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Nagashima T, Taira M, Hasegawa M, Kugo Y, Watanabe T, Miyagawa S. The usefulness of staged extra-anatomic bypass for coarctation of the aorta with arch hypoplasia, from premature neonate to adult. Asian Cardiovasc Thorac Ann 2024; 32:215-218. [PMID: 38483813 DOI: 10.1177/02184923241240184] [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] [Indexed: 06/18/2024]
Abstract
Various surgical techniques have been developed for coarctation of the aorta. However, coarctation repair in neonates with arch hypoplasia remains challenging. We herein report a case in which a premature neonate under 1500 g with coarctation of the aorta and arch hypoplasia underwent an extra-anatomical bypass at 18 days old. A second extra-anatomical bypass was performed at 3 years of age, and a third extra-anatomic bypass for recurrent coarctation was performed in adulthood. By increasing the size of the graft as the patient grows, extra-anatomic bypass can be a useful surgical option for premature neonates with coarctation and arch hypoplasia.
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Affiliation(s)
- Toshiaki Nagashima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Moyu Hasegawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Kugo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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2
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Aslan S, Liu X, Wu Q, Mass P, Loke YH, Johnson J, Huddle J, Olivieri L, Hibino N, Krieger A. Virtual Planning and Patient-Specific Graft Design for Aortic Repairs. Cardiovasc Eng Technol 2024; 15:123-136. [PMID: 37985613 DOI: 10.1007/s13239-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Patients presenting with coarctation of the aorta (CoA) may also suffer from co-existing transverse arch hypoplasia (TAH). Depending on the risks associated with the surgery and the severity of TAH, clinicians may decide to repair only CoA, and monitor the TAH to see if it improves as the patient grows. While acutely successful, eventually hemodynamics may become suboptimal if TAH is left untreated. The objective of this work aims to develop a patient-specific surgical planning framework for predicting and assessing postoperative outcomes of simple CoA repair and comprehensive repair of CoA and TAH. METHODS The surgical planning framework consisted of virtual clamp placement, stenosis resection, and design and optimization of patient-specific aortic grafts that involved geometrical modeling of the graft and computational fluid dynamics (CFD) simulation for evaluating various surgical plans. Time-dependent CFD simulations were performed using Windkessel boundary conditions at the outlets that were obtained from patient-specific non-invasive pressure and flow data to predict hemodynamics before and after the virtual repairs. We applied the proposed framework to investigate optimal repairs for six patients (n = 6) diagnosed with both CoA and TAH. Design optimization was performed by creating a combination of a tubular graft and a waterslide patch to reconstruct the aortic arch. The surfaces of the designed graft were parameterized to optimize the shape. RESULTS Peak systolic pressure drop (PSPD) and time-averaged wall shear stress (TAWSS) were used as performance metrics to evaluate surgical outcomes of various graft designs and implantation. The average PSPD improvements were 28% and 44% after the isolated CoA repair and comprehensive repair, respectively. Maximum values of TAWSS were decreased by 60% after CoA repair and further improved by 22% after the comprehensive repair. The oscillatory shear index was calculated and the values were confirmed to be in the normal range after the repairs. CONCLUSION The results showed that the comprehensive repair outperforms the simple CoA repair and may be more advantageous in the long term in some patients. We demonstrated that the surgical planning and patient-specific flow simulations could potentially affect the selection and outcomes of aorta repairs.
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Affiliation(s)
- Seda Aslan
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA.
| | - Xiaolong Liu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - Qiyuan Wu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Paige Mass
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | | | - Laura Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
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3
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Gong T, Zhang F, Feng L, Zhu X, Deng D, Ran T, Li L, Kong L, Sun L, Ji X. Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study. Front Cardiovasc Med 2023; 10:1078038. [PMID: 37554364 PMCID: PMC10405080 DOI: 10.3389/fcvm.2023.1078038] [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] [Received: 10/23/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation, and improvements in the diagnostic process for surgical decision-making are important. We sought to compare the diagnostic accuracy of transthoracic echocardiography (TTE) with computed tomographic angiography (CTA) to diagnose CoA. METHODS We retrospectively reviewed 197 cases of CoA diagnosed by TTE and CTA and confirmed at surgery from July 2009 to August 2019. RESULTS The surgical findings confirmed that 19 patients (9.6%) had isolated CoA and 178 (90.4%) had CoA combined with other congenital cardiovascular malformations. The diagnostic accuracy of CoA by CTA was significantly higher than that of TTE (χ2 = 6.52, p = 0.01). In contrast, the diagnostic accuracy of TTE for associated cardiovascular malformations of CoA was significantly higher than that of CTA (χ2 = 15.36, p < 0.0001). Infants and young children had more preductal type of CoA, and PDA was the most frequent cardiovascular lesion associated with CoA. The pressure gradient was significantly decreased after the first operation, similar at 6 months, 1 year, and 3 years follow-ups by TTE. CONCLUSIONS CTA is more accurate as a clinical tool for diagnosing CoA; however, TTE with color Doppler can better identify associated congenital cardiovascular malformations. Therefore, combining TTE and CTA would benefit clinical evaluation and management in patients suspected of CoA. TTE was valuable for post-operation follow-up and clinical management.
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Affiliation(s)
- Ting Gong
- Department of Ultrasound, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyan Zhang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lingxin Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Deng
- School of Medical Imaging, Changsha Medical University, Changsha, China
| | - Tingting Ran
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liling Li
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kong
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Xiaojuan Ji
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
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Meidell Blylod V, Rinnström D, Pennlert J, Ostenfeld E, Dellborg M, Sörensson P, Christersson C, Thilén U, Johansson B. Interventions in Adults With Repaired Coarctation of the Aorta. J Am Heart Assoc 2022; 11:e023954. [PMID: 35861813 PMCID: PMC9707821 DOI: 10.1161/jaha.121.023954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Coarctation of the aorta coexists with other cardiac anomalies and has long‐term complications, including recoarctation, which may require intervention after the primary coarctation repair. This study aims to clarify the prevalence of and risk factors for interventions related to the coarctation complex as well as late mortality in a large contemporary patient population.
Methods and Results
The Swedish National Register of Congenital Heart Disease was used, which comprised 683 adults with repaired coarctation of the aorta. Analysis was performed on freedom from intervention thereafter at the coarctation site, aortic valve, left ventricular outflow tract, or ascending aorta. One hundred ninety‐six (29%) patients had at least 1 of these interventions. Estimated freedom from either of these interventions was 60% after 50 years. The risk of undergoing such an intervention was higher among men (hazard ratio, 1.6 [95% CI, 1.2–2.2]). Estimated freedom from another intervention at the coarctation site was 75% after 50 years. In women, there was an increase in interventions at the coarctation site after 45 years. Patients who underwent one of the previously mentioned interventions after the primary coarctation repair had poorer left ventricular function. Eighteen patients (3%) died during follow‐up in the register. The standardized mortality ratio was 2.9 (95% CI, 1.7–4.3).
Conclusions
Interventions are common after coarctation repair. The risk for and time of interventions are affected by sex. Our results have implications for planning follow‐up and giving appropriate medical advice to the growing population of adults with repaired coarctation of the aorta.
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Affiliation(s)
| | - Daniel Rinnström
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund Clinical Physiology, Lund University Lund Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden
| | - Peder Sörensson
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - Ulf Thilén
- Department of Clinical Sciences Lund Cardiology, Lund University Lund Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
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Sadeghi R, Tomka B, Khodaei S, Daeian M, Gandhi K, Garcia J, Keshavarz-Motamed Z. Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling. Sci Rep 2022; 12:9718. [PMID: 35690596 PMCID: PMC9188592 DOI: 10.1038/s41598-022-12894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/28/2023] Open
Abstract
Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn't change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.
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Affiliation(s)
- Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Benjamin Tomka
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - MohammadAli Daeian
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Krishna Gandhi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Julio Garcia
- grid.489011.50000 0004 0407 3514Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Cardiac Sciences, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, Calgary, AB Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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6
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Cherpak BV, Davydova YV, Kravchenko VI, Yaschuk NS, Siromakha SO, Lazoryshynets VV. Management of percutaneous treatment of aorta coarctation diagnosed during pregnancy. J Med Life 2022; 15:208-213. [PMID: 35419094 PMCID: PMC8999110 DOI: 10.25122/jml-2021-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Management of coarctation of the aorta (CoA) during pregnancy is complicated by increased procedural risks to the pregnant woman and her fetus. The aim of this research was to analyze 10-years of experience of CoA treatment diagnosed during pregnancy. During 2010–2020 we performed percutaneous stents implantations (SI) in 4 women during 15–23 weeks of pregnancy and in 6 women 48 hours – 5 years after delivery. In all presented cases, successful CoA repair was achieved. There was a significant decrease of peak-to-peak invasive systolic pressure gradient across the CoA (60.0±31.2 and 11.8±7.3 mmHg, p=0.001) and mean noninvasive systolic arterial pressure (163.0±46.2 and 120.5±9.2 mmHg, p=0.01) after SI. All percutaneously treated women during pregnancy (n=4) delivered healthy full-term babies. At follow-up (from 2 months to 10 years), all 10 women are alive without significant Doppler gradient across CoA with no signs of aortic aneurysm formation. To the best of our knowledge, we presented the largest published cohort of CoA percutaneous treatment during pregnancy. We categorized our experience in managing aortic coarctation diagnosed during pregnancy in one algorithm. Our experience demonstrates that excellent maternal and neonatal pregnancy outcomes can be obtained in women after CoA percutaneous repair, diagnosed during pregnancy. An aortic stent implantation is effective and safe for both mother and fetus.
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Affiliation(s)
- Bogdan Volodymyrovych Cherpak
- Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine,*Corresponding Author: Bogdan Volodymyrovych Cherpak, Pediatric Cardiology and Cardiosurgery Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine. E-mail:
| | - Yulia Volodymyrivna Davydova
- Obstetrics Department for Extragenital Pathology in Pregnant Women, Institute of Pediatrics, Obstetrics and Gynecology NAMS, Kyiv, Ukraine
| | - Vitalii Ivanovich Kravchenko
- Department of Surgical Treatment of Aortic Pathology, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
| | - Natalia Sergiivna Yaschuk
- Pediatric Cardiology Intervention Department, National Amosov Institute of Cardiovascular Surgery NAMS, Kyiv, Ukraine
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7
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Saran N, Pochettino A. Management of Coarctation and Aortic Arch Anomalies in the Adult. Semin Thorac Cardiovasc Surg 2021; 33:1061-1068. [PMID: 34091017 DOI: 10.1053/j.semtcvs.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Congenital Aortic arch malformations are rare in adults. Often they present with hypertension or tracheoesophageal compression. The involved anatomy is dependent on the sidedness of the aortic arch and the variable development of the primitive pharyngeal arches. Sternotomy and thoracotomy are usually required for surgical repair, while need for circulatory arrest is not uncommon. With caution and adequate planning, surgery can be carried out with satisfactory results.
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Affiliation(s)
- Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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8
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Pu X, Wang M, Huang X, Zhang H, Huang L. Case report: a novel approach for the emergency repair of acute aortic rupture associated with congenital aortic Coarctation. J Cardiothorac Surg 2021; 16:170. [PMID: 34112233 PMCID: PMC8191040 DOI: 10.1186/s13019-021-01552-5] [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: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital aortic coarctation (CoA) associated with aortic rupture is a rare but extremely lethal condition. In pregnant patients, the condition becomes very risky. CASE PRESENTATION We presented a case of a pregnant (20 weeks gestation) patient with CoA associated with ruptured aortic pseudoaneurysm who was successfully rescued using a novel hybrid strategy. CONCLUSIONS This hybrid approach may be a life-saving bridging intervention in patients with CoA associated with devastating complications, such as ruptured aneurysms, especially with extremely narrowed access.
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Affiliation(s)
- Xin Pu
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyong Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Department of Intervention Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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9
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Bugge AS, Kvitting JPE, Sundset A, Birkeland S. Lung autotransplantation and extra-anatomic bypass to treat an aortobronchial fistula after previous surgery for aortic coarctation. J Card Surg 2021; 36:2924-2927. [PMID: 34018253 DOI: 10.1111/jocs.15660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Lung autotransplantation can be a surgical alternative to gain access to the posterior mediastinum and the thoracic portion of the descending aorta through a sternotomy. We present a case of hemoptysis and bronchial obstruction due to a presumed infected aortobronchial fistula, secondary to stent graft placement in a patient with multiple previous surgeries for aortic coarctation, treated with lung autotransplantation and an extra-anatomic bypass.
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Affiliation(s)
- Anders Standal Bugge
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John-Peder Escobar Kvitting
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arve Sundset
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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10
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Al-Husayni F, Samman A, Althobaiti M, Alghamdi A, Alkashkari W. Late Complications After Previous Surgical Repair for Coarctation With Extra-Anatomic Bypass Graft: Report on Two Cases. Cureus 2021; 13:e12722. [PMID: 33614325 PMCID: PMC7882194 DOI: 10.7759/cureus.12722] [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: 01/23/2023] Open
Abstract
Surgical correction of aortic coarctation (CoA) has been the standard treatment in infants and adolescents to prevent late consequences related to obstruction and distal hypoperfusion. Several surgical techniques for CoA repair have traditionally been applied. However, late complications, including re-CoA and pseudoaneurysm formation, are not uncommon. The incidence of complications is highly related to the type of initial surgery. Here, we are reporting two cases of late complications related to an infrequently used surgical technique, the extra-anatomical aortic bypass graft (EABG). The first case presented with pseudoaneurysm at the distal anastomosis site with the descending aorta and treated by endovascular stent graft. The second case presented with stenosis at the proximal anastomosis site with the left subclavian artery (LSCA) and treated medically upon the request of the patient.
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Affiliation(s)
- Faisal Al-Husayni
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU.,Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Ahmed Samman
- Cardiology, King Fahad General Hospital, Ministry of Health, Jeddah, SAU
| | - Mohammed Althobaiti
- Radiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | | | - Wail Alkashkari
- Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.,Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
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11
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Shmukler A, Haramati A, Haramati LB. Overview of Common Surgical Procedures in CHD. Semin Roentgenol 2020; 55:264-278. [PMID: 32859343 DOI: 10.1053/j.ro.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Shmukler
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY..
| | - Adina Haramati
- Department of Radiology, Northwell Health, Manhasset, NY
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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12
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Abstract
We report a case of a 45-year-old male suffering from arterial hypertension who was found to have an aortic coarctation with marked hypertrophic compensatory collateral arterial circulation. Although coarctation is relatively rare, this must be included in the differential diagnosis in patients with arterial hypertension with a positive gradient between upper and lower limbs.
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Affiliation(s)
- Umberto G Rossi
- Department of Diagnostic Imaging, Interventional Radiology Unit, Ente Ospedaliero Galliera Hospital, Genova, Italy.,Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy
| | - Anna Maria Ierardi
- Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy
| | - Gianpaolo Carrafiello
- Department of Services and Preventive Medicine, Radiology Unit, Ca' Granda Fondation, Maggiore Policlinic Hospital, University of Milan, Milano, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy
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13
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Angelini A, di Gioia C, Doran H, Fedrigo M, Henriques de Gouveia R, Ho SY, Leone O, Sheppard MN, Thiene G, Dimopoulos K, Mulder B, Padalino M, van der Wal AC. Autopsy in adults with congenital heart disease (ACHD). Virchows Arch 2020; 476:797-820. [PMID: 32266476 PMCID: PMC7272495 DOI: 10.1007/s00428-020-02779-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
The adult congenital heart diseases (ACHD) population is exceeding the pediatric congenital heart diseases (CHD) population and is progressively expanding each year, representing more than 90% of patients with CHD. Of these, about 75% have undergone surgical and/or percutaneous intervention for palliation or correction. Autopsy can be a very challenging procedure in ACHD patients. The approach and protocol to be used may vary depending on whether the pathologists are facing native disease without surgical or percutaneous interventions, but with various degrees of cardiac remodeling, or previously palliated or corrected CHD. Moreover, interventions for the same condition have evolved over the last decades, as has perioperative myocardial preservations and postoperative care, with different long-term sequelae depending on the era in which patients were operated on. Careful clinicopathological correlation is, thus, required to assist the pathologist in performing the autopsy and reaching a diagnosis regarding the cause of death. Due to the heterogeneity of the structural abnormalities, and the wide variety of surgical and interventional procedures, there are no standard methods for dissecting the heart at autopsy. In this paper, we describe the most common types of CHDs that a pathologist could encounter at autopsy, including the various types of surgical and percutaneous procedures and major pathological manifestations. We also propose a practical systematic approach to the autopsy of ACHD patients.
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Affiliation(s)
- Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Cira di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Helen Doran
- Department of Pathology, Manchester Foundation Trust Wythenshawe Hospital, Manchester, UK
| | - Marny Fedrigo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Rosa Henriques de Gouveia
- Department of Pathology, Hospital de Santa Cruz (CHLO), Lisbon & Forensic Pathology, INMLCF & FMUC, Coimbra, Portugal
| | - Siew Yen Ho
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Ornella Leone
- Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mary N Sheppard
- Department of Cardiovascular Pathology, St Georges Medical School, London, UK
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Barbara Mulder
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Massimo Padalino
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Allard C van der Wal
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
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14
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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15
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Higuchi K, Furukawa K, Nakamura E, Imamura H, Gi T, Nakamura K. Congenital Abdominal Aortic Aneurysm in a Four Year Old Girl. EJVES Vasc Forum 2020; 48:12-18. [PMID: 33078163 PMCID: PMC7327408 DOI: 10.1016/j.ejvsvf.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/12/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Abdominal aortic aneurysm (AAA) in neonates, infants, and children is uncommon, usually occurring as a result of infections, connective tissue disorders, vasculitis, or iatrogenic trauma. A case of idiopathic congenital AAA, an extremely rare disease of unknown origin, is described. Report In March 2018, a 40 mm hypoechoic mass adjacent to the left kidney was detected incidentally by abdominal ultrasound for investigation of hypercalciuria in a four year old girl. Contrast enhanced computed tomography (CT) revealed an infrarenal fusiform AAA measuring 39 mm in maximum diameter, a 15 mm left renal artery aneurysm, a 14 mm right hypogastric artery aneurysm, and a 12 mm left hypogastric artery aneurysm. Cerebral magnetic resonance imaging revealed multiple intracranial aneurysms between 8 and 15 mm in diameter. Considering the size of the AAA and risk of rupture, surgical repair was planned. In May 2018, the congenital AAA was successfully repaired with a 10 mm Dacron aorto-aortic tube graft. Increases in the size of the left renal artery aneurysm and a left middle meningeal artery aneurysm were detected 12 and 14 months post-operatively, respectively. Coil embolisations were performed. An intracranial dural arteriovenous fistula (AVF) was discovered incidentally by cerebral angiography for treatment of the left middle meningeal artery aneurysm. Transarterial embolisation for AVF was also performed. At the 21 month post-operative follow up, the patient is doing well, and the untreated aneurysms have not grown. Conclusion Long term outcomes after surgical repair for congenital AAA are unclear. Moreover, growth of residual aneurysms was detected post-operatively, so follow up with frequent multimodality imaging for multiple aneurysms is necessary.
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Affiliation(s)
- Kazuhiro Higuchi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan.,Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Koji Furukawa
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Eisaku Nakamura
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Hideaki Imamura
- Division of Paediatrics, Department of Developmental and Urological-Reproductive Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Kunihide Nakamura
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
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16
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Mercuri M, Wustmann K, von Tengg-Kobligk H, Göksu C, Hose DR, Narracott A. Subject-specific simulation for non-invasive assessment of aortic coarctation: Towards a translational approach. Med Eng Phys 2020; 77:69-79. [PMID: 31926831 DOI: 10.1016/j.medengphy.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022]
Abstract
We present a multi-scale CFD-based study conducted in a cohort of 11 patients with coarctation of the aorta (CoA). The study explores the potential for implementation of a workflow using non-invasive routinely collected medical imaging data and clinical measurements to provide a more detailed insight into local aortic haemodynamics in order to support clinical decision making. Our approach is multi-scale, using a reduced-order model (1D/0D) and an optimization process for the personalization of patient-specific boundary conditions and aortic vessel wall parameters from non-invasive measurements, to inform a more complex model (3D/0D) representing 3D aortic patient-specific anatomy. The reliability of the modelling approach is investigated by comparing 3D/0D model pressure drop estimation with measured peak gradients recorded during diagnostic cardiac catheterization and 2D PC-MRI flow rate measurements in the descending aorta. The current study demonstrated that the proposed approach requires low levels of user interaction, making it suitable for the clinical setting. The agreement between computed blood pressure drop and catheter measurements is 10 ± 8 mmHg at the coarctation site. The comparison between CFD derived and catheter measured pressure gradients indicated that the model has to be improved, suggesting the use of time varying pressure waveforms to further optimize the tuning process and modelling assumptions.
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Affiliation(s)
- Massimiliano Mercuri
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; Therenva, Rennes, France; INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, U.K..
| | - Kerstin Wustmann
- Center for Congenital Heart Disease, Cardiac Magnetic Resonance Imaging, Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland
| | | | - D Rodney Hose
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland; Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Andrew Narracott
- Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom; INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, U.K
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17
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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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