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Ramos-Rosillo V, Cabello-Ganem A, Guerra EC, Salas-Martinez A, Panchos YAV, Luna-Alcala S, Martinez-Dominguez P, Aparicio-Ortiz AD, Antonio-Villa NE, Espinola-Zavaleta N. Diagnostic approach and treatment of ventricular septal defect associated with PDA, coarctation of aorta, hypoplastic aortic arch and multiple valvular heart disease in a tertiary center: An infrequent association. Radiol Case Rep 2024; 19:3461-3464. [PMID: 38872743 PMCID: PMC11169064 DOI: 10.1016/j.radcr.2024.05.034] [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: 10/23/2023] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Ventricular septal defect is the most common congenital heart disease in children and is associated with patent ductus arteriosus in 1%-7% of cases. The coexistence of both malformities with hypoplastic aortic arch and aortic coarctation is even rarer. We present the case of a 6-year-old girl referred to our hospital because of dyspnea on feeding, recurrent respiratory infections, poor weight gain, and a heart murmur. The image studies revealed a ventricular septal defect, patent ductus arteriosus, severe hypoplasia of the aortic arch with critical stenosis of the proximal portion, severe dilatation of the pulmonary artery and pulmonary, mitral, tricuspid, and aortic regurgitation. We will discuss the diagnostic approach and treatment in a tertiary reference center for patients with cardiovascular diseases.
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Affiliation(s)
- Varna Ramos-Rosillo
- Immunology Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- MD–PhD (PECEM) Program, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Pavel Martinez-Dominguez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | | | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Department of Echocardiography, ABC Medical Center IAP, Mexico City, Mexico
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2
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Margarint IM, Youssef T, Robu M, Rotaru I, Popescu A, Untaru O, Filip C, Stiru O, Iliescu VA, Vladareanu R. The Management of Aortic Coarctation Associated with Hypoplastic Arches and Particular Arch Anatomies: A Literature Review. J Pers Med 2024; 14:732. [PMID: 39063986 PMCID: PMC11277657 DOI: 10.3390/jpm14070732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
The surgical management of aortic coarctation in newborns needs to ensure postoperative evolution and long-term results as much as possible. Patients with a Gothic arch have a higher rate of postoperative hypertension, while newborns with a bovine arch have higher rates of restenosis and, thus, an additional risk of mortality. Late hypertension, even in anatomically successfully repaired patients, confers a high risk for cardiovascular events. This review of the literature focuses on the management of aortic coarctations associated with hypoplastic arch and particular arch anatomies, focusing on surgical techniques and their outcomes.
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Affiliation(s)
- Irina-Maria Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Tammam Youssef
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Iulian Rotaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Alexandru Popescu
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Olguta Untaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Cristina Filip
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Radu Vladareanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
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Iguidbashian J, Malone LJ, Browne LP, Nguyen M, Frank B, Schafer M, Campbell DN, Mitchell MB, Jaggers J, Stone ML. Regional Arch Measurements Differ Between Imaging Modalities in Infants With Aortic Coarctation. Ann Thorac Surg 2024; 118:209-215. [PMID: 38072352 DOI: 10.1016/j.athoracsur.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Aortic arch measurements provide a framework for surgical decision-making in neonatal aortic coarctation, specifically in the determination of approach for arch repair by lateral thoracotomy vs median sternotomy. The purpose of this study was to evaluate our experience with transthoracic echocardiography (TTE) and computed tomography angiography (CTA) in the preoperative evaluation of infants with aortic coarctation, specifically comparing arch dimensions as a function of imaging modality. METHODS Imaging data were reviewed for all infants undergoing surgical repair of aortic coarctation at our institution from 2012 to 2022. Infants with both TTE and CTA evaluations were included. Aortic measurements were compared at predefined anatomic regions including ascending aorta, proximal arch, distal arch, and isthmus. RESULTS During the study period, 372 infants underwent surgical coarctation repair; 72 (19.4%) infants had TTE and CTA arch evaluations preoperatively. Significant discrepancies between imaging modalities were defined by poor correlation coefficients and absolute measurement differences and were most prominent in the proximal aortic arch (R2 = 0.23 [-4.4 to 3.2 mm]) and isthmus regions (R2 = 0.11 [-4.2 to 1.7 mm]). Improved correlation was demonstrated in the ascending aorta (R2 = 0.63) and distal aortic arch (R2 = 0.54). CONCLUSIONS Significant variability exists between TTE- and CTA-derived aortic measurements in infants with coarctation, with proximal arch measurements demonstrating the poorest correlation. This anatomic location represents a commonly used arch region for the determination of approach for repair of neonatal aortic coarctation. Thus, these findings have important implications for current preoperative surgical decision-making paradigms and future prospective study to minimize the risk of residual or recurrent arch obstruction.
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Affiliation(s)
- John Iguidbashian
- Division of General Surgery, Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
| | - LaDonna J Malone
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Lorna P Browne
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Michael Nguyen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Benjamin Frank
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Michal Schafer
- Division of General Surgery, Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - David N Campbell
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Max B Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - James Jaggers
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Matthew L Stone
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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Stephens EH, Feins EN, Karamlou T, Anderson BR, Alsoufi B, Bleiweis MS, d'Udekem Y, Nelson JS, Ashfaq A, Marino BS, St Louis JD, Najm HK, Turek JW, Ahmad D, Dearani JA, Jacobs JP. The Society of Thoracic Surgeons Clinical Practice Guidelines on the Management of Neonates and Infants with Coarctation. Ann Thorac Surg 2024:S0003-4975(24)00337-0. [PMID: 38904587 DOI: 10.1016/j.athoracsur.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Although coarctation of the aorta without concomitant intracardiac pathology is relatively common, there is lack of guidance regarding aspects of its management in neonates and infants. METHODS A panel of experienced congenital cardiac surgeons, cardiologists, and intensivists was created, and key questions related to the management of isolated coarctation in neonates and infants were formed using the PICO (Patients/Population, Intervention, Comparison/Control, Outcome) Framework. A literature search was then performed for each question. Practice guidelines were developed with classification of recommendation and level of evidence using a modified Delphi method. RESULTS For neonates and infants with isolated coarctation, surgery is indicated in the absence of obvious surgical contraindications. For patients with risk factors for surgery, medical management before intervention is reasonable. For those stable off prostaglandin E1, the threshold for intervention remains unclear. Thoracotomy is indicated when arch hypoplasia is not present. Sternotomy is preferable when arch hypoplasia is present that cannot be adequately addressed through a thoracotomy. Sternotomy may also be considered in the presence of a bovine aortic arch. Antegrade cerebral perfusion may be reasonable when the repair is performed through a sternotomy. Extended end-to-end, arch advancement, and patch augmentation are all reasonable techniques. CONCLUSIONS Surgery remains the standard of care for the management of isolated coarctation in neonates and infants. Depending on degree and location, arch hypoplasia may require a sternotomy approach as opposed to a thoracotomy approach. Significant opportunities remain to better delineate management in these patients.
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Affiliation(s)
| | - Eric N Feins
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Bahaaldin Alsoufi
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Kentucky
| | - Mark S Bleiweis
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Yves d'Udekem
- Children's National Heart Institute, Children's National Hospital, Washington, DC
| | - Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| | - Awais Ashfaq
- Division of Cardiovascular Surgery, Department of Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | | | - James D St Louis
- Departent of Surgery, Children's Hospital of Georgia, Augusta, Georgia; Departent of Surgery, Inova L.J. Murphy Children's Hospital, Falls Church, Virginia
| | - Hani K Najm
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph W Turek
- Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, North Carolina
| | - Danial Ahmad
- Cardiac Surgery Research Laboratory, Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Pediatrics, University of Florida, Gainesville, Florida.
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5
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Barabas IJ, Vegh D, Bottlik O, Kreuter P, Hartyanszky I, Merkely B, Palkovics D. The role of 3D technology in the practical education of congenital coarctation and its treatment-a feasibility pilot study. BMC MEDICAL EDUCATION 2024; 24:357. [PMID: 38553706 PMCID: PMC10981329 DOI: 10.1186/s12909-024-05293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education. METHODS Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions. RESULTS 21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference. CONCLUSIONS Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students.
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Affiliation(s)
- Imre J Barabas
- SE3D Center, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Daniel Vegh
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | | | - Patrik Kreuter
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | | | - Bela Merkely
- SE3D Center, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Daniel Palkovics
- SE3D Center, Semmelweis University, Budapest, Hungary.
- Department of Periodontology, Semmelweis University, Budapest, Hungary.
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Gupta VS, Popp EC, Ebanks AH, Greenleaf CE, Annavajjhala V, Patel N, Robie DK, LaPar DJ, Lally KP, Harting MT. Isolated aortic arch anomalies are associated with defect severity and outcome in patients with congenital diaphragmatic hernia. Pediatr Surg Int 2022; 39:69. [PMID: 36580203 DOI: 10.1007/s00383-022-05354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Congenital diaphragmatic hernia (CDH) patients often have suspected isolated aortic arch anomalies (IAAA) on imaging. The purpose of this work was to describe the incidence and outcomes of CDH + IAAA patients. METHODS Cardiovascular data were collected for infants from the CDH Study Group born between 2007 and 2019. IAAA were defined as coarctation of aorta, hypoplastic aortic arch, interrupted aortic arch, and aortic aneurysmal disease on early, postnatal echocardiography. Patients with major cardiac malformations and/or chromosomal abnormalities were excluded. Primary outcomes included the rate of aortic intervention, rates of extracorporeal life support (ECLS) utilization, and mortality. RESULTS Of 6357 CDH infants, 432 (7%) were diagnosed with a thoracic aortic anomaly. Of these, 165 were diagnosed with IAAA, most commonly coarctation of the aorta (n = 106; 64%) or hypoplastic aortic arch (n = 58; 35%). CDH + IAAA patients had lower birthweights (3 kg vs. 2.9 kg) and Apgar scores (7 vs. 6) than patients without IAAA (both χ2 p < 0.001). CDH + IAAA were less likely to undergo diaphragm repair (72 vs. 87%, p < 0.001), and overall mortality was higher for CDH + IAAA infants (58 vs. 24%, p < 0.001). When controlling for defect size, birth weight, and Apgar, IAAA were significantly associated with mortality (OR 3.3, 95% CI 2.2-5.0; p < 0.01) but not associated with ECLS (OR 0.98, 95% CI 0.65-1.50; p = 0.90). Only 17% (n = 28) of CDH + IAAA patients underwent aortic intervention. CONCLUSIONS IAAA in CDH are associated with increased mortality. This often simply reflects severity of the defect and thoracic anatomic derangement, as opposed to unique aortic pathology, given few CDH + IAAA patients undergo aortic intervention.
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Affiliation(s)
- Vikas S Gupta
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Elizabeth C Popp
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Ashley H Ebanks
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Christopher E Greenleaf
- Division of Pediatric and Congenital Heart Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Vidhya Annavajjhala
- Department of Pediatrics, Division of Pediatric Cardiology, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children Glasgow, Glasgow, Scotland
| | | | - Damien J LaPar
- Division of Pediatric and Congenital Heart Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA.
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7
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Huuskonen A, Hui L, Runeckles K, Hui W, Barron DJ, Friedberg MK, Honjo O. Growth of unrepaired hypoplastic proximal aortic arch and reintervention rate after aortic coarctation repair. J Thorac Cardiovasc Surg 2022; 165:1631-1640.e1. [PMID: 36202666 DOI: 10.1016/j.jtcvs.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Treatment of tubular hypoplasia of the aortic arch (THAA) associated with aortic coarctation (CoA) remains controversial. We aimed to evaluate growth of unrepaired hypoplastic proximal aortic arches (PAAs) after surgical repair for CoA. METHODS Preoperative and follow-up echocardiographic images of 139 patients who underwent CoA repairs from 2005 to 2012 were reviewed. THAA was defined as PAA z-score <-3 and non-THAA group z-score ≥-3. Reintervention rates due to aortic obstruction were assessed using competing risk models and diameters of the aorta were compared with Mann-Whitney U tests. RESULTS Fifty patients (36%) had THAA and 89 (64%) had non-THAA. The survival rate was 94% at 10 years. The overall reintervention rate at 10 years was 9% in the THAA group and 16% in the non-THAA group (P = .54). The catheter reintervention rate at ten years was 2% in the THAA group and 16% in the non-THAA group (P = .031). The surgical reintervention rate at ten years was 7% in the THAA group and 0% in the non-THAA group (P = .016). All 4 patients who required surgical reintervention were in the THAA group and 3 patients with PAA obstruction had preoperative PAA z-scores -3.6, -4.2, and -4.3. Follow-up echocardiograms showed PAA catch-up growth in the THAA group compared with the non-THAA group (preoperative z-score of -3.6 vs -2.3, and at 7 years of -1.1 vs -1.2; P < .001). CONCLUSIONS Unrepaired PAA hypoplasia grows after CoA repair. Reintervention rates were comparable between groups but those with THAA had higher surgical reintervention rates.
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Grieshaber P, Merbecks M, Jaschinski C, Fonseca E, Arnold R, Karck M, Gorenflo M, Loukanov T. Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta. World J Pediatr Congenit Heart Surg 2022; 13:426-435. [PMID: 35757941 PMCID: PMC9243453 DOI: 10.1177/21501351221099933] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Neonatal coarctation of the aorta (CoA) is primarily treated by surgical repair. However, under certain high-risk constellations, initial stent angioplasty may be considered followed by surgical repair. We report our experience with this staged approach. Methods: All patients undergoing surgical CoA repair following prior stenting at our institution between January 2011 and December 2019 were included in this retrospective analysis. The patients were classified to be at high risk because of cardiogenic shock, associated complex cardiac malformations, neonatal infection, necrotizing enterocolitis, and extracardiac conditions, respectively. Outcomes were analyzed and compared with neonates who underwent surgical CoA repair without prior stenting in the same observation period. RESULTS Twenty-six neonates received stent implantation at a median age of 20 days (IQR 9-33 days). Subsequent surgical repair was conducted at an age of 4.2 months (IQR 3.2-6.1 months) with a median body weight of 5.6 kg (IQR 4.5-6.5 kg). Cardiopulmonary bypass was applied in 96% of cases. Extended end-to-end anastomosis was possible in 11 patients. Extended reconstruction with patch material was necessary in the remaining patients. One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 5.2 years after initial stenting, all remaining patients were alive; 15/25 patients (60%) were free from re-intervention. Of note, re-intervention rates were comparable in neonates (n = 76) who were operated on with native CoA (28/74 patients; 38%; P = .67). CONCLUSIONS Neonatal stent angioplasty for CoA results in increased complexity of the subsequent surgical repair. Nevertheless, this staged approach allows to bridge high-risk neonates to later surgical repair with reduced perioperative risk and acceptable midterm outcomes.
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Affiliation(s)
- Philippe Grieshaber
- Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany,Philippe Grieshaber, Division of Congenital
Cardiac Surgery, Department of Cardiac Surgery, Im Neuenheimer Feld 430, 69120
Heidelberg, Germany.
| | - Moritz Merbecks
- Department of Pediatric Cardiology, University Hospital
Heidelberg, Heidelberg, Germany
| | - Christoph Jaschinski
- Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
| | - Elizabeth Fonseca
- Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
| | - Raoul Arnold
- Department of Pediatric Cardiology, University Hospital
Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
| | - Matthias Gorenflo
- Department of Pediatric Cardiology, University Hospital
Heidelberg, Heidelberg, Germany
| | - Tsvetomir Loukanov
- Department of Cardiac Surgery, University Hospital
Heidelberg, Heidelberg, Germany
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9
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Li C, Ma J, Yan Y, Chen H, Shi G, Chen H, Zhu Z. Surgical options for proximal and distal transverse arch hypoplasia in infants with coarctation. Transl Pediatr 2022; 11:330-339. [PMID: 35378967 PMCID: PMC8976682 DOI: 10.21037/tp-21-557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although various surgical techniques have been reported for aortic arch reconstruction for proximal and distal transverse arch (PDTA) hypoplasia, no consensus has been reached on a surgical option for initial arch reconstruction. This study was undertaken to review various arch reconstruction options for PDTA hypoplasia in Chinese infants. METHODS A retrospective review of 121 infants who underwent initial arch reconstruction of the proximal and distal aortic arches between 2010 and 2020 was performed. Freedom from recoarctation was analyzed using Kaplan-Meier analysis. Univariate and multivariable Cox regression analyses were performed to determine perioperative data associated with an increased risk of recoarctation after surgery. RESULTS Aortic arch reconstruction was performed by end-to-side anastomosis (ESA) (n=37) or patch repair [autologous pericardial patch (APP), n=53; bovine pericardial patch (BPP), n=20; autologous pulmonary artery patch (APAP), n=11]. The relative diameter of the proximal arch was 0.51±0.07, and the relative diameter of the distal arch was 0.43±0.07. The median follow-up time was 679 (range, 388-1,362) days. Recoarctation was observed in 44 (36.4%) patients. ESA was an independent risk factor for further development of recoarctation after the initial aortic arch reconstruction [hazard ratio (HR) =2.13; P=0.020]. CONCLUSIONS Aortic arch reconstruction via ESA was an independent risk factor for late recoarctation of the proximal and distal aortic arches in patients who underwent the initial surgery in infancy. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR2100048212.
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Affiliation(s)
- Cong Li
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jidan Ma
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yichen Yan
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongtong Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongqun Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Kozyrev IA, Kotin NA, Averkin II, Ivanov AA, Latypov AA, Gordeev ML, Vasichkina ES, Pervunina TM, Grekhov EV. Modified technique for coarctation of aorta with hypoplastic distal aortic arch. J Card Surg 2021; 36:2063-2069. [PMID: 33738821 DOI: 10.1111/jocs.15492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A combination of coarctation of aorta with various severity of distal arch hypoplasia frequently occurs in newborns. Traditional techniques in the neonatal period such as extended end-to-end anastomosis or inner curve patch are controversial. Arch geometry has a marked role in long-term outcomes. We introduce a modified Amato technique of distal aortic arch enlargement with native tissue-to-tissue reconstruction. METHODS Neonatal patients with coarctation of aorta and distal aortic arch hypoplasia who underwent surgical reconstruction using this technique between January 2016 and December 2019 in our center were included. Patients with concomitant complex heart defects were excluded. Data were obtained from echo protocols, CT scans before and after repair. The dimensions of the arch were assessed using Z-score, arch geometry was evaluated with height/width ratio. RESULTS Thirty-two patients (22 males, 10 females) were included. Median age and weight were 7 days (5; 18) and 3.5 kg (3.1; 4.0), respectively. The Z-score of distal part of the arch before and after procedure was significantly different (<0.01). No mortality, recoarctation, or bronchial compression was found during 18 (6-38) months of follow-up. CONCLUSION Modified technique for coarctation of aorta with hypoplastic distal aortic arch provides favorable geometry of the aorta with a low risk of morbidity. The proper selection and accurate technique could minimize potential risks. This method is relatively safe and might improve long-term outcomes associated with the geometry of aorta.
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Affiliation(s)
- Ivan A Kozyrev
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Nikolai A Kotin
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Igor I Averkin
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Andrey A Ivanov
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Alexander A Latypov
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Mikhail L Gordeev
- Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Elena S Vasichkina
- Pediatric Cardiology Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Tatyana M Pervunina
- Pediatric Cardiology Department, Almazov National Medical Research Center, St. Petersburg, Russia
| | - Evgeny V Grekhov
- Pediatric Cardiac Surgery Department, Almazov National Medical Research Center, St. Petersburg, Russia
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El Nihum LI, Li Z, Chinnadurai P, Bavare CS, Reardon MJ, MacGillivray TE, Lin CH. CT-Guided Endovascular Exclusion of Pseudoaneurysmal Subclavian Bypass After Early-Age Surgical Correction of Complex Aortic Coarctation. JACC Case Rep 2021; 3:225-229. [PMID: 34317507 PMCID: PMC8310991 DOI: 10.1016/j.jaccas.2020.11.026] [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: 08/24/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022]
Abstract
We describe a 64-year-old woman with subclavian pseudoaneurysm after aortic coarctation repair, treated using a hybrid approach involving true three-dimensional analysis and image fusion-guided placement of thoracic endovascular aortic repair stents. This case illustrates the potential complications of coarctation repair and need for lifelong surveillance in these patients. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | - Zhongyu Li
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Charudatta S Bavare
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J Reardon
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | - C Huie Lin
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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