery.
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Affiliation(s)
- A F Corno
- Centre Hospitalier Universitaire Vaudois, 46 rue du Bugnon, CH-1011 Lausanne, Switzerland.
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