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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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Szaluś-Jordanow O, Barszcz K, Mądry W, Buczyński M, Czopowicz M, Gierulski A, Moroz-Fik A, Mickiewicz M, Grzegorczyk M, Jaroszewicz J. Hydrops fetalis caused by a complex congenital heart defect with concurrent hypoplasia of pulmonary blood vessels and lungs visualized by micro-CT in a French Bulldog. BMC Vet Res 2024; 20:189. [PMID: 38734649 PMCID: PMC11088049 DOI: 10.1186/s12917-024-04060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Hydrops fetalis (HF) is fluid accumulation in fetus body cavities and subcutaneous tissue. The condition has been described in various farm and companion animal species, including dogs. Most of cases result from a heart defect. Exact nature of this defect is rarely clarified. CASE PRESENTATION A newborn, male French bulldog puppy with severe HF underwent a full anatomopathological examination to diagnose the primary cause of HF. Based on the anatomopathological examination, fetal ultrasound, and micro-computed tomography, transposition of the great arteries with hypoplasia of the ascending aorta, aortic arch interruption, ostium secundum atrial septal defect, severe tricuspid valve dysplasia, as well as hypoplasia of pulmonary vessels and lungs were diagnosed. CONCLUSIONS This is the first report of HF caused by severe, complex congenital heart defects with concurrent pulmonary vessel and lung hypoplasia.
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Affiliation(s)
- Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska Str. 159c, Warsaw, 02-776, Poland.
| | - Karolina Barszcz
- Department of Morphological Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159, Warsaw, 02-776, Poland
| | - Wojciech Mądry
- Department of Heart, Chest and Transplant Surgery, Medical University of Warsaw, Żwirki i Wigury 63A, Warsaw, 02-091, Poland
| | - Michał Buczyński
- Department of Heart, Chest and Transplant Surgery, Medical University of Warsaw, Żwirki i Wigury 63A, Warsaw, 02-091, Poland
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Adam Gierulski
- Private Practice, Animal Veterinary Clinic, Młynarska 29, Łódź, Poland
| | - Agata Moroz-Fik
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, Warsaw, 02-776, Poland
| | - Michał Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chałubińskiego 5, Warsaw, 02-004, Poland
| | - Jakub Jaroszewicz
- Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, Warsaw, 02-507, Poland
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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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Heremans L, Henkens A, de Beco G, Carbonez K, Moniotte S, Rubay JE, Momeni M, Houtekie L, Poncelet AJ. Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience. World J Pediatr Congenit Heart Surg 2021; 12:492-499. [PMID: 34278865 DOI: 10.1177/21501351211003505] [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: 11/15/2022]
Abstract
BACKGROUND Aortic coarctation is among the most common cardiovascular congenital abnormalities requiring repair after birth. Besides mortality, morbidity remains an important aspect. Accordingly, we reviewed our 20-year experience of aortic coarctation repair by thoracotomy, with emphasis on both short- and long-term outcomes. METHODS From 1995 through 2014, 214 patients underwent coarctation repair via left thoracotomy. Associated arch lesions were distal arch hypoplasia (n = 117) or type A interrupted aortic arch (n = 6). Eighty-four patients had isolated coarctation (group 1), 66 associated ventricular septal defect (group 2), and 64 associated complex cardiac lesions (group 3). Median follow-up was 8.4 years. RESULTS There was one (0.5%) procedure-related death. Nine (4.2%) patients died during index admission. In-hospital mortality was 0.7% in group 1 and 2 and 12.5% in group 3 (P < .001). No patient had paraplegia. Actuarial five-year survival was 97.5% in group 1, 94% group 2 and 66% in group 3. Recurrent coarctation developed in 29 patients, all but four (1.8%) successfully treated by balloon dilatation. Freedom from reintervention (dilatation or surgery) at five years was 86%. At hospital discharge, 28 (13.5%) patients were hypertensive. At follow-up, hypertension was present in 11 (5.3%) patients. CONCLUSIONS Long-term results of aortic coarctation repair by thoracotomy are excellent, with percutaneous angioplasty being the procedure of choice for recurrences. Patient prognosis is dependent on associated cardiac malformations. In this study, the prevalence of late arterial hypertension was lower than previously reported.
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Affiliation(s)
- Louis Heremans
- Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Arnaud Henkens
- Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Geoffroy de Beco
- Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Karlien Carbonez
- Department of Pediatric Cardiology, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Stéphane Moniotte
- Department of Pediatric Cardiology, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Jean E Rubay
- Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Mona Momeni
- Department of Anesthesiology, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Laurent Houtekie
- Department of Pediatric Intensive Care, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Alain J Poncelet
- Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain (UCLouvain), 70492Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
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