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Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
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Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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Amoozgar H, Nouri N, Shabanpourhaghighi S, Bagherian N, Mehdizadegan N, Edraki MR, Naghshzan A, Mohammadi H, Ajami G, Abdollahi A. Effect of coarctation of aorta anatomy and balloon profile on the outcome of balloon angioplasty in infantile coarctation. BMC Cardiovasc Disord 2021; 21:594. [PMID: 34911460 PMCID: PMC8672566 DOI: 10.1186/s12872-021-02396-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Coarctation of the Aorta (CoA) is a relatively common cardiovascular disorder. The present study aimed to evaluate the effect of COA anatomy and high versus low-pressure balloons on the outcome of balloon angioplasty among neonates and infants. METHODS In this retrospective study, the neonates and infants undergoing balloon angioplasty at Namazi hospital were enrolled. After balloon angioplasty, immediate data results were promptly recorded.Moreover, midterm echocardiographic information was collected via electronic cardiac records of pediatric wards and clinical and echocardiographic data at least 12 months after balloon angioplasty. Finally, data were analyzed using SPSS-20. RESULTS In this study, 42 infants were included. The median age at the time of balloon angioplasty was 1.55 (range 0.1-12) months and 66.7% of the patients were male. The mean pressure gradient of coarctation was 38.49 ± 24.97 mmHg, which decreased to 7.61 ± 8.00 mmHg (P < 0.001). A high-pressure balloon was used in 27, and a low-pressure balloon was used in 15 patients. COA's pressure gradient changed 30.89 ± 18.06 in the high-pressure group and 24.53 ± 20.79 in the low-pressure balloon group (P = 0.282). In the high-pressure balloon group, 14.81% and in the low-pressure group, 33.33% had recoarctation and need second balloon angioplasty (p < 0.021). The infant with discrete coarctation had a higher decrease in gradient and lower recoarctation. CONCLUSION Recoarctation rate was lower in the high-pressure balloon. The infant with discrete COA had a better response to the balloon with more decrease in gradient and lower recoarctation rate. Therefore, the stenotic segment anatomy needs to be considered in the selection of treatment methods.
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Affiliation(s)
- Hamid Amoozgar
- Neonatal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narjes Nouri
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Neda Bagherian
- School of Medicine, Shiraz University of Medical Sciences, Jahrom, Iran
| | - Nima Mehdizadegan
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
- The Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Reza Edraki
- Neonatal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Naghshzan
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Mohammadi
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Pediatric Department, School of Medicine, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Abdollahi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Wu Y, Jin X, Kuang H, Lv T, Li Y, Zhou Y, Wu C. Is balloon angioplasty superior to surgery in the treatment of paediatric native coarctation of the aorta: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2018; 28:291-300. [PMID: 30060099 DOI: 10.1093/icvts/ivy224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/12/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xin Jin
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongyu Kuang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Tiewei Lv
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Cardiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuehang Zhou
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Abstract
BACKGROUND Optimal management strategy for native aortic coarctation in neonates and young infants is still a matter of debate. The surgical procedure, histopathologic research, and clinical outcome in 15 neonates who underwent surgery after successful balloon angioplasty is the basis of this study. METHOD Between 01 October, 2014 and 01 August, 2017, we enrolled 15 patients with native aortic coarctation for this study. These patients had complications regarding recoarctation, following balloon angioplasty intervention at our institute and other centres. Surgically extracted parts were examined histopathologically and patient's data were collected retrospectively.ResultThe reasons for recurrence of recoarctation after balloon angioplasty are as follows: patients with higher preoperative echocardiographic gradients had recoarctation earlier, neointimal proliferation, aortic intimal fibrosis at the region of ductal insertion, and ductal residual tissue debris after balloon angioplasty. No repeat intervention was required in the 15 patients who underwent surgery followed by balloon angioplasty. Early mortality was seen in one patient after surgery. Postoperative complication in the surgical group occurred in the form of chylothorax in one patient. CONCLUSION In centres in which the neonatal ICU is inexperienced, balloon angioplasty is particularly recommended. In developing neonatal clinics, balloon angioplasty, when performed on patients at their earliest possible age, delays actual corrective operation to a later date, which in turn provides less risky surgical outcomes in infants who are gaining weight, growing, and do not have any haemodynamic complaints.
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Beckmann E, Jassar AS. Coarctation repair-redo challenges in the adults: what to do? J Vis Surg 2018; 4:76. [PMID: 29780722 DOI: 10.21037/jovs.2018.04.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.
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Affiliation(s)
- Erik Beckmann
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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6
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Misenheimer JA, Poommipanit P, Amin Z. Retrograde percutaneous repair of aortic coarctation utilizing trans-septal puncture in patients with complex anatomy. Catheter Cardiovasc Interv 2016; 87:446-50. [PMID: 26508264 DOI: 10.1002/ccd.26165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/27/2015] [Indexed: 11/06/2022]
Abstract
Coarctation of the aorta (COA) is one of the more common congenital anomalies, occurring in four in ten thousand live births and accounting for five to eight percent of all congenital heart defects. COA lesions can be challenging to treat percutaneously, especially if complex vascular anatomy is a barrier to crossing the lesion. We present two cases of COA that utilized a trans-septal approach to cross the lesion in anterograde fashion, subsequently facilitating retrograde stenting of the lesions after snaring and externalizing the wire. In both cases, the trans-septal approach was employed because traditional femoral and radial approaches failed due to complex anatomy, and the trans-septal approach allowed for effective intervention without the need for surgery.
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Affiliation(s)
- Jacob A Misenheimer
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
| | - Paul Poommipanit
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
| | - Zahid Amin
- Division of Congenital and Structural Heart Disease, Georgia Regents University, Augusta, Georgia
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Grohmann J, Sigler M, Siepe M, Stiller B. A new breakable stent for recoarctation in early infancy: Preliminary Clinical Experience. Catheter Cardiovasc Interv 2016; 87:E143-50. [DOI: 10.1002/ccd.26393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/14/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Jochen Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care; University Hospital Göttingen; Göttingen Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery; Heart Center, University of Freiburg; Freiburg Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology; Heart Center, University of Freiburg; Freiburg Germany
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He L, Liu F, Wu L, Qi CH, Zhang LF, Huang GY. Percutaneous balloon angioplasty for severe native aortic coarctation in young infants less than 6 months: medium- to long-term follow-up. Chin Med J (Engl) 2015; 128:1021-5. [PMID: 25881593 PMCID: PMC4832939 DOI: 10.4103/0366-6999.155069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Although balloon angioplasty (BA) has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta (CoA) during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role of percutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods: The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient's weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results: The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient (PG) across the coarctation was 41.0 ± 16.0 mmHg (range 13–76 mmHg). The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm (range 0.5–2.8 mm). All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg (range 0–40 mmHg), and the diameter of coarctation significantly improved to 3.8 ± 0.9 mm (range 2.5–5.3 mm). No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year: (1) The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; (2) in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; (3) tricuspid regurgitation and pulmonary hypertension improved in all patients; (4) all patients were doing well and were asymptomatic. Conclusions: Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.
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Affiliation(s)
| | - Fang Liu
- Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai 201102, China
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9
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Saha SP, Ziada KM, Whayne TF. Surgical, interventional, and device innovations in the management of hypertension. Int J Angiol 2015; 24:1-10. [PMID: 25780322 DOI: 10.1055/s-0034-1374808] [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: 10/25/2022] Open
Abstract
The prevalence of hypertension around the world has increased significantly with projections for an increasing major global burden of hypertension. Medication-resistant hypertension can be perplexing and frustrating. The existence of these difficult patients results in the need for additional approaches to treatment including surgery, percutaneous interventions, and device management. The sophistication of these techniques has progressed markedly and initial procedures such as classical sympathectomy and renal artery bypass are almost never performed. Newer techniques of angioplasty with stenting, renal artery denervation, and baroreflex activation therapy via electrical stimulation of the carotid baroreceptors are now in use with increasing evidence for significant benefit.
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Affiliation(s)
- Sibu P Saha
- Division of Cardiothoracic Surgery, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Thomas F Whayne
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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10
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Dzsinich C, Vaszily M, Vallus G, Dzsinich M, Berek P, Barta L, Darabos G, Nyiri G, Nagy G, Pataki T, Szentpétery L. [Late complications and treatment options of aortic coarctation operated in childhood]. Orv Hetil 2014; 155:1189-95. [PMID: 25063701 DOI: 10.1556/oh.2014.29915] [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: 11/19/2022]
Abstract
INTRODUCTION The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. AIM The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. METHOD Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. RESULTS In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. CONCLUSIONS The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.
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Affiliation(s)
- Csaba Dzsinich
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Miklós Vaszily
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gábor Vallus
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Máté Dzsinich
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Péter Berek
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - László Barta
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gábor Darabos
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gabriella Nyiri
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gabriella Nagy
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Tibor Pataki
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - László Szentpétery
- Magyar Honvédség Egészségügyi Központ Szív-, Ér- és Mellkas-sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
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Vergales JE, Gangemi JJ, Rhueban KS, Lim DS. Coarctation of the aorta - the current state of surgical and transcatheter therapies. Curr Cardiol Rev 2014; 9:211-9. [PMID: 23909637 PMCID: PMC3780346 DOI: 10.2174/1573403x113099990032] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 01/20/2013] [Indexed: 12/11/2022] Open
Abstract
Aortic coarctation represents a distinct anatomic obstruction as blood moves from the ascending to the descending aorta and can present in a range of ages from infancy to adulthood. While it is often an isolated and discrete narrowing, it can also be seen in the more extreme scenario of severe arch hypoplasia as seen in the hypoplastic left heart syndrome or in conjunction with numerous other congenital heart defects. Since the first description of an anatomic surgical repair over sixty years ago, an evolution of both surgical and transcatheter therapies has occurred allowing clinicians to manage and treat this disease with excellent results and low morbidity and mortality. This review focuses on the current state of both transcatheter and surgical therapies, paying special attention to recent data on long-term follow-up of both approaches. Further, current thoughts will be explored about future therapeutic options that attempt to improve upon historical long-term outcomes.
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Affiliation(s)
- Jeffrey E Vergales
- Children’s Hospital Heart Center, Department of Pediatrics, University of Virginia, USA.
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12
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Centella Hernández T, Stanescu D, Stanescu S. Coartación aórtica. Interrupción del arco aórtico. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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13
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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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Früh S, Knirsch W, Dodge-Khatami A, Dave H, Prêtre R, Kretschmar O. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg 2010; 39:898-904. [PMID: 21169030 DOI: 10.1016/j.ejcts.2010.09.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study was to analyze immediate results, rate of complications and re-interventions during medium-term outcome in pediatric patients with native or recurrent aortic coarctation. We focused on an age-related therapeutic approach comparing surgical and trans-catheter treatment. METHODS This is a retrospective, single-centre, clinical observational trial including 91 consecutive patients (age: 1 day-18 years) treated for native coarctation in 67 and recurrent aortic coarctation in 24 patients. Surgical treatment was performed in 56, trans-catheter treatment with balloon dilatation in 17, and by stent implantation in 18 patients. According to the age groups, we treated 48 children in group A (<6 months of age), 16 in group B (6 months-6 years), and 27 in group C (>6 years). A total of 41 patients in group A were operated (85%), patients in group B received either surgical or trans-catheter treatment (50% vs 50%), and 16 patients in group C were treated by stent implantation (62%). RESULTS Immediate results were excellent with a significant release of pressure gradient in all three age groups (64.7% in group A, 69.1% in group B, and 63.3% in group C). Complication rate and re-intervention rate (surgical and interventional) both were [corrected] comparable between the three age groups (complications: group A 8.3%, group B 6.3%, and group C 3.7%, [corrected] re-interventions: group A 16.6%, group B 18.8%, and group C 14.8%). [corrected] Midterm outcome after a median follow-up period of 17.5 months was satisfactory with a re-intervention-free survival after 17.5 months of 83.4%, 81.2%, and 81.5% in group A, group B, and group C, respectively. CONCLUSIONS The current strategy of an age-related therapy for native and recurrent aortic coarctation in our institution is surgery in infants <6 months (group A), either surgery or balloon dilatation in younger patients <6 years (group B), while in older children >6 years of age (group C) the trans-catheter treatment with stent implantation is an excellent alternative to surgery. Balloon dilatations showed limited results with an overall re-intervention rate of 53% and, therefore, should mainly be performed as a rescue procedure or in recurrent aortic coarctation in neonates.
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Affiliation(s)
- Seraina Früh
- Division of Pediatric and Congenital Cardiac Surgery, University Children's Hospital Zurich, Zurich, Switzerland
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Turkay S, Abdullah E, Celal A, Cenap Z, Nurdan E, Fadli D, Halil D, Ali AN, Ahmet C. Multiple transcatheter interventions in the same session in congenital cardiopathies. J Cardiovasc Dis Res 2010; 1:181-90. [PMID: 21264182 PMCID: PMC3023895 DOI: 10.4103/0975-3583.74261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To investigate the methods of percutaneous transcatheter interventions for combined congenital heart disease and to evaluate its efficacy in children. MATERIALS AND METHODS Thirty cases (ages 3 days-13.5 years, body weight 3-35 kg) that underwent two multiple transcatheter interventions for combined or solitary congenital heart disease were retrospectively analyzed and presented. RESULTS A total of 61 transcatheter interventions were performed in 30 patients as combined procedures. In 29 patients, two different procedures were combined in the same session, in remaining one patient, combination of three interventions were performed in the same catheter session. Interventions performed in combined procedures were as follows: Coarctation balloon angioplasty in 12 cases, pulmonary balloon valvuloplasty in 10, PDA coil embolization in 10, aortic balloon valvuloplasty in 8, VSD closure in 5, ASD closure in 4, ductal stent implantation in 4, palliative pulmonary balloon valvuloplasty in 3, recanalization and angioplasty of the systemic-pulmonary shunt in 2, balloon atrial septostomy in one, aortic coarctation stent implantation in one, coil embolization of a pulmonary lobar sequestration in one and pulmonary valve perforation plus pulmonary balloon valvuloplasty in one were performed as first or second procedure. There was no mortality or major morbidity in relation to combined procedures. CONCLUSION Multiple transcatheter interventions in the same session are feasible, safe and effective with satisfactory good results. Second intervention may be performed as complementary procedure or independently to the first intervention.
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Affiliation(s)
- Saritas Turkay
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Erdem Abdullah
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Akdeniz Celal
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Zeybek Cenap
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Erol Nurdan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Demir Fadli
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Demir Halil
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
| | - Aydemir Numan Ali
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Cardiovascular Surgery, Istanbul, Turkey
| | - Celebi Ahmet
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center and Research Hospital, Pediatric Cardiology, Istanbul, Turkey
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Rothman A, Galindo A, Evans WN, Collazos JC, Restrepo H. Effectiveness and safety of balloon dilation of native aortic coarctation in premature neonates weighing < or = 2,500 grams. Am J Cardiol 2010; 105:1176-80. [PMID: 20381673 DOI: 10.1016/j.amjcard.2009.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/03/2009] [Accepted: 12/03/2009] [Indexed: 12/23/2022]
Abstract
Six neonates weighing < or = 2,500 g with native coarctation of the aorta underwent balloon dilation. Of the 6 neonates, 4 were female and 2 were male, with a mean age of 14 days (range 9 to 20) and a mean weight of 1,900 g (range 790 to 2,500). The procedure was acutely successful in all 6 patients; the peak gradient decreased from 38 + or - 19 mm Hg to 11 + or - 3 mm Hg. The diameter increased from 1.5 + or - 0.6 mm to 3.6 + or - 0.7 mm. Of the 6 patients, 3 had required no additional intervention at a mean of 42 months after the initial dilation, and 3 had developed restenosis a mean of 2.4 months after the initial dilation and underwent successful redilation. Of the latter 3 patients, 2 developed restenosis and underwent surgical repair 37 and 68 days after the second dilation, and 1 of these patients developed recoarctation after surgery that was treated successfully with balloon dilation 54 days after the end-to-end repair. In conclusion, premature neonates weighing < or = 2,500 g with coarctation of the aorta appear to respond acutely to balloon dilation. Some patients will have a successful long-term result after a single balloon dilation procedure. However, restenosis is common and tends to develop rapidly.
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Response to Commentary--Ebels T, Maruszewski B, Blackstone EH. What is the preferred therapy for patients with aortic coarctation--the standard gamble and decision analysis versus real results? Cardiol Young 2008; 18: 18-21. Cardiol Young 2008; 18:445-7; author reply 448. [PMID: 18533070 DOI: 10.1017/s1047951108002412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Controversy about coarctation. Cardiol Young 2008; 18:361-2. [PMID: 18577306 DOI: 10.1017/s1047951108002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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