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Mortezaeian H, Rezanejad E, Pasebani Y, Zamani R, Khalili Y, Ghaemi H, Jafari F, Sabri M, Moosavi J, Mohebbi B, Abdi A, Montazeri Namin S, Sadeghipour P, Haulon S, Fraisse A. Five-Year Outcomes of Coarctoplasty with Stents in the Pediatric Population: Results from a Retrospective Single-Center Cohort with Centrally Adjudicated Outcomes. Pediatr Cardiol 2024:10.1007/s00246-024-03551-4. [PMID: 38940826 DOI: 10.1007/s00246-024-03551-4] [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] [Received: 04/22/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
Transcatheter stent implantation is a widely performed procedure for treating native coarctation of the aorta (CoA) in pediatric patients. However, data on mid- to long-term outcomes are limited. The aim of this study was to evaluate the mid-term safety and efficacy of transcatheter CoA stenting based on centrally adjudicated outcomes. This retrospective cohort study included patients aged 15 years or younger undergoing de novo stenting for CoA or recoarctation (reCoA) between 2006 and 2017. Immediate and 5-year outcomes were assessed. Immediate outcomes (procedural and in-hospital) were retrieved from electronic records. Rates of 5-year reCoA, stent fractures, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were mid-term outcomes. The study included 274 patients (64% male and 36% female) with a median (interquartile range) age of 9 (6-12) years. Procedural success was achieved in 251 patients (91.6%). Procedural complications occurred in 4 patients (1.4%), consisting of stent migration in 1 (0.3%) and small non-expanding non-flow-limiting aortic wall injuries in 3 (1.1%). Major vascular access complications were observed in 18 patients (6.6%), acute limb ischemia in 8 (2.9%). In-hospital mortality occurred in 4 patients (1.4%). Five-year cumulative incidence rates of stent fractures, reCoA, and aortic aneurysmal/pseudoaneurysmal formation were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Of 73 reCoAs, 47 were treated with balloon angioplasty, and 15 underwent a second stent implantation. Five-year all-cause mortality occurred in 4/251 (1.6%) patients. Coarctoplasty with stents was safe and effective in our pediatric population during a 5-year follow-up despite a high rate of reCoA.
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Affiliation(s)
- Hojjat Mortezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Elham Rezanejad
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Yeganeh Pasebani
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Raheleh Zamani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Yasaman Khalili
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Hamidreza Ghaemi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Farshad Jafari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Mahshad Sabri
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Jamal Moosavi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Bahram Mohebbi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Amir Abdi
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran
| | - Sara Montazeri Namin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Tehran, 1995614331, Iran
| | - Parham Sadeghipour
- Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, Iran.
| | - Stephan Haulon
- Aortic Centre, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, SW3 6NP, UK
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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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Demir İH, Kardas M, Yucel İK, Yekeler Rİ, Bulut MO, Hekim Yılmaz E, Sürücü M, Epçaçan S, Celebi A. Transverse arch stenting and its effect on systemic hypertension. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:151-161. [PMID: 38933307 PMCID: PMC11197410 DOI: 10.5606/tgkdc.dergisi.2024.25931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 06/28/2024]
Abstract
Background This study aimed to investigate the safety and efficacy of transverse aortic arch stenting and evaluate the course of hypertension and the act of arch stenting on systemic hypertension. Methods The transverse aortic arch stenting procedures between January 2007 and May 2023 were retrospectively analyzed. Detailed procedure information, technical aspects, pressure measurements, angiographic data, balloons and stents used, complications, and immediate results were examined. Early and mid-term results were assessed. Results Eighteen patients (10 males and 8 females; mean age: 14.5±5.3 years; range, 4 to 23 years) were included in the study, all of whom were hypertensive before the procedure. The mean weight was 56.8±19.6 kg. In seven patients, the stent struts had to be dilated due to the stent causing jailing at the entrance of nearby arch vessels. After stenting, there was a significant increase in arch diameter and a decrease in ascending aorta pressure and the pressure gradient across the aorta. There were no early mortality or major complications. Late migration of the stent was observed in one patient. Three patients became normotensive immediately after the intervention, and five became drug-free during the follow-up. The requirement for dual antihypertensive therapy was significantly reduced. Conclusion Residual transverse arch lesions may contribute to the persistence of systemic hypertension after coarctation treatment. Transverse arch stent implantation can be performed safely with favorable outcomes, facilitating better blood pressure control. However, it should be noted that these patients remain at risk for lifelong hypertension and should be closely monitored in this regard.
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Affiliation(s)
- İbrahim Halil Demir
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Kardas
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - İlker Kemal Yucel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Rukiye İrem Yekeler
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Emine Hekim Yılmaz
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Sürücü
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Serdar Epçaçan
- Department of Pediatric Cardiology, Van Training and Research Hospital, Van, Türkiye
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
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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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5
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Barış VÖ, Poyraz F, Kaya EE. Novel Technique to Percutaneous Stent Implantation for Coarctation of the Aorta: Safari Wire Pacing. Anatol J Cardiol 2024; 28:E3-E5. [PMID: 38167794 PMCID: PMC10796240 DOI: 10.14744/anatoljcardiol.2023.3786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Veysel Özgür Barış
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
| | - Fatih Poyraz
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
| | - Emin Erdem Kaya
- Department of Cardiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Türkiye
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Seri A, Baral N, Yousaf A, Sriramoju A, Chinta SR, Agasthi P. Outcomes of Heart Failure Hospitalizations in Adult Patients With Coarctation of Aorta: Report From National Inpatient Sample. Curr Probl Cardiol 2023; 48:101888. [PMID: 37343776 DOI: 10.1016/j.cpcardiol.2023.101888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
Coarctation of aorta (CoA) is a common congenital anomaly which portends patients to early diastolic and systolic heart failure. In this retrospective cohort study, we aimed to evaluate the impact of CoA on heart failure hospitalization. Using the national inpatient sample, the study compared the outcomes of heart failure hospitalization between patients with and without CoA. We noted increasing prevalence of CoA related heart failure admissions over the last decade. Heart failure patients with CoA were younger (mean age 57 vs 71.6 years, P < 0.001), had a longer length of stay (7.4 vs 5.4 days, P < 0.001), and a higher incidence of cardiogenic shock (6.5% vs 2.1%, P = 0.001). However, there was no statistically significant difference in in-hospital mortality (OR 1.45, 95% CI: 0.58, 3.62, P = 0.421) between both groups. These findings demonstrate that CoA increase healthcare resource utilization in patients admitted with heart failure without any significant increase in in-hospital mortality.
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Affiliation(s)
- Amith Seri
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Nischit Baral
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Amman Yousaf
- Department of Internal Medicine, McLaren Health Care and Michigan State University, Flint, MI
| | - Anil Sriramoju
- Department of Internal Medicine, University of North Dakota, Fargo, ND
| | - Siddharth Reddy Chinta
- Division of Cardiology, Department of Internal Medicine, Tufts medical center, Boston, MA
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Miyagawa M, Kitano D, Okumura Y. Coarctation of the Aorta. Chonnam Med J 2023; 59:202. [PMID: 37840672 PMCID: PMC10570859 DOI: 10.4068/cmj.2023.59.3.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Masatsugu Miyagawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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8
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Liu C, Dai X, Zhou G, Zhang Y, Liu X. Descending thoracic aortic dissection after covered stent for adult aortic coarctation: Technical or physiopathologic? Heliyon 2023; 9:e15272. [PMID: 37089362 PMCID: PMC10114236 DOI: 10.1016/j.heliyon.2023.e15272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Covered stent graft implantation is currently the most commonly used modality for the management of adult aortic coarctation. Although the risk of descending thoracic aortic dissection after covered stent graft implantation is low, sometimes it may cause serious medical consequences or even death. We report one adult aortic coarctation patient with early postoperative descending thoracic aortic dissection after covered stent graft implantation. The patient underwent second operation of thoracic endovascular aortic reconstruction and was discharged 6 days after the operation. This case is not rare, but we hope that the complete diagnosis and treatment process of this case and discussion pertaining to surgical treatment method and its complications could serve as a reference for clinicians in dealing with such situations.
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9
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Verheijen DBH, Stöger JL, van der Kley F, Schalij MJ, Jongbloed MRM, Vliegen HW, Kiès P, Egorova AD. A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview. Front Cardiovasc Med 2022; 9:1012147. [PMID: 36620635 PMCID: PMC9815109 DOI: 10.3389/fcvm.2022.1012147] [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: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d'entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic "sawtooth" pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.
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Affiliation(s)
- D. B. H. Verheijen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J. Lauran Stöger
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - F. van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. J. Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. R. M. Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - H. W. Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - P. Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - A. D. Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: A. D. Egorova,
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10
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Castaldi B, Ciarmoli E, Di Candia A, Sirico D, Tarantini G, Scattolin F, Padalino M, Vida V, Di Salvo G. Safety and efficacy of aortic coarctation stenting in children and adolescents. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sadeghipour P, Mohebbi B, Firouzi A, Khajali Z, Saedi S, Shafe O, Pouraliakbar HR, Alemzadeh-Ansari MJ, Shahdi S, Samiei N, Sadeghpour A, Babaei M, Ghadrdoost B, Afrooghe A, Rokni M, Dabbagh Ohadi MA, Hosseini Z, Abdi S, Maleki M, Bassiri HA, Haulon S, Moosavi J. Balloon-Expandable Cheatham-Platinum Stents Versus Self-Expandable Nitinol Stents in Coarctation of Aorta: A Randomized Controlled Trial. JACC Cardiovasc Interv 2022; 15:308-317. [PMID: 35144787 DOI: 10.1016/j.jcin.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to compare the safety and efficacy of the balloon-expandable stent (BES) and the self-expandable stent (SES) in the endovascular treatment of coarctation of aorta. BACKGROUND Coarctoplasty with stents has conferred promising results. Although several nonrandomized studies have approved the safety and efficacy of the BES and the SES, no high-quality evidence exists for this comparison. METHODS In the present open-label, parallel-group, blinded endpoint randomized pilot clinical trial, adult patients with de novo native aortic coarctation were randomized into Cheatham-platinum BES and uncovered nitinol SES groups. The primary outcome of the study was a composite of procedural and vascular complications. The secondary outcomes of the study consisted of the incidence of aortic recoarctation, thoracic aortic aneurysm/pseudoaneurysm formation, and residual hypertension at a 12-month follow-up. RESULTS Among 105 patients who were screened between January 2017 and December 2019, 92 eligible patients (32 women [34.8%]) with a median age of 30 years (IQR: 20-36 years) were randomized equally into the BES and SES groups. The composite of procedural and vascular complications occurred in 10.9% of the BES group and 2.2% of the SES group (odds ratio: 0.18; 95% CI: 0.02-1.62; P = 0.20). Aortic recoarctation occurred in 5 patients (5.4%), 3 patients (6.5%) in the BES group and 2 patients (4.3%) in the SES group (odds ratio: 0.65; 95% CI: 0.10-4.09; P = 0.64). Only 1 patient (1.1%) was complicated by aortic pseudoaneurysm. Hypertension control was achieved in 50% of the study population, with an equal distribution in the 2 study groups at the 12-month follow-up. CONCLUSIONS Both the BES and the SES were safe and effective in the treatment of native coarctation.
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Affiliation(s)
- Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. https://twitter.com/psadeghipour
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, 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
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahdi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Behshid Ghadrdoost
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arya Afrooghe
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrad Rokni
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Bassiri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Stephan Haulon
- Aortic Centre, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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12
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Prica M, Kamalathasan S, Gopaul K, Warriner D. Adult congenital heart disease: a review of the simple lesions. Br J Hosp Med (Lond) 2022; 83:1-12. [DOI: 10.12968/hmed.2021.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There has been a dramatic improvement in mortality rates among children with congenital heart disease with advances in neonatal screening and surgical techniques, resulting in a significant increase in the prevalence of adults living with congenital heart disease. The most common simple lesions of congenital heart disease include atrial and ventricular septal defects, patent ductus arteriosus and coarctation of the aorta, which are typically detected and treated in childhood. However, they may also present in adulthood with non-specific symptoms or incidental findings, such as refractory hypertension. As the adult population of those living with congenital heart disease grows, it is imperative that all clinicians remain abreast of these common cardiac conditions, irrespective of their specialty, as patients may present with sequelae of their congenital heart disease or other non-cardiac conditions.
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Affiliation(s)
- Milos Prica
- Department of Adult Congenital Heart Disease, Leeds General Infirmary, Leeds, UK
| | - Stephe Kamalathasan
- Department of Adult Congenital Heart Disease, Leeds General Infirmary, Leeds, UK
| | - Karina Gopaul
- Department of Adult Congenital Heart Disease, Leeds General Infirmary, Leeds, UK
| | - David Warriner
- Department of Adult Congenital Heart Disease, Leeds General Infirmary, Leeds, UK
- Department of Cardiology, Doncaster Royal Infirmary, Doncaster, UK
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13
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Bae SB, Kang EJ, Choo KS, Lee J, Kim SH, Lim KJ, Kwon H. Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations. J Cardiovasc Imaging 2022; 30:231-262. [PMID: 36280266 PMCID: PMC9592245 DOI: 10.4250/jcvi.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.
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Affiliation(s)
- Sang Bin Bae
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Hyeon Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Kyoung Jae Lim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Heejin Kwon
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
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14
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Boulouiz S, Kossir A, Mouedder F, Miri C, Ismaili N, El Ouafi N. Shone syndrome revealed by treatment-resistant hypertension. Ann Med Surg (Lond) 2021; 71:102955. [PMID: 34729182 PMCID: PMC8545662 DOI: 10.1016/j.amsu.2021.102955] [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] [Received: 09/07/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance: Shone complex is a congenital heart defect consisting of four obstructive defects in the left heart: a mitral supravalvular ring, sub-aortic stenosis, parachute mitral valve, and coarctation of the aorta (CoA), which affects only a small minority of people. Case presentation We report the case of a 25-year-old woman with a past medical history of moderate mitral stenosis, since she was 10-year-old with uncontrolled high blood pressure, treated with nicardipine. admitted to our emergency department with high blood pressure: 190/80 mmhg, in whom The transthoracic echocardiography (TTE) revealed: sub-mitral membrane, with a single sub-papillary muscle, and coarctation of the aorta and the CT scan showed narrowed aortic arch and a left superior vena cava allowing to retain shone syndrome as the main diagnosis. The patient was treated with an antihypertensive treatment combining (perindopril/indapamide/amlodipine) while waiting for surgery. Clinical discussion In this mini-review, we aim to describe this rare pathological condition its pathophysiological thoughts, and the way to diagnosis this complex early. Conclusion Treatment required the coordinated efforts of a team of specialists. It could be either surgical with different method or by Trans catheter treatments.
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Affiliation(s)
- Soumia Boulouiz
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Corresponding author.
| | - Amine Kossir
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Fadoua Mouedder
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Chaimae Miri
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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15
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Hayes D, French B, Tan SL. Objective Improvement in Cognitive Function following Aortic Coarctation Repair in an Adult. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:33-34. [PMID: 34607382 PMCID: PMC8489994 DOI: 10.1055/s-0041-1724004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Coarctation of the aorta is a rare finding in adults and can present with vague symptoms. We report a case of a 64-year-old cognitively impaired female who presented with fatigue and tinnitus. After extensive workup, she was diagnosed with coarctation of the aorta and subsequently underwent repair. After operative intervention for her coarctation, her cognitive impairment was found to have an objective improvement evidenced by the Montreal Cognitive Assessment.
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Affiliation(s)
- Danielle Hayes
- Department of General Surgery, Swedish Medical Center, Seattle, Washington
| | - Bryce French
- Department of General Surgery, Swedish Medical Center, Seattle, Washington
| | - Swee Lian Tan
- Department of Vascular Surgery, Virginia Mason, Seattle, Washington
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16
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Marchese A, Tito A, Resta F, Tarantini G. Transcatheter Therapies in Challenging Aortic Ailments: TAVR in Extreme Horizontal Aortic Root With CoA Stenting. JACC Case Rep 2021; 3:905-909. [PMID: 34317652 PMCID: PMC8311283 DOI: 10.1016/j.jaccas.2021.04.006] [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: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/02/2021] [Indexed: 11/12/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis in older adults may be challenging because of additional aortic comorbidities such as aortic coarctation (CoA). We report successful snared-assisted transfemoral TAVR in a patient with an extremely horizontal ventriculoaortic axis that was worsened by a previous endovascular repair of complex CoA. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | - Antonio Tito
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
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17
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Greenberg JH, McArthur E, Thiessen-Philbrook H, Zappitelli M, Wald R, Kaushal S, Ng DK, Everett AD, Chanchlani R, Garg AX, Parikh CR. Long-term Risk of Hypertension After Surgical Repair of Congenital Heart Disease in Children. JAMA Netw Open 2021; 4:e215237. [PMID: 33830227 PMCID: PMC8033439 DOI: 10.1001/jamanetworkopen.2021.5237] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The long-term risk of hypertension in children after surgery for congenital heart disease (CHD) is unclear. OBJECTIVE To assess the incidence of hypertension after cardiac surgery in children with CHD. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective matched cohort study was conducted in Ontario, Canada, using administrative databases. A total of 3600 children with surgical repair of CHD were matched to 10 children (n = 36 000) from the general population without CHD on age, sex, index date, rurality, and neighborhood income. MAIN OUTCOMES AND MEASURES Diagnosis of hypertension over a median follow-up time of 9.8 years (interquartile range, 6.8-12.9 years) after surgery. The last follow-up was March 31, 2019. RESULTS Overall, in 3600 children with surgical repair of CHD, the median age at first surgery was 150 days (interquartile range, 40-252 days) and 2005 (55.7%) were boys. During follow-up, 445 (12.4%) children with surgical repair of CHD developed hypertension compared with 398 (1.1%) in the matched control group. The incidence rate of hypertension in children who received surgery for CHD was 141.3 (95% CI, 128.8-155.1) per 10 000 person-years compared with children in the matched control group, who had a rate of 11.1 (95% CI, 10.1-12.3) per 10 000 person-years. The risk of hypertension was higher in children with index surgical dates at an age of less 150 days compared with those who had surgical dates at an age of 150 days or older (P = .006 for interaction). The risk of hypertension was increased in children with more complex surgery, particularly children with hypoplastic left heart syndrome (49 of 140 [35.0%]), and in children who received dialysis (22 of 126 [17.5%]; hazard ratio, 1.67; 95% CI, 1.09-2.56) during the index cardiac surgery hospitalization. CONCLUSIONS AND RELEVANCE The incidence of long-term hypertension in this study was 12 times higher in children with surgical repair of CHD compared with children in the matched control group. The findings suggest that interventions aimed at reducing the long-term risk of hypertension after cardiac surgery in this population are needed.
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Affiliation(s)
- Jason H. Greenberg
- Division of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Michael Zappitelli
- Division of Pediatric Nephrology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ron Wald
- ICES, London, Ontario, Canada
- Division of Nephrology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sunjay Kaushal
- Department of Surgery, University of Maryland, Baltimore
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Allen D. Everett
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Amit X. Garg
- ICES, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Chirag R. Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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18
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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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19
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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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20
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What Is the Most Common Cause of Secondary Hypertension?: An Interdisciplinary Discussion. Curr Hypertens Rep 2020; 22:101. [PMID: 33119816 DOI: 10.1007/s11906-020-01106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Traditional statements in medical textbooks pointed that 90 to 95% of cases of hypertension is essential or primary. However, secondary hypertension seems to be common in those patients with resistant forms of hypertension. Appropriate investigation and treatment may have prognostic impact but frequently hypertension remission did not occur raising concerns about the real meaning of secondary hypertension. Here, we provided an interdisciplinary and critical discussion comprising an endocrinologist, a nephrologist, and a cardiologist with expertise in resistant hypertension. We reviewed the literature approaching each one of the recognizable cause of hypertension. RECENT FINDINGS Recent studies pointed that the most common causes of secondary hypertension are those who overall responses to their treatments do not promote hypertension remission including obstructive sleep apnea (OSA), chronic kidney disease, renovascular hypertension and primary aldosteronism. The authors raised concerns regarding the lack of inclusion of obesity by several societies as a formal cause of hypertension considering not only the biologic plausibility but also the huge impact of weight loss therapies such as bariatric surgery on hypertension remission. In contrast, there is no discussion that a very rare condition-namely pheochromocytoma-is the most "typical" cause of hypertension by promoting hypertension remission in the majority of patients after surgical procedure. Hypertension is a complex condition with multiple environmental and genetics interactions. In clinical practice, it is challenging to prove causality in hypertension. Common conditions largely acceptable as causes of hypertension (OSA, chronic kidney disease, renovascular hypertension, and primary aldosteronism) frequently occur in a setting of an established hypertension background and therefore do not promote hypertension remission in a significant proportion of patients. If obesity becomes largely accepted by several societies as a secondary form of hypertension, this pandemic condition will be certainly the most common cause of hypertension.
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21
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Mikami T, Kamada T, Uchiyama H, Kuroda Y, Harada R, Naraoka S, Kawaharada N. A rare case of pseudoaneurysm at the site of untreated coarctation of the aorta in an adult patient. Gen Thorac Cardiovasc Surg 2020; 69:740-743. [PMID: 33111217 PMCID: PMC7981309 DOI: 10.1007/s11748-020-01525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022]
Abstract
Here we report a rare case of pseudoaneurysm at the site of aortic coarctation. Aortic coarctation and a saccular aortic aneurysm protruding from the site of this coarctation were detected in a 50-year-old woman. Owing to the shape of the aneurysm and high risk of rupture, an open surgical repair was performed. The pathological findings of the removed aneurysm revealed a pseudoaneurysm consisting of only a thin adventitial wall. Adult uncorrected aortic coarctation has a poor prognosis. One of its causes may be the formation of such a pseudoaneurysm.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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22
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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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23
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Alkashkari W, Al-Husayni F, Alfouti M, Alsofyani R, Alfawaz S. Endovascular Treatment for Pseudoaneurysms After the Surgical Repair of Aortic Coarctation. Cureus 2020; 12:e8978. [PMID: 32775060 PMCID: PMC7402439 DOI: 10.7759/cureus.8978] [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] [Indexed: 01/11/2023] Open
Abstract
In this report, we describe the case of a 28-year-old male who presented to our hospital with shortness of breath and sudden, severe central chest pain that radiated across his chest and back. The patient had a history of coarctation of the aorta (CoA) repair using Dacron patch aortoplasty at the age of 10 years, and he had been lost to clinical follow-up. A chest X-ray (CXR) revealed the widening of the upper mediastinum. He underwent emergency CT angiography, which demonstrated extensive mediastinal hematoma and contrast leaking from a 4x12 cm complex pseudoaneurysm of the proximal thoracic descending aorta. After the heart-team meeting, the transcatheter approach was deemed more feasible and safer than a surgical approach. The patient was taken to cardiac catheterization laboratory and, under general anaesthesia, we successfully implanted a tapered (28 mm - 26 mm) x 150 mm Valiant Thoracic Stent Graft with the Captivia Delivery System (Medtronic Vascular, Santa Rosa, CA). In this case, we demonstrated the feasibility and safety of using a stent graft to treat late surgical complications after CoA repair, which are not uncommon.
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Affiliation(s)
- Wail Alkashkari
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Husayni
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Mawaddah Alfouti
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Rahaf Alsofyani
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Sarah Alfawaz
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
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Alkashkari W, Albugami S, Al-Husayni F, AlRahimi J, Althobaiti M. Percutaneous Intervention With Balloon-Expandable Covered Stent for the Treatment of Traumatic Aortic Pseudoaneurysm in a Paediatric Patient. Cureus 2020; 12:e8453. [PMID: 32523859 PMCID: PMC7274260 DOI: 10.7759/cureus.8453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this report, we describe the case of a 13-year-old male who presented to our hospital after sustaining injuries from a motor vehicle accident (MVA). A full-body CT scan revealed multiple injuries, including subgaleal hematoma, hemorrhagic brain contusion, moderate-size aortic pseudoaneurysm with associated mediastinal hematoma, and multiple stable visceral organ lacerations. Additionally, there were numerous fractures, including in the right femur associated with large hematoma. The patient was deemed at high risk for systemic anticoagulation required for an urgent operative aortic repair. Available percutaneous endograft sizes were deemed too large for his descending aortic diameter, and the associated potential risk of vessel injury from the large sheath required to implant the endograft removed this option from consideration. The decision was made to use a balloon-expandable covered stent, which is routinely used to treat coarctation of the aorta (CoA) as a life-saving alternative. A BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) measuring 16x38 mm was successfully implanted percutaneously with complete exclusion of the pseudoaneurysm without any procedural complications.
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Affiliation(s)
- Wail Alkashkari
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Saad Albugami
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Husayni
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Jamilah AlRahimi
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed Althobaiti
- Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Radiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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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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Alkashkari W, Al-Husayni F, Althobaiti M, Omeish A, Alqahtani SA. Transcatheter Intervention For Severe Aortic Coarctation in a Patient With Uninterrupted Left-Sided Inferior Vena Cava Presenting With Recurrent Abdominal Pain. Cureus 2020; 12:e8204. [PMID: 32455092 PMCID: PMC7243082 DOI: 10.7759/cureus.8204] [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] [Indexed: 11/05/2022] Open
Abstract
We describe a case of a 17-year-old male patient who was admitted to the hospital for an evaluation of his recurrent postprandial abdominal pain and fatigue on exertion. He was discovered to have severe post-ductal aortic coarctation (CoA) and uninterrupted left-sided inferior vena cava (IVC) draining into the right atrium crossing anterior to the abdominal aorta. There were no signs of IVC compression. Patient symptoms improved dramatically after CoA stenting on follow up. The presence of uninterrupted left-sided IVC in this particular case created a diagnostic dilemma, and it was of great importance to know such anomaly before the procedure. This association of uninterrupted left-sided IVC with CoA is unusual, and to our knowledge, our case is the first to report such congenital association.
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Affiliation(s)
- Wail Alkashkari
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Faisal Al-Husayni
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Mohammed Althobaiti
- Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Radiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Attafah Omeish
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Saad A Alqahtani
- Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
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Abstract
Secondary hypertension is associated with increased cardiovascular risk and exaggerated target organ damage, not only due to the higher and more sustained blood pressure values often observed in these patients but also because certain forms of hypertension can increase cardiovascular risk and organ damage by the neurohormonal and/or molecular pathways activation they exert. Early identification of secondary forms of hypertension can help mitigate organ damage and prevent cardiovascular complications. Signs and symptoms distinction among types of secondary hypertension is essential in order to prevent complications.
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Affiliation(s)
- Oscar H Cingolani
- Division of Cardiology, Hypertension Program, Johns Hopkins University Hospital, 601 North Caroline Street, Outpatient Center, 7th Floor, Suite 7263, Baltimore, MD 21287, USA.
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