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Luo S, Haller C, Nield LE, Deng MX, Varenbut J, Honjo O. Coronary artery lesions are associated with adverse cardiac events in children undergoing supravalvular aortic stenosis repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae017. [PMID: 38331410 PMCID: PMC10948283 DOI: 10.1093/icvts/ivae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/24/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The aim of this study was to identify the prevalence and anatomic characteristics of coronary artery lesions and their associated postoperative risk in patients undergoing supravalvular aortic stenosis repair. METHODS The association between structural risk factors, postoperative ST-segment changes, and major adverse cardiac events was explored using logistic regression and the Fisher's exact test. RESULTS In 51 consecutive patients with supravalvular aortic stenosis treated between 2000 and 2017, a total of 48 coronary lesions were identified in 27 patients (53%). Prominent ostial ridge (type I) was the most common coronary lesion, followed by small ostium with (IIIb) or without (IIIa) diffuse long-segment coronary narrowing, and adhesion of the coronary cusp (type II). There were 54 concomitant coronary procedures, including 43 primary corrections and 11 revisions. Thirty-three patients underwent supravalvular aortic stenosis repair with a bifurcated patch, of which 13 (39.4%) had right coronary artery distortion/kinking requiring patch plication (n = 8) and reimplantation (n = 5). Postoperative major adverse cardiac events (MACE) occurred in 9 patients (17.6%), including 3 deaths, 4 needing mechanical circulatory support, and 6 experiencing ventricular arrhythmias. Twenty-two patients (43.1%) had postoperative ST-segment changes, including 13 early changes that resolved within 24 h and 9 persistent changes lasting >24 h. Patients with type III lesions were associated with postoperative persistent ST-segment change (P = 0.04) and these lesions independently predicted postoperative MACE (P = 0.02). Patients with pre-existing coronary lesions were at elevated risk of right coronary artery distortion/kinking (P = 0.045). CONCLUSIONS The prevalence of ST-segment changes and MACE is high in patients undergoing supravalvular aortic stenosis repair. The preoperative presence of complex coronary lesions is the most important predictor for postoperative major adverse cardiac events.
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Affiliation(s)
- Shuhua Luo
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Christoph Haller
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Lynne E Nield
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mimi Xiaoming Deng
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jaymie Varenbut
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Osami Honjo
- Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Hohri Y, Yamagishi M, Maeda Y, Asada S, Hongu H, Numata S, Yaku H. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6580210. [PMID: 35512199 PMCID: PMC9387505 DOI: 10.1093/icvts/ivac119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Corresponding author. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. Tel: +81-75-2515752; fax: +81-75-2575910; e-mail: (Y. Hohri)
| | - Masaaki Yamagishi
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisayuki Hongu
- Department of Paediatric Cardiovascular Surgery, Children’s Medical Centre, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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3
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Li D, Guo P, Chen L, Wu Y, Wang G, Xiao C. Outcomes of Surgical Patch Angioplasty of The Coronary Artery for Diffuse Coronary Artery Disease. Braz J Cardiovasc Surg 2020; 35:706-712. [PMID: 33118736 PMCID: PMC7598967 DOI: 10.21470/1678-9741-2019-0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Diffuse coronary artery disease (CAD) has a poor prognosis and many patients are ineligible for conventional coronary artery bypass grafting (CABG). This study evaluated the 12-month outcomes of coronary artery reconstruction and surgical patch angioplasty of the coronary artery for diffuse CAD. Methods A retrospective cohort study of patients who underwent CABG with surgical patch angioplasty of the coronary artery (reconstruction group) or standard CABG alone (standard group) at the Cardiovascular Surgery Department of the local Hospital between January 2014 and January 2016. Follow-up was censored at 12 months after surgery. Results Cardiopulmonary bypass and aortic cross-clamping durations were longer in the reconstruction group (n=32) than in the standard group (n=125) (P<0.05). There were no differences in graft blood flow and postoperative levels of cardiac markers between the two groups (P>0.05). In the reconstruction group, one patient died; a vein graft showed occlusion. In the standard group, two patients died; one left internal mammary artery graft and three vein grafts showed occlusion. There were no significant differences in mortality, major adverse cardiovascular and cerebrovascular events, and patency between the two groups (P>0.05). Conclusion Coronary artery reconstruction and surgical patch angioplasty of the coronary artery can be performed for diffuse CAD. Patient outcomes were not significantly different from those of patients who underwent standard CABG.
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Affiliation(s)
- Dong Li
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Pengfei Guo
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Lei Chen
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Yang Wu
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Gang Wang
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Cangsong Xiao
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
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Commentary: Femoral artery homograft for coronary artery plasty-will it withstand the test of time? JTCVS Tech 2020; 4:237-238. [PMID: 34318026 PMCID: PMC8306567 DOI: 10.1016/j.xjtc.2020.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022] Open
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5
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Andersen ND, Borisuk MJ, Hoganson DM, Rathod RH, Baird CW. Three-Patch Aortic Root Reconstruction With Extended Left Main Coronary Artery Patch Augmentation in Neonates and Infants. Semin Thorac Cardiovasc Surg 2019; 31:99-101. [DOI: 10.1053/j.semtcvs.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022]
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6
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Singh G, Khemani H, Singla R, Bansal NO. Successful Percutaneous Balloon Dilatation of Supravalvular Aortic Membrane. Heart Views 2019; 20:21-24. [PMID: 31143383 PMCID: PMC6524425 DOI: 10.4103/heartviews.heartviews_98_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Supravalvular aortic stenosis is the least common type of left ventricular outflow tract obstruction. Primary balloon dilatation of membranous supravalvular aortic stenosis was performed in a 10-year-old male child with a remarkable reduction in systolic pressure gradient. Balloon dilatation is a feasible treatment modality for membranous supravalvular aortic stenosis. It provides good immediate results and sustained relief of stenosis.
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Affiliation(s)
- Gurkirat Singh
- Department of Cardiology, Grant Medical College and J.J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Hemant Khemani
- Department of Cardiology, Grant Medical College and J.J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Rahul Singla
- Department of Cardiology, Grant Medical College and J.J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Narender Omprakash Bansal
- Department of Cardiology, Grant Medical College and J.J. Group of Hospitals, Mumbai, Maharashtra, India
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Thammineni K, Vinocur JM, Harvey B, Menk JS, Kelleman MS, Korakiti AM, Thomas AS, Moller JH, St Louis JD, Kochilas LK. Outcomes after surgical coronary artery revascularisation in children with congenital heart disease. Heart 2018; 104:1417-1423. [PMID: 29472291 PMCID: PMC6092219 DOI: 10.1136/heartjnl-2017-312652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Surgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD. METHODS This is a retrospective cohort study of children (<18 years old) with CHD who underwent surgical coronary revascularisation between 1982 and 2011. In-hospital mortality and graft patency data were obtained from the registry. Long-term transplant-free survival through 2014 was achieved for patients with adequate identifiers via linkage with the US National Death Index and the Organ Procurement and Transplantation Network. RESULTS Coronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days-17.4 years) or other operations (n=65, median age 2.6 years, range 5 days-16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent 'rescue' revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%). CONCLUSIONS Surgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.
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Affiliation(s)
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian Harvey
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremiah S Menk
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Anna-Maria Korakiti
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amanda S Thomas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - James H Moller
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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8
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Szaflik K, Kaźmierczak P, Moll JJ, Moll JA. Severe Congenital Obstruction of the Left Main Coronary Artery Coexisting With Supravalvular Aortic Stenosis in Williams Syndrome. World J Pediatr Congenit Heart Surg 2015; 7:216-9. [DOI: 10.1177/2150135115586269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/16/2015] [Indexed: 01/19/2023]
Abstract
Congenital obstruction of the left main coronary artery is a complicating feature of supravalvular aortic stenosis. We describe an eight-month-old female patient with Williams syndrome, supravalvular aortic stenosis, and branch pulmonary artery stenosis, with concomitant anomaly of severe obstruction of the left coronary artery orifice.
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Affiliation(s)
- Katarzyna Szaflik
- Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr Kaźmierczak
- Department of Cardiac Surgery, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Jacek Jan Moll
- Department of Cardiac Surgery, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Jadwiga Anna Moll
- Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
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9
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Yildiz O, Altin FH, Kaya M, Ozyılmaz I, Guzeltas A, Erek E. Left coronary artery stenosis causing left ventricular dysfunction in two children with supravalvular aortic stenosis. World J Pediatr Congenit Heart Surg 2015; 6:311-6. [PMID: 25870356 DOI: 10.1177/2150135114563767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital supravalvar aortic stenosis (SVAS) is an arteriopathy associated with Williams-Beuren syndrome (WBS) and other isolated elastin gene deletions. Cardiovascular manifestations associated with WBS are characterized by obstructive arterial lesions such as SVAS and pulmonary artery stenosis in addition to bicuspid aortic valve and mitral valve prolapse. However, coronary artery ostial stenosis may be associated with SVAS, and it increases the risk of sudden death and may complicate surgical management. In this report, we present our experience with two patients having SVAS and left coronary artery ostial stenosis with associated left ventricular dysfunction.
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Affiliation(s)
- Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Firat H Altin
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaya
- Department of Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Isa Ozyılmaz
- Department of Pediatric Cardiology, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Rao N, Gajjar T, Desai N. Supravalvar aortic stenosis: 19 years of surgical experience. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0369-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Aroca Á, Polo L, González Á, Rey J, Greco R, Villagrá F. Estenosis congénita a la salida del ventrículo izquierdo. Técnicas y resultados. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Ou P, Kutty S, Khraiche D, Sidi D, Bonnet D. Acquired coronary disease in children: the role of multimodality imaging. Pediatr Radiol 2013; 43:444-53. [PMID: 22972555 DOI: 10.1007/s00247-012-2478-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 06/01/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
Coronary sequelae of Kawasaki disease, post-surgical coronary lesions and cardiac allograft vasculopathy are the main causes of acquired coronary pathology in childhood. Surveillance and timely recognition of coronary problems in children who are at risk of ischemic events are imperative and noninvasive imaging is increasingly utilized for these purposes. Herein, we summarize the causes of acquired coronary disease in children and discuss the role of various imaging techniques that are available to establish the diagnosis and guide management.
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Affiliation(s)
- Phalla Ou
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, University Paris-Descartes, 149 rue de Sèvres, 75743, Paris Cedex 15, France.
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13
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Gajjar T, Rao JN, Desai N. Surgical management of supravalvar aortic stenosis with coronary artery involvement. J Card Surg 2012; 27:678-81. [PMID: 23016886 DOI: 10.1111/jocs.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supravalvar aortic stenosis is characterized by an obstruction of the left ventricular outflow tract distal to the aortic valve. Its association with left main coronary artery stenosis is well known but right coronary artery involvement has not been reported. We describe two cases of supravalvar aortic stenosis with coronary artery stenosis and its surgical management.
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Affiliation(s)
- Trushar Gajjar
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, District Anantapur, Andhra Pradesh, India.
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14
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Greutmann M, Tobler D, Sharma NC, Vonder Muhll I, Mebus S, Kaemmerer H, Schuler PK, Deanfield JE, Beauchesne L, Salehian O, Hoffmann A, Golovatyuk V, Oechslin EN, Silversides CK. Cardiac outcomes in adults with supravalvar aortic stenosis. Eur Heart J 2012; 33:2442-50. [DOI: 10.1093/eurheartj/ehs206] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Marini D, Defilippi C, Bordese R, Agnoletti G. Non invasive diagnosis of coronary obstruction in an infant with elastine-gene mutation by high resolution multislice computed tomography. Int J Cardiol 2012; 157:e14-5. [PMID: 21985753 DOI: 10.1016/j.ijcard.2011.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 09/06/2011] [Indexed: 11/16/2022]
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16
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Okada T, Shimamoto M, Yamazaki F, Nakai M, Miura Y, Itonaga T, Nomura R, Takahashi D, Abe N, Terai Y. Occlusion of left coronary artery ostium by left coronary cusp fusion. Ann Thorac Surg 2011; 91:1986-8. [PMID: 21620002 DOI: 10.1016/j.athoracsur.2010.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 11/25/2022]
Abstract
We report two cases of adults who had occlusion of the left coronary artery ostium by the left coronary cusp. Both patients were treated with the Bentall procedure, and both revealed a good, long-term course. We offer proper strategy of perioperative management consisting of precise preoperative diagnosis with a multimodality imaging study and adequate operative technique.
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Affiliation(s)
- Tatsuji Okada
- Department of Cardiovascular Surgery, Shizuoka City Hospital, Shizuoka, Japan.
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Mitchell MB, Goldberg SP. Supravalvar aortic stenosis in infancy. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14:85-91. [PMID: 21444053 DOI: 10.1053/j.pcsu.2011.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Supravalvar aortic stenosis (SVAS) is a rare anomaly of the aortic root caused by a genetically based deficiency in elastin production. Concomitant primary and secondary cardiovascular lesions complicate surgical management and impact early and late outcomes. Because SVAS is a rare lesion, surgical series are relatively small and span lengthy time periods. Consequently, risk factors that influence early and late outcomes are not well defined. Patients who come to surgery during infancy are particularly challenging, but little attention has been directed as to whether or not young age influences outcomes. This review suggests that complicating associated features of elastin arteriopathy are more prevalent in patients who require relief of SVAS during infancy, and that concomitant lesions significantly increase the difficulty and risk of treating younger patients with SVAS.
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Affiliation(s)
- Max B Mitchell
- Department of Surgery, University of Colorado at Denver Health Sciences Center, Denver, CO, USA.
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Imamura M, Prodhan P, Dossey AM, Jaquiss RD. Reoperation After Supravalvular Aortic Stenosis Repair. Ann Thorac Surg 2010; 90:2016-22. [DOI: 10.1016/j.athoracsur.2010.07.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 10/18/2022]
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Silversides CK, Kiess M, Beauchesne L, Bradley T, Connelly M, Niwa K, Mulder B, Webb G, Colman J, Therrien J. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: outflow tract obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan's syndrome. Can J Cardiol 2010; 26:e80-97. [PMID: 20352138 DOI: 10.1016/s0828-282x(10)70355-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part II of the guidelines includes recommendations for the care of patients with left ventricular outflow tract obstruction and bicuspid aortic valve disease, coarctation of the aorta, right ventricular outflow tract obstruction, tetralogy of Fallot, Ebstein anomaly and Marfan's syndrome. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk and follow-up requirements. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
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Inan BK, Ucak A, Gullu AU, Temizkan V, Ugur M, Yilmaz AT. Left Main Coronary Artery and Supravalvular Aortic Stenosis in Adult: Treatment with Ostial Patchplasty and Modified Brom Procedure. J Card Surg 2009; 24:299-300. [DOI: 10.1111/j.1540-8191.2008.00795.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary. Circulation 2008; 118:2395-451. [DOI: 10.1161/circulationaha.108.190811] [Citation(s) in RCA: 490] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 628] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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[Valvular aortic stenosis, left anterior cusp hypoplasia and obstruction of left main coronary artery ostium by a congenital membrane]. Ann Cardiol Angeiol (Paris) 2008; 57:303-6. [PMID: 18937929 DOI: 10.1016/j.ancard.2008.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 08/27/2008] [Indexed: 11/23/2022]
Abstract
Aortic stenosis and obstruction of the left main coronary artery ostium is very rare. This report describes the case of one patient with valvular aortic stenosis, left anterior cusp hypoplasia and obstruction of the left main coronary artery by a congenital membrane. Surgical treatment with aortic valve removal and excision of the congenital membrane was successful.
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26
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Pober BR, Johnson M, Urban Z. Mechanisms and treatment of cardiovascular disease in Williams-Beuren syndrome. J Clin Invest 2008; 118:1606-15. [PMID: 18452001 DOI: 10.1172/jci35309] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Williams-Beuren syndrome (WBS) is a microdeletion disorder caused by heterozygous loss of approximately 1.5-Mb pairs of DNA from chromosome 7. Patients with WBS have a characteristic constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. Human and mouse studies establish that defects in the elastin gene, leading to elastin haploinsufficiency, underlie the arteriopathy. In this review we describe potential links between elastin expression and arteriopathy, possible explanations for disease variability, and current treatment options and their limitations, and we propose several new directions for the development of nonsurgical preventative therapies based on insights from elastin biology.
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Affiliation(s)
- Barbara R Pober
- Department of Pediatrics, MassGeneral Hospital for Children, Simches Research Building, Rm. 222, 185 Cambridge St., Boston, Massachusetts 02114, USA.
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Arnáiz E, Koolbergen D, Adsuar A, Hazekamp MG. Surgery for supravalvular aortic stenosis - the three-patch technique. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2006.002329. [PMID: 24415669 DOI: 10.1510/mmcts.2006.002329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this paper is to describe the three-patch technique for repair of supravalvular aortic stenosis (SVAS). Supravalvular aortic stenosis is a rare malformation as a result of an abnormal thickening of the aortic wall. SVAS may present in two forms: a localized form (affecting only the aortic sinotubular junction) and a diffuse form, where the aortic arch and its side branches are also affected. Since 1960, multiple surgical techniques have been described with the aim of relieving the aortic narrowing and restoring the aortic root. We present the three-patch technique as originally developed by Brom. After transection of the aorta at the sinotubular junction, three longitudinal incisions are made into the three sinuses. The aortic root geometry is then restored by placement of three separate patches of autologous pericardium in the opened sinuses. Brom's technique provides a complete and symmetric restoration of the aortic anatomy. The technique is illustrated by angiographies, surgical drawings, videos and a review of the literature. The results of the three-patch technique are good and our long-term experience will be described.
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Affiliation(s)
- Elena Arnáiz
- Department of Pediatric Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Ishibashi N, Aoki M, Fujiwara T, Watanabe M, Isomatsu Y. Modified Myers and coronary artery bypass grafting using free internal thoracic artery graft for complicated supravalvular aortic stenosis. J Card Surg 2007; 22:56-7. [PMID: 17239214 DOI: 10.1111/j.1540-8191.2007.00341.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The left main trunk stenosis with Williams syndrome and supravalvular stenosis is a cause of sudden death and a serious disease. We performed modified Myers procedure with patch aortoplasty concomitant with coronary artery bypass grafting (CABG) using a free right internal thoracic artery (ITA) graft for a 2-year-old patient with this disease. The proximal cuff of the free right ITA graft was implanted in the posterior wall of the reconstructed aorta. The postoperative clinical course was uneventful, and aortic regurgitation and ischemic signs were not detected. CABG using this technique is useful for coronary artery stenosis in infants and young children, and favorable long-term outcomes are expected.
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Affiliation(s)
- Nobuyuki Ishibashi
- Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan.
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Solomon NAG, Finucane KA, Skinner JR, Kerr A. Mild Supravalvular Aortic Stenosis With Left Coronary Obstruction in a Neonate. Ann Thorac Surg 2005; 79:2153-5. [PMID: 15919336 DOI: 10.1016/j.athoracsur.2003.12.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2003] [Indexed: 11/27/2022]
Abstract
A premature infant with a large patent ductus arteriosus and mild supravalvular aortic stenosis had evidence of severe myocardial ischemia after ductus ligation. Urgent reoperation was required to relieve severe obstruction of the left coronary orifice and the supravalvular stenosis was repaired. This unusual presentation early in infancy emphasizes that left coronary artery obstruction should be suspected even in the presence of mild supravalvular stenosis.
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Affiliation(s)
- Neville A G Solomon
- Department of Pediatric Cardiac Surgery, Green Lane Hospital, Auckland, New Zealand.
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31
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Shiraishi I, Yamagishi M, Toiyama K, Osawa Y, Nakagawa M, Takahashi A, Shuntoh K, Hamaoka K. Coronary artery obstruction due to membranous ridge of the right sinus valsalva associated with Tetralogy of Fallot: syncope mimics anoxic spell. Ann Thorac Surg 2004; 77:321-2. [PMID: 14726090 DOI: 10.1016/s0003-4975(03)00751-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report an infant with Tetralogy of Fallot who had suffered from repetitive attacks of syncope without obvious cyanosis. Careful observation by means of echocardiography and angiography revealed that the attacks resulted from acute coronary artery obstruction due to membranous ridge covering the sinus Valsalva. Surgical resection of the abnormal ridge and repair of Tetralogy of Fallot successfully improved the patient's symptoms. Syncope in children should be extensively investigated to exclude obstruction of the coronary arteries.
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Affiliation(s)
- Isao Shiraishi
- Department of Pediatrics, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Iwase J, Tajima K, Io A, Minho S, Katou W, Tanaka K. Successful repair of supravalvular aortic stenosis with ostial stenosis of the left coronary artery using Brom's three patch technique. Gen Thorac Cardiovasc Surg 2003; 51:612-5. [PMID: 14650592 DOI: 10.1007/bf02736702] [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: 10/22/2022]
Abstract
Stenotic lesion of the left coronary artery is an unnoticed but complicating feature of supravalvular aortic stenosis (SAS). We present successful repair of SAS with left coronary ostial stenosis. A 9-year-old girl was diagnosed as Williams syndrome associated with SAS. She had no symptoms of angina but cardiac catheterization revealed severe stenosis of the left coronary artery ostium. We adopted Brom's three patch technique, which could enlarge the aortic root and ostial lesion of left coronary artery inclusively. This method is also ideal regarding restoration of the aortic root geometry.
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Affiliation(s)
- Jinichi Iwase
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Driessen JJ, van Oort AM, Booij LHDJ. Severe myocardial ischaemia during mask induction of anaesthesia in an infant with unknown critical supravalvular aortic stenosis. Anaesthesia 2003; 58:568-70. [PMID: 12846623 DOI: 10.1046/j.1365-2044.2003.03146.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital supravalvular aortic stenosis is an uncommon type of aortic obstruction. When critical, it represents an extreme variant of outflow tract obstruction with increased risk of cardiovascular instability during exercise or anaesthesia. We present a case of severe myocardial ischaemia during induction of anaesthesia with sevoflurane in a 3-month baby with a presumed diagnosis of valvular aortic stenosis for which a percutaneous balloon dilatation of the aortic valve was scheduled.
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Affiliation(s)
- J J Driessen
- Department of Anaesthesiology, University Medical Center St Radboud, Geert Groote Plein 10, 6500 HB Nijmegen, The Netherlands.
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Careaga Reyna G, Salazar Garrido D, Argüero R. [Congenital aortic supravalvular stenosis. Frequency and results of surgical treatment in a third level hospital]. Rev Esp Cardiol 2003; 56:211-4. [PMID: 12605769 DOI: 10.1016/s0300-8932(03)76848-1] [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: 11/19/2022]
Abstract
In a prospective study made between 1 September 1996 and 31 December 2001, pediatric patients with a diagnosis of supravalvular aortic stenosis confirmed by a reduction in the aortic inner diameter and a gradient > or = 50 mmHg were detected. Of 83 patients with aortic stenosis, only 7 (8.4%) had supravalvular aortic stenosis. All 7 patients underwent surgical treatment consisting of resection of fibrous tissue and reconstruction of the ascending aorta with a preclotted Dacron patch. One patient with severe, diffuse stenosis died and the another had perioperative heart failure, cardiac arrest and reversible neurological sequelae. A significant decrease in the postoperative gradient was obtained (p < 0.05). At present all surviving patients are free of symptoms. It was concluded that supravalvular aortic stenosis is infrequent in Mexico. In our experience, surgical treatment produced good results and success depended on the magnitude and type of stenosis.
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Affiliation(s)
- Guillermo Careaga Reyna
- División de Cirugía Cardiotorácica, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, IMSS, México DF, Mexico.
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