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Margarint IM, Youssef T, Robu M, Rotaru I, Popescu A, Untaru O, Filip C, Stiru O, Iliescu VA, Vladareanu R. The Management of Aortic Coarctation Associated with Hypoplastic Arches and Particular Arch Anatomies: A Literature Review. J Pers Med 2024; 14:732. [PMID: 39063986 PMCID: PMC11277657 DOI: 10.3390/jpm14070732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
The surgical management of aortic coarctation in newborns needs to ensure postoperative evolution and long-term results as much as possible. Patients with a Gothic arch have a higher rate of postoperative hypertension, while newborns with a bovine arch have higher rates of restenosis and, thus, an additional risk of mortality. Late hypertension, even in anatomically successfully repaired patients, confers a high risk for cardiovascular events. This review of the literature focuses on the management of aortic coarctations associated with hypoplastic arch and particular arch anatomies, focusing on surgical techniques and their outcomes.
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Affiliation(s)
- Irina-Maria Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Tammam Youssef
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Iulian Rotaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Alexandru Popescu
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Olguta Untaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Cristina Filip
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Radu Vladareanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
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Cherpak BV, Yaschuk NS, Yermolovych YV, Golovenko OS, Panichkin YV. The Choice of Optimally Necessary Devices for Endovascular Treatment of Coarctation of the Aorta. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/cy062-6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim. To determine the optimally necessary devices for endovascular stenting of coarctation of the aorta (CoA), considering the anatomical features of the defect and the age of the patient.
Materials and methods. Examination and endovascular treatment of 189 patients aged 5 to 60 years with CoA of different anatomical and morphological variants was performed.
Results and discussion. We presented the clinical features of different anatomical andmorphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish dependence of the frequency of complications on the type of the stent used. There were no cases of in-hospital death. The effectiveness of the intervention was 99.4 %. All the patients were discharged from the hospital in good condition 3-7 days (3.3 ± 1.9 days) after the procedure. Currently, 95.7 % are being followed up. During the 5-year follow-up period, 1 patient died due to concomitant heart failure, heart rhythm disturbances (atrial fibrillation) and mitral insufficiency. There were 10.1 % patients (n = 19) with complications: 4.9 % (n = 4) with open-cell stents, 12.1 % (n = 13) with closed-cell stents, 2.2 % (n = 4) with stent-grafts, 7.9 % (n = 16) with uncovered stents. The frequency of reinterventions was 45.0 % in patients older than 25 years, 37.2 % in those aged 5-18 years and 17.6 % in those aged 19-25 years.
Conclusions. The choice of optimally necessary devices for endovascular stenting of the aorta is recommended to be carried out considering the anatomical features of the defect and the age of the patient.
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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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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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