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Mohammadzadeh Shabestari M, Eshraghi A, Hakim Attar F, Ghaderi F, Poorzand H, Mohammadzadeh Shabestari AH, Alizadeh B, Morovatdar N, Shahri B, Alimi H, Tayyebi M, Gholoobi A, Askari VR, Garivani YA, Mohammadzadeh Shabestari M, Baradaran Rahimi V. Evaluation of short and mid-term clinical outcomes in patients with aortic coarctation treated with self-expandable stents. Sci Rep 2024; 14:11748. [PMID: 38783056 PMCID: PMC11116370 DOI: 10.1038/s41598-024-62607-w] [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: 02/05/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
The present study aimed to evaluate the outcomes of percutaneous treatment of aortic coarctation using self-expandable uncovered Nitinol stents. We conducted a retrospective clinical data review of all patients with aortic coarctation and treated with self-expandable uncovered Nitinol stents at our institution between 2009 and 2019. The gradient pressure across the coarctation site was measured using aortography. Follow-up echocardiography and computed tomography angiography were performed to assess possible stent complications. A total of 127 stents were successfully implanted in 125 patients (64.8% males) with a mean age of 35.36 ± 11.9 years. The gradient across the coarctation site decreased significantly from 67.48 ± 14.79 to 5.04 ± 3.01 mmHg (P < 0.001) after self-expandable stent implantation. Systolic blood pressure (SBP) decreased significantly from 175.53 ± 15.99 to 147.22 ± 12.83 mmHg (P < 0.001) after self-expandable stenting. There were no major technical or clinical complications, including balloon rupture, aneurysmal formation, infection, secondary stent migration, thrombosis, death during the procedure, and in-hospital mortality. On a mean follow-up of 48 ± 23.6 months (12-120 months), the gradient [from 59.43 ± 15.42 to 3.72 ± 1.38 mmHg (P < 0.001)] and SBP [from 175.53 ± 15.99 to 127.99 ± 7.82 mmHg (P < 0.001)] decreased significantly. There was no mortality, aneurysmal formation in the stent site, dislocation, or aortic re-stenosis requiring intervention during mid-term follow-up. Treatment of aortic coarctation using a self-expandable uncovered nitinol stent is safe and effective with promising mid-term outcomes.
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Affiliation(s)
| | - Ali Eshraghi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Fereshteh Ghaderi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Behzad Alizadeh
- Division of Congenital and Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Shahri
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Tayyebi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Gholoobi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Reza Askari
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yousef Ali Garivani
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Dos Santos FJ, Hernandez BA, Santos R, Machado M, Souza M, Capello Sousa EA, Andrade A. Bioabsorbable Polymeric Stent for the Treatment of Coarctation of the Aorta (CoA) in Children: A Methodology to Evaluate the Design and Mechanical Properties of PLA Polymer. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4403. [PMID: 37374585 DOI: 10.3390/ma16124403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.
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Affiliation(s)
- Flávio José Dos Santos
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Bruno Agostinho Hernandez
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Rosana Santos
- Department of Engineering, PUC-Pontifical Catholic University of São Paulo, São Paulo 05014-901, Brazil
| | - Marcel Machado
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Mateus Souza
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Edson A Capello Sousa
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Aron Andrade
- CEAC-Centre for Engineering in Circulatory Assistance, Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil
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Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults. Cardiol Young 2023; 33:354-361. [PMID: 36259152 DOI: 10.1017/s1047951122003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report our experience and early outcomes of using the BeGraft aortic stent in children, adolescents, and young adults. BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) requires a smaller long sheath compared to other covered stents, and it has a low profile and adequate radial power. With these features, it can overcome some limitations in the treatment of coarctation, especially in children. This is a single centre retrospective analysis of 11 implanted BeGraft aortic stents in coarctation of the aorta between July 2020 and November 2021. The eleven stents were successfully implanted in 11 patients (10 males). The median age of the patients was 13.7 years (interquartile range 12-16 years), and the median weight was 43 kg (interquartile range 35-62 kg). In five patients, after the stents were opened completely by the first balloon, they were exchanged with a Z-MED II™ balloon, 1-3 mm larger in diameter, and the stents were redilated. The median catheter-derived systolic peak-to-peak pressure gradient was 23 mm Hg (interquartile range 16-37 mmHg) before the procedure and 3 mm Hg (interquartile range 1-5 mm Hg) after the procedure. Except for the partial femoral artery thrombosis in two patients, no other procedural complications were observed in our study. The median follow-up duration was 5 months (interquartile range 2-12 months). During follow-up, only one patient (9%) had stent narrowing that required dilation. Our initial results and short-term follow-up showed that the BeGraft aortic stent implantation and redilation can be performed effectively, safely, and successfully in the treatment of coarctation of the aorta.
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Homsi M, El Khoury M, Hmedeh C, Arabi M, El Rassi I, Bulbul Z, Sawaya F, Bitar F, Haddad F. Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 39:66-72. [PMID: 34916158 DOI: 10.1016/j.carrev.2021.10.010] [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: 06/15/2021] [Revised: 10/10/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks. MATERIALS/METHODS A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done. RESULTS 18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p < 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications. CONCLUSIONS Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.
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Affiliation(s)
- Mouafak Homsi
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Maya El Khoury
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Caroline Hmedeh
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Mariam Arabi
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Issam El Rassi
- American University of Beirut Medical Center, Department of surgery, Children Heart Center, Lebanon
| | - Ziad Bulbul
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fadi Sawaya
- American University of Beirut Medical Center, Department of Medicine, Lebanon
| | - Fadi Bitar
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fady Haddad
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon.
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Schleiger A, Michel J, Kramer P, Buz S, Peters B, Photiadis J, Berger F, Nordmeyer J, Schubert S. Revascularization of Left Subclavian to Common Carotid Artery Prepares for Covered Stent Implantation in Patients With Complex Aortic Coarctation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:237-243. [PMID: 35616926 DOI: 10.1177/15569845221099298] [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: 01/28/2023]
Abstract
Seven adult patients underwent a two-stage treatment of complex coarctation (CoA), including surgical revascularization of the left subclavian artery (LSA) to left common carotid artery (LCCA), followed by transcatheter covered stent implantation. The majority of patients (5 of 7, 71%) received 1 covered stent (covered Cheatham Platinum stent: 8 zig/45 mm [n = 2], 10 zig/60 mm [n = 1], 10 zig/65 mm [n = 1]; BeGraft: 24/48 mm [n = 2]). In 1 patient (14%), the implantation of 2 covered stents (BeGraft 20/48 mm) was necessary. During a median follow-up of 2.4 years (interquartile range, 0.1 to 4.9 years), complications occurred in 3 of 7 patients (43%), including an asymptomatic but severe stenosis of the LSA bypass (n = 1), a recoarctation with a mild endoleak (n = 1), and a severe endoleak (n = 1). Surgical revascularization of the LSA to the LCCA can successfully prepare for covered stent implantation in complex CoA in adult patients. This two-stage approach was feasible and safe with complications occurring in 3 of 7 patients (43%). All complications were managed by catheter reintervention only.
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Affiliation(s)
- Anastasia Schleiger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Jörg Michel
- Department of Pediatric Cardiology, Pulmonology, and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Peter Kramer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Björn Peters
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Clinic of Ruhr University Bochum, Bad Oeynhausen, Germany.,Anastasia Schleiger and Jörg Michel share first authorship, and Johannes Nordmeyer and Stephan Schubert share last authorship
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Bioptome-assisted stent repositioning in the case of stent migration during balloon-expandable stenting for coarctation of the aorta. Cardiol Young 2022; 32:127-129. [PMID: 34114534 DOI: 10.1017/s1047951121002262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coarctation of aorta is commonly treated with endovascular interventions such as coarctation stenting. Migration of stent is the most dreaded complication of coarctation stenting. A 60-year-old lady with severe malaligned coarctation underwent endovascular stent placement. The expanded stent migrated to proximal aorta, which could be stabilized with a bioptome, re-positioned with a balloon and postdilated to its optimal size, resulting in a good outcome.
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Cañas-Galvis MA, Lince-Varela R, Díaz-Medina LH, Correa R, Restrepo D. Recoartación de la aorta en pacientes sometidos a angioplastia percutánea con o sin implantación de stent. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:444-452. [PMID: 34852190 PMCID: PMC8641448 DOI: 10.24875/acm.20000339] [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: 11/17/2022] Open
Abstract
Objetivo: La coartación de la aorta puede ser tratada quirúrgicamente o con angioplastia con balón. El objetivo de nuestro estudio fue describir los resultados postangioplastia percutánea con balón con o sin implantación de stent para coartación de la aorta y establecer la incidencia de recoartación en el seguimiento. Método: Estudio de cohorte, se incluyeron pacientes de cualquier edad en un periodo de seguimiento de nueve años. Resultados: Se incluyeron 89 pacientes, un 69.0% hombres. La media de seguimiento para todos los participantes fue de 33.66 meses. Al 32.5% se les implantó un stent en angioplastia; de los cuales el 24.1% se recoartaron durante el seguimiento. En el grupo sin stent se recoartaron un 36.6%. No hubo diferencia significativa en las curvas de supervivencia de los dos grupos (p = 0.889). Conclusiones: La implantación de stent durante la angioplastia con balón para tratar coartación de aorta no influyó en la incidencia de recoartación de la aorta; pero factores como la hipertensión arterial preangioplastia y el gradiente final de angioplastia > 20 mmHg se asoció con recoartación de la aorta.
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Affiliation(s)
| | | | - Luis H Díaz-Medina
- Servicio de Cardiología Pediátrica, Clínica CardioVID. Medellín, Colombia
| | - Rafael Correa
- Servicio de Cardiología Pediátrica, Clínica CardioVID. Medellín, Colombia
| | - Diana Restrepo
- Servicio de Cardiología Pediátrica, Clínica CardioVID. Medellín, Colombia
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Farias M, Fleishman CE, Nykanen D, DeCampli WM. Clinical update on the hybrid comprehensive stage II operation. JTCVS OPEN 2021; 7:327-335. [PMID: 36003736 PMCID: PMC9390143 DOI: 10.1016/j.xjon.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
Objective We previously described the hybrid comprehensive stage II operation as an alternate surgical procedure for a subset of patients with single ventricle congenital heart disease with adequate native ascending aortic outflow. Here we provide a clinical update on the 4 patients who have undergone this procedure. Methods After undergoing a hybrid approach to the stage I Norwood palliation, the hybrid comprehensive stage II procedure was performed with an incision to the main pulmonary artery (PA), dilation of the ductal stent, creation of a stented baffle between the branch PAs, and a bidirectional Glenn connection. With this approach, dissection of the distal arch and creation of a Damus-Kaye-Stansel anastomosis was avoided. A standard Fontan procedure was planned after the usual period of growth. Results The first patient, who had trisomy 21 and elevated PA pressures, died postoperatively due to left PA thrombosis. The subsequent 3 patients survived the procedure and remain clinically well. All have required catheterizations for reintervention on their stented intrapulmonary baffles and ductal arches, and all have undergone successful completion of their Fontan procedures. Conclusions The hybrid comprehensive stage II is a feasible, less complex alternative to the conventional comprehensive stage II operation in a subset of patients with single ventricle physiology. Early postoperative anticoagulation therapy to avoid PA thrombosis is recommended, and restenting of the ductal arch is anticipated. Although the long-term consequences of separate outflow tracts supplying the upper and lower body is unknown, the 3 surviving patients with this circulation are doing well with their Fontan circulation at midterm follow-up.
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Affiliation(s)
- Michael Farias
- The Heart Center, Arnold Palmer Hospital for Children Orlando, Fla
| | | | - David Nykanen
- The Heart Center, Arnold Palmer Hospital for Children Orlando, Fla
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YIN XIAOWEN, HU XIAOMIN, LI TONG, MA JIAYAO. A NEW RING STENT WITH GRADED GEOMETRY FOR TREATING COARCTATION OF CURVED AORTA ARTERIES. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ring stent implantation has been widely used to treat coarctation of the aorta (CoA) as an alternative to surgery. Currently adopted stents with uniform geometry may cause uneven stress distribution and high stress concentration in curved vessels, leading to in-stent restenosis (ISR). Inspired by functional graded material, here we propose a new ring-and-link stent, which has graded geometry in order to achieve a reduced peak stress when deployed in curved arteries. Numerical simulation of a single ring of the graded stent indicated that by varying the circumferential spacing of wave crest, the maximum stress exerted on the artery was reduced by as much as 27.86% in comparison with the uniform one. The effects of stent geometric parameters and artery curvature were also obtained through a parametric study. Finally, a whole stent was studied to verify the design, and a maximum stress reduction by 31.96% was achieved. In summary, the proposed graded ring stent shows great potential in clinical applications to reduce the risk of ISR.
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Affiliation(s)
- XIAOWEN YIN
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin 300350, P. R. China
| | - XIAOMIN HU
- Tianjin Third Central Hospital, 83 Jintang Road, Tianjin 300170, P. R. China
| | - TONG LI
- Tianjin Third Central Hospital, 83 Jintang Road, Tianjin 300170, P. R. China
| | - JIAYAO MA
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Tianjin 300350, P. R. China
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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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Abdel-Hadi O, Thomson J, McPherson SJ. Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up. CVIR Endovasc 2021; 4:12. [PMID: 33427973 PMCID: PMC7801534 DOI: 10.1186/s42155-020-00193-4] [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: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.
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Affiliation(s)
- Omar Abdel-Hadi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK
| | - John Thomson
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds LS1 3EX, West Yorkshire. LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - Simon J McPherson
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK. .,University of Leeds, Leeds, UK.
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Ghosh S, Abozeed M, Bin Saeedan M, Raman SV. Chest radiography of contemporary trans-catheter cardiovascular devices: a pictorial essay. Cardiovasc Diagn Ther 2020; 10:1874-1894. [PMID: 33381431 DOI: 10.21037/cdt-20-617] [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: 11/06/2022]
Abstract
There is a plethora of cardiovascular devices used for therapy and monitoring, and newer devices are being introduced constantly. As a result of advancement of medical technology and rapid development of such technology to address unmet needs across cardiovascular care, multiple conditions which were previously treated surgically or with medications now benefit from trans-catheter device-based evaluation and management. Moreover, innovation to existing technology has transformed the structural design of many traditional cardiovascular devices, making them safer and enabling easier deployment within the chest (catheter-based versus surgical). A post-procedure chest radiography (CXR) is often the first routine imaging test ordered in these patients. A CXR is a relatively inexpensive and noninvasive imaging tool, which can be obtained at the patient's bedside if needed. Commonly implanted cardiovascular devices can be quite easily checked for appropriate positioning on routine CXRs. Potential complications associated with mal-positioning of such devices may be life-threatening. Such complications often manifest early on CXRs and may not be readily apparent on clinical examination. Prompt recognition of such abnormal radiographic appearances is critical for timely diagnosis and effective management. Clinicians need to be familiar with new devices in order to assess proper placement and identify complications related to mal-positioning. This pictorial essay aims to describe the radiologic appearances of contemporary cardiovascular devices, review indications for their usage and potential complications, and discuss magnetic resonance imaging (MRI) compatibility.
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Affiliation(s)
- Subha Ghosh
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mostafa Abozeed
- Cardiopulmonary Imaging Division, University of Alabama at Birmingham, Birmingham, AL, USA.,Radiology Department, Al-Azhar University, Cairo, Egypt
| | - Mnahi Bin Saeedan
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha V Raman
- Indiana University Health and IU Krannert Institute of Cardiology, Indianapolis, IN, USA
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Shahanavaz S, Aldoss O, Carr K, Gordon B, Seckeler MD, Hiremath G, Seaman C, Zablah J, Morgan G. Acute and medium term results of balloon expandable stent placement in the transverse arch-a multicenter pediatric interventional cardiology early career society study. Catheter Cardiovasc Interv 2020; 96:1277-1286. [PMID: 32902911 DOI: 10.1002/ccd.29248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES AND BACKGROUND Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multi-center retrospective cohort. METHODS TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. RESULTS Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days-42 years), median weight 54 kg (1.1-141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0-57 mmHg) to 0 mmHg (0-23 mmHg) (p < .001). The narrowest arch diameter increased from 9 mm (1.4-16 mm) to 14 mm (2.9-25 mm) (p < .001), with a median increase of 4.9 mm (1.1-10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4-7.3 years). CONCLUSIONS TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.
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Affiliation(s)
- Shabana Shahanavaz
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, ST Louis, Missouri, USA
| | - Osamah Aldoss
- Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Kaitlin Carr
- Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Brent Gordon
- Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona, USA
| | - Gurumurthy Hiremath
- Pediatrics, Division of Pediatric Cardiology, University of Minnesota, Masonic Children's Hospital, Pediatric Heart Center, Minneapolis, Minnesota, USA
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jenny Zablah
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
| | - Gareth Morgan
- The Heart Institute, Children's Hospital of Colorado, Anschutz Medical Campus, Denver, Colorado, USA
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Egbe AC, Anderson JH, Ammash NM, Taggart NW. Left Ventricular Remodeling After Transcatheter Versus Surgical Therapy in Adults With Coarctation of Aorta. JACC Cardiovasc Imaging 2020; 13:1863-1872. [PMID: 32199847 PMCID: PMC7486991 DOI: 10.1016/j.jcmg.2020.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/17/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this retrospective cohort study was to compare remodeling of left ventricular (LV) structure and function after transcatheter stent therapy with remodeling of LV structure and function after surgical therapy for COA. BACKGROUND Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However, LV remodeling after transcatheter COA intervention has not been systematically investigated. METHODS LV remodeling was assessed at 1, 3, and 5 years post-intervention by using LV mass index (LVMI), LV end-diastolic dimension, LV ejection fraction, LV global longitudinal strain (LVGLS), LV mitral annular tissue Doppler early velocity (LVe'), and ratio of mitral inflow pulsed wave Doppler early velocity and e' (E/e') ratio. RESULTS There were 44 patients in the transcatheter group and 128 patients in the surgical group. Compared to the surgical group, the transcatheter group had less regression of LVMI (-4.6; 95% confidence interval [CI]: -5.5 to -3.7 vs. -7.3; 95% CI: -8.4 to -6.6 g/m2; p < 0.001), less improvement in LVGLS (2.1; 95% CI: 1.8 to 2.4 vs. 2.9; 95% CI: 2.6 to 3.2%; p = 0.024), and in e' (1.0 ; 95% CI: 0.7 to 1.2 vs. 1.5 ; 95% CI: 1.3 to 1.7 cm/s; p = 0.009) at 5 years post-intervention. Exploratory analysis showed a correlation between change in LVMI and LVGLS, and between change in LVMI and mitral annular tissue Doppler early velocity (e'), and this correlations were independent of the type of intervention received. CONCLUSIONS Transcatheter stent therapy was associated with less remodeling of LV structure and function during mid-term follow-up. As transcatheter stent therapy becomes more widely used in the adult COA population, there is a need for ongoing clinical monitoring to determine if these observed differences in LV remodeling translate to differences in clinical outcomes.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota.
| | - Jason H Anderson
- Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota
| | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
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Promphan W, Han Siang K, Prachasilchai P, Jarutach J, Makonkawkeyoon K, Siwaprapakorn W, Chutimapongrat N, Sueachim P, Butchan Y. Feasibility and early outcomes of aortic coarctation treatments with
BeGraft
Aortic stent. Catheter Cardiovasc Interv 2020; 96:E310-E316. [DOI: 10.1002/ccd.28892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Worakan Promphan
- Pediatric Heart Center, Queen Sirikit National Institute of Child Health, College of MedicineRangsit University Bangkok Thailand
| | - Koay Han Siang
- Pediatric Heart Center, Queen Sirikit National Institute of Child Health, College of MedicineRangsit University Bangkok Thailand
- Department of Pediatric CardiologyPenang General Hospital Penang Malaysia
| | - Pimpak Prachasilchai
- Pediatric Heart Center, Queen Sirikit National Institute of Child Health, College of MedicineRangsit University Bangkok Thailand
| | - Jirayut Jarutach
- Faculty of Medicine, Department of PediatricsPrince of Songkla University Songkhla Thailand
| | | | | | - Nantapol Chutimapongrat
- Department of Internal Medicine, Rajavithi Hospital, College of MedicineRangsit University Bangkok Thailand
| | - Pantipa Sueachim
- Pediatric Heart Center, Queen Sirikit National Institute of Child Health, College of MedicineRangsit University Bangkok Thailand
| | - Yuttana Butchan
- Pediatric Heart Center, Queen Sirikit National Institute of Child Health, College of MedicineRangsit University Bangkok Thailand
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Abstract
PURPOSE OF REVIEW Aortic coarctation is a common congenital abnormality causing significant morbidity and mortality if not corrected. Re-coarctation or restenosis of the aorta following treatment is a relatively common long-term problem and the optimal therapy has not been elucidated. In this review, we identify the challenges associated with and the optimal management for recurrent aortic coarctation and the most appropriate therapy for different patient cohorts. RECENT FINDINGS Open surgery provides a durable long-term aortic repair, however, given the complex nature of the procedure, has a somewhat higher rate of serious complications. Endovascular repair, although less invasive and relatively safe, has limitations in treated complex anatomy and is more likely to require repeat intervention. Open surgical repair is more appropriate for infants that have not been intervened on and endovascular therapy should be reserved for older children and adults and those that require repeat intervention.
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17
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Computational fluid dynamics simulations as a complementary study for transcatheter endovascular stent implantation for re-coarctation of the aorta associated with minimal pressure drop: an aneurysmal ductal ampulla with aortic isthmus narrowing. Cardiol Young 2019; 29:768-776. [PMID: 31198121 DOI: 10.1017/s1047951119000751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter stent implantation has been employed to treat re-coarctation of the aorta in adolescents and young adults. The aim of this work is to use computational fluid dynamics to characterise haemodynamics associated with re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing, which created minimal pressure drop, and to incorporate computational fluid dynamics's findings into decision-making concerning catheter-directed treatment. METHODS Computational fluid dynamics permits numerically solving the Navier-Stokes equations governing pulsatile flow in the aorta, based on patient-specific data. We determined flow-velocity fields, wall shear stresses, oscillatory shear indices, and particle stream traces, which cannot be ascertained from catheterisation data or magnetic resonance imaging. RESULTS Computational fluid dynamics showed that, as flow entered the isthmus, it separated from the aortic wall, and created vortices leading to re-circulating low-velocity flow that induced low and multidirectional wall shear stress, which could sustain platelet-mediated thrombus formation in the ampulla. In contrast, as flow exited the isthmus, it created a jet leading to high-velocity flow that induced high and unidirectional wall shear stress, which could eventually undermine the wall of the descending aorta. SUMMARY We used computational fluid dynamics to study re-coarctation involving an aneurysmal ductal ampulla and aortic isthmus narrowing. Despite minimal pressure drop, computational fluid dynamics identified flow patterns that would place the patient at risk for: thromboembolic events, rupture of the ampulla, and impaired descending aortic wall integrity. Thus, catheter-directed stenting was undertaken and proved successful. Computational fluid dynamics yielded important information, not only about the case presented, but about the complementary role it can serve in the management of patients with complex aortic arch obstruction.
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18
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Cangussú LR, Lopes MR, Barbosa RHDA. The importance of the early diagnosis of aorta coarctation. ACTA ACUST UNITED AC 2019; 65:240-245. [PMID: 30892450 DOI: 10.1590/1806-9282.65.2.240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Coarctation of the aorta is a congenital heart disease characterized by a narrowing that occurs in the aortic artery. This constriction can occur anywhere along its entire length; however, it is more common between the origin of the left subclavian artery and the ductus arteriosus. Its incidence corresponds to 3 cases per 10,000 births. Thus, it is a common cardiopathy, but with high mortality and morbidity rates, which are related to a failure in the early diagnosis. METHOD In the research, articles of the national and international literature in Pubmed, Scielo and Lilacs databases were selected using the following descriptors: coarctation, aorta, diagnosis, heart diseases, congenital abnormalities. RESULTS The pathophysiology of CoA and its systemic implications in the life of newborn and adults are well elucidated. However, due to the lack of habit to palpate pulses and to check the blood pressure in both upper and lower limbs during the physical examination, it is still a pathology little diagnosed in childhood. There are several techniques used in the repair of coarctation, each with their specifics, although, when not treated, aneurysms, heart failure, coronary diseases, and stroke are the main complications arising from the evolution of this pathology, which explains the low survival rate of these patients. CONCLUSION Coarctation of the aorta is, therefore, a cardiac malformation of significant importance due to its incidence and its significant mortality risk. In this sense, the early diagnosis stands out as an essential piece for better prognosis of the patient.
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Affiliation(s)
- Luana Resende Cangussú
- Medical student, Federal University of Vale do São Francisco, Paulo Afonso, Bahia, Brasil
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20
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Single stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating the Cabrol technique: a case report. J Cardiothorac Surg 2018; 13:75. [PMID: 29929527 PMCID: PMC6013943 DOI: 10.1186/s13019-018-0761-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background A 44 year old man who presented with a history of chest pain and dyspnoea was found to have an aneurysm of the aortic root, aortic valve insufficiency, and coarctation of the aorta. Case presentation The patient underwent a single stage procedure to treat the aortic root, valve and coarctation with a composite valved conduit and extra-anatomic bypass of the coarctation. The modified Cabrol technique was necessary to attach the coronary buttons due to grossly abnormal anatomy. The patient made a remarkable recovery and was discharged on the 8th post-operative day. Conclusion This case report highlights the feasibility and efficacy of performing a single stage procedure on complex coarctation with associated cardiac defects. To the best of our knowledge, this is the first report of the modified Cabrol technique being used in this particular setting.
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Complications After Stent Placement for Aortic Coarctation: A Pictorial Essay of Computed Tomographic Angiography. J Thorac Imaging 2018; 32:W69-W80. [PMID: 29065009 DOI: 10.1097/rti.0000000000000303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Stent placement is commonly used to treat aortic coarctation. Although invasive angiography remains the gold standard, follow-up is often performed using computed tomography, which allows rapid, noninvasive assessment of the aorta and surrounding tissues. The goal of this pictorial essay is to provide a guide to the interpretation of these examinations. Normal and abnormal computed tomographic appearance of different stent types is shown along with reconstructions that can help assess stent integrity and the stent position in relation to the aortic wall and branches. Furthermore, imaging findings of complications including aortic wall injuries, restenosis, and intimal hyperplasia are depicted.
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22
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Outcomes of thoracic endovascular aortic repair in adult coarctation patients. J Vasc Surg 2018; 67:369-381.e2. [DOI: 10.1016/j.jvs.2017.06.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/17/2017] [Indexed: 12/17/2022]
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Rad EM, Mortezaeian H, Pouraliakbar HR, Hijazi ZM. Pitfalls of stenting coarctation of an angulated right circumflex aortic arch in Goldenhar syndrome. Ann Pediatr Cardiol 2017; 10:194-196. [PMID: 28566829 PMCID: PMC5431033 DOI: 10.4103/apc.apc_134_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report stenting of coarctation of an angulated right circumflex aortic arch (RCAA) using four Cheatham Platinum stents in a child with Goldenhar syndrome. Difficulties in measuring the accurate length of the curved and narrowed transverse aortic arch marked discrepancy between the luminal diameters of the long narrow transverse arch and wide descending thoracic aorta, increased displacement force caused by the 90° bend between the two parts resulted in repeated stent migrations. We discuss the tips to avoid distal stent migration in the setting of an angulated RCAA.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatrics, Children's Medical Center (Pediatrics Center of Excellence), Tehran University of Medical Sciences, Tehran 1419733151, Iran
| | - Hojjat Mortezaeian
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Medical and Research Center, Weill Cornell Medicine, New York, USA
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Jha NK, Tofeig M, Kumar RA, ElTahir A, Athar SM, AlHakami A, Khan A, Khan MD. Stent dilatation of atretic aortic coarctation in an adult-case report and literature review. J Cardiothorac Surg 2016; 11:10. [PMID: 26781635 PMCID: PMC4717556 DOI: 10.1186/s13019-016-0395-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/06/2016] [Indexed: 12/01/2022] Open
Abstract
Background Patients with functional aortic interruption of the descending thoracic aorta at the isthmus due to severe coarctation in association with atretic lumen are extremely rare in the adult population. The management is challenging and carries high morbidity and mortality. Case presentation We describe successful percutaneous reconstruction using a covered stent in a similar patient who is doing well two-years after intervention. A literature search was done to explore management strategies and their long-term outcomes for better understanding. Conclusions This report is an attempt to highlight the role of minimal invasive approach in the management of rare, severe coarctation of the aorta in adult patients to avoid morbidity and mortality associated with more invasive procedures.
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Affiliation(s)
- Neerod Kumar Jha
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Magdi Tofeig
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Rajappan Arun Kumar
- Institute of Anesthesiology, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Amin ElTahir
- Institute of Surgery, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Syed Mohammad Athar
- Institute of Medicine, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Aref AlHakami
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Arshad Khan
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
| | - Mohammad Daud Khan
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City (managed by Cleveland Clinic), PO Box 51900, Abu Dhabi, United Arab Emirates.
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