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Apithanung L, Sethasathien S, Silvilairat S, Sittiwangkul R, Makonkawkeyoon K, Saengsin K, Woragidpoonpol S. Correlation between pressure gradient from echocardiography and peak-to-peak pressure gradient from cardiac catheterization or surgery in patients with coarctation of aorta. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03086-y. [PMID: 38558331 DOI: 10.1007/s10554-024-03086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
The gold standard for assessing pressure gradients (PG) across coarctation involves measurements obtained through cardiac catheterization or surgical intervention. There has been ongoing discussion regarding the accuracy of non-invasive methods for estimating these gradients. This study sought to establish the correlation and agreement between the systolic blood pressure (SBP) gradient between the upper and lower extremities, as well as, the mean and maximum PG derived from echocardiography, in comparison to the peak-to-peak pressure gradient obtained from either cardiac catheterization or surgery. We conducted a retrospective study on patients < 18 years diagnosed with coarctation at Chiang Mai University Hospital from 2011 to 2022. The study involved the measurement of the SBP gradient between the upper and lower extremities, mean and maximum PG using echocardiography, peak-to-peak pressure gradient obtained from cardiac catheterization, and pressure gradient recorded during surgical procedures. The Spearman's correlation and Bland-Altman analysis were employed to assess correlation and agreement. Fifty-four patients with aortic coarctation were enrolled. The mean PG measured by echocardiography showed a significantly moderate correlation (r = 0.78, p < 0.001) and the highest level of agreement according to Bland Altman plots, in comparison to the peak-to-peak pressure gradient measured during both cardiac catheterization and surgical procedure. The max PG demonstrated a notable overestimation compared to the gold standard (mean difference + 13.14 with a slope of biases + 0.64, p < 0.001). The mean PG obtained through echocardiography has more potential to be applied in practical application in predicting pressure gradient in patients with coarctation.
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Affiliation(s)
- Lalitpat Apithanung
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saviga Sethasathien
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rekwan Sittiwangkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krit Makonkawkeyoon
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kwannapas Saengsin
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surin Woragidpoonpol
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Gibb JJC, Kim WC, Barlatay FG, Tometzki A, Pateman A, Caputo M, Taliotis D. Medium-Term Outcomes of Stent Therapy for Aortic Coarctation in Children Under 30 kg with New Generation Low-Profile Stents: A Follow-Up Study of a Single Centre Experience. Pediatr Cardiol 2024; 45:544-551. [PMID: 38315219 PMCID: PMC10891239 DOI: 10.1007/s00246-023-03402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
We previously reported short-term outcomes for stenting of aortic coarctation (CoA) (native or re-coarctation) with newer generation low-profile stents (Valeo, Formula, and Begraft stents) in children under 30 kg. We present here the medium-term outcomes of this procedure. Retrospective review of patients weighing under 30 kg who had percutaneous stent treatments for coarctation between 2012 and 2021 was performed. Clinical and procedural data were collected; 19 patients were included. The median age at the time of procedure was 5.1 [4.1-6.4] years and median weight 21.0 [17.3-22.3] kg. One patient had a history of re-coarctation. Thirteen (68%) patients were on anti-hypertensives pre-procedure. Different types of stents were used (14 Valeo™, 4 Formula® 535, 1 BeGraft), which can all be dilated to 18 mm or larger. One patient required a 9 F sheath, all others required a 7 F sheath. The narrowest diameter in the aorta increased from a median of 3.5 [3.0-4.5] to 9.4 [8.9-9.8] mm, p < 0.001; there was a reduction in the median pressure gradient across the coarctation from 35.0 [30.0-43.0] to 5.0 [0-10.0] mmHg, p < 0.001. There were no intra-procedural complications. Follow-up was for a median of 56.0 [13.0-65.0] months. Five (26%) of patients underwent re-intervention after a median time frame of 40.0 [39.5-52.0] months; four had balloon dilation, one had repeat stent implantation. Five (26%) patients were on anti-hypertensive agent(s) post-intervention. Our single centre experience demonstrates that percutaneous stenting for coarctation of aorta in children under 30 kg, with low-profile stents, had no significant complications during the median follow-up time of 56 months. This study demonstrated that the procedure is safe and effective for short and medium-term therapy in this group of patients with a 26% re-intervention rate. A quarter of patients remained on anti-hypertensive medication post stenting, emphasizing the importance of long-term follow-up.
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Affiliation(s)
- Jack J C Gibb
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Wan Cheol Kim
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS, B3H 3A7, Canada
| | - Francisco Gonzalez Barlatay
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Andrew Tometzki
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Alan Pateman
- Noah's Ark Children's Hospital for Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Massimo Caputo
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Demetris Taliotis
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
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Atherton M, Levitan B, Ramachandran P. "Mind Your Arch"-An Unusual Cause of Systemic Hypertension in Pregnancy. CASE (Phila) 2024; 8:210-214. [PMID: 38524972 PMCID: PMC10954578 DOI: 10.1016/j.case.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•CoA must be considered in a young patient with severe uncontrolled hypertension. •Presentation may be delayed due to extensive collateral circulation. •Multimodality imaging is often necessary for preprocedural planning. •Despite treatment there is continued risk for long-term vascular disease.
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Affiliation(s)
- Mara Atherton
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Bryana Levitan
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Preeti Ramachandran
- Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky
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Kohli U, Perrotta ML, Aljemmali S, Sosnowski C, Cardenas YM, Sharma K. Dichorionic Diamniotic Twin Pairs with Complex Congenital Heart Disease. Pediatr Cardiol 2023:10.1007/s00246-023-03339-y. [PMID: 37964109 DOI: 10.1007/s00246-023-03339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Complex congenital heart disease (CHD) in each of dichorionic diamniotic (DiDi) twin pairs is extremely rare and has not been well characterized. Four DiDi twin pairs were included in this multi-institutional case series. The congenital cardiac abnormalities noted included tetralogy of Fallot (ToF) with pulmonary atresia and collaterals (n = 1), ToF with absent pulmonary valve (n = 1), ToF (n = 2), discontinuous right pulmonary artery (RPA) (n = 1), tricuspid atresia (TA) with normally related great arteries and pulmonary valve stenosis or atresia (n = 2) and coarctation of aorta (CoA) with bicuspid aortic valve (BAV) and borderline left-sided structures (n = 1). Genetic testing was obtained on seven of the eight twins but did not reveal any causal abnormality. A comprehensive review of literature yielded another 8 DiDi twin pairs with complex CHD. The CHD noted in these twin pairs included ToF (n = 2), CoA (n = 4), corrected transposition of great arteries (ccTGA) (n = 2), truncus arteriosus (n = 2), complete common atrioventricular canal (CCAVC) (n = 2), hypoplastic left heart syndrome (HLHS) (n = 2), Shone's complex (n = 1), and hypoplastic right heart syndrome (HRHS) (n = 1). Limited genetic testing was obtained on 4 of these twins and revealed trisomy 21 in a twin pair. Conotruncal abnormalities (42%), CoA (21%), and abnormalities of the right ventricle, the right ventricular outflow tract and pulmonary arteries (17%) are more prevalent in DiDi twins with complex CHD. Clustering of these abnormalities suggests a possible genetic basis; however, genetic testing was obtained on eleven of the twins, and except for trisomy 21 in a twin pair both of whom had CCAVC, did not reveal any causal abnormality. A major direct genetic contribution is therefore unlikely and like other CHD, the underlying etiopathological basis is likely multifactorial.
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Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, 64 Medical Center Drive, Robert C. Byrd Health Sciences Center, PO Box 9214, Morgantown, WV, 26506, USA.
| | - Melissa L Perrotta
- Department of Pediatrics, Division of Pediatric Cardiology, University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY, 40202, USA
| | - Saif Aljemmali
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Cyndi Sosnowski
- Department of Pediatrics, Section of Pediatric Cardiology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yvonne M Cardenas
- Department of Pediatrics, Division of Pediatric Cardiology, West Virginia University Children's Hospital and West Virginia University School of Medicine, 64 Medical Center Drive, Robert C. Byrd Health Sciences Center, PO Box 9214, Morgantown, WV, 26506, USA
| | - Kavita Sharma
- Department of Pediatrics, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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Kong X, Zhao L, Pan Z, Li H, Wei G, Wang Q. Acute renal injury after aortic arch reconstruction with cardiopulmonary bypass for children: prediction models by machine learning of a retrospective cohort study. Eur J Med Res 2023; 28:499. [PMID: 37941080 PMCID: PMC10631067 DOI: 10.1186/s40001-023-01455-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Acute renal injury (AKI) after aortic arch reconstruction with cardiopulmonary bypass leads to injury of multiple organs and increases perioperative mortality. The study was performed to explore risk factors for AKI. We aim to develop a prediction model that can be used to accurately predict AKI through machine learning (ML). METHODS A retrospective analysis was performed on 134 patients with aortic arch reconstruction with cardiopulmonary bypass who were treated at our hospital from January 2002 to January 2022. Risk factors for AKI were compositive and were evaluated with comprehensive analyses. Six artificial intelligence (AI) models were used for machine learning to build prediction models and to screen out the best model to predict AKI. RESULTS Weight, eGFR, cyanosis, PDA, newborn birth and duration of renal ischemia were closely related to AKI. By integrating the results of the training cohort and validation cohort, we finally confirmed that the logistic regression model was the most stable model among all the models, and the logistic regression model showed good discrimination, calibration and clinical practicability. Based on 6 independent factors, the dynamic nomogram can be used as a predictive tool for clinical application. CONCLUSIONS DHCA could be considered in aortic arch reconstruction if additional perfusion of lower body were not performed especially when renal ischemia is greater than 30 min. Machine Learning models should be developed for early recognition of AKI. TRIAL REGISTRATION ChiCTR, ChiCTR2200060552. Registered 4 june 2022.
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Affiliation(s)
- Xiangpan Kong
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Lu Zhao
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Guanghui Wei
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Quan Wang
- Department of Cardiothoracic Surgery Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China.
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Hui C, Ren Q, Zhuang J, Chen J, Li X, Cui H, Cen J, Xu G, Wen S. Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad186. [PMID: 37991842 PMCID: PMC10681811 DOI: 10.1093/icvts/ivad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction. METHODS A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with cardiac computed tomographic angiography. Bedside flexible fibre-optic bronchoscopy was routinely performed after surgery in intensive care unit. RESULTS There were 104 consecutive patients (median age 39.5 days) who underwent extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation. Early mortality was 3.8% and overall survival was 94.1% [95% confidence interval (CI) 89.6-98.8%] at 1, 3 and 5 years. Reobstruction-free survival was 85.1% (95% CI 78.4-92.3%) at 1 year, 80.6% (95% CI 73.1-88.9%) at 3 years and 77.4% (95% CI 69.2-86.6%) at 5 years. Preoperative aortic arch geometric parameters were not important factors for reobstruction. Nineteen patients (18.3%) were detected with left main bronchus compression (LMBC) on flexible fibre-optic bronchoscopy. Cardiopulmonary bypass time [P < 0.001, hazard ratio (95% CI): 1.02 (1.01-1.03)] and postoperative LMBC [P = 0.034, hazard ratio (95% CI): 2.99 (1.09-8.23)] were independent predictive factors on multivariable Cox regression analysis of reobstruction-free survival. CONCLUSIONS Aortic arch can be satisfactorily repaired by extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation via median sternotomy in CoA/HAA. Cardiopulmonary bypass time and postoperative LMBC detected by flexible fibre-optic bronchoscopy are significant predictors for long-term arch reobstruction.
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Affiliation(s)
- Chengyi Hui
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiushi Ren
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiac Surgery, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiac Surgery, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiaohua Li
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Hujun Cui
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Gang Xu
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Stephens EH, Andi K, Abozied O, Connolly HM. Left ventricular adaptation to aortic regurgitation in adults with repaired coarctation of aorta. Int J Cardiol 2023:S0167-5273(23)00650-2. [PMID: 37149005 DOI: 10.1016/j.ijcard.2023.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/05/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e') and onset of symptoms before aortic valve replacement, and LV reverse remodeling (%-change in LVMI, LVEF and E/e') after aortic valve replacement in patients with versus without repaired COA presenting with AR. METHODS Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group). RESULTS Although both groups (AR-COA n = 52, and control n = 104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124 ± 28 versus 102 ± 25 g/m2, p < 0.001) and E/e' (12.3 ± 2.3 versus 9.5 ± 2.1, p = 0.02) but similar LVEF (63 ± 9% versus 67 ± 10%, p = 0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49-2.37, p < 0.001), older age, E/e', and LV hypertrophy were associated with onset of symptoms. Of 89 patients (AR-COA n = 41, and control n = 48) with echocardiographic data at 1-year post- aortic valve replacement, the AR-COA group had less regression of LVMI (-8% [95%CI -5 to -11] versus -17% [95%CI -15 to -21], p < 0.001) and E/e' (-5% [95% CI -3 to -7] versus -16% [95% CI -13 to -19], p < 0.001). CONCLUSIONS Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.
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Affiliation(s)
- Alexander C Egbe
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America.
| | - William R Miranda
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Jason H Anderson
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Patricia A Pellikka
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Elizabeth H Stephens
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Kartik Andi
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Omar Abozied
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
| | - Heidi M Connolly
- Cardiovascular Medicine, and Department of Cardiovascular Surgery, Mayo Clinic Rochester, MN 55905, United States of America
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Lemos M, Rato J, da Mata MF, Sequeira M, Mendes SC, Anjos R. Diastolic Function and Left Atrial Strain in Young Patients with History of Aortic Coarctation Repair. Pediatr Cardiol 2023; 44:674-680. [PMID: 36028777 DOI: 10.1007/s00246-022-02992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Aortic coarctation (AoCo) leads to long-term sequelae that may impair heart function. Data regarding new echocardiographic function parameters such as atrial strain, in affected patients, are scarce. This study aims to describe these parameters in AoCo patients and define their association with severity measures. 53 AoCo patients and 31 healthy controls, aged 12-40 years, were evaluated. Effectively corrected AoCo (cAoCo) was defined as aortic trans-isthmic corrected Doppler gradient (Dgrad) ≤ 20 mmHg (n = 36), and recoarctation (rAoCo) as Dgrad > 20 mmHg (n = 17). Dependent variables were: E/E'; atrial reservoir strain (Ares); and atrial conduit strain (Acd). T-tests/Mann-Whitney U tests were used to compare these among groups. Multivariable regression was used to test correlation with systolic blood pressure (SBP), indexed LV mass (ILVM), Dgrad, and the ratio between the narrowest diameter of aortic arch and aorta at diaphragm level (Aoratio). In cAoCo and rAoCo patients, E/E' was higher (p < 0.001), Ares, and Acd were lower (p < 0.001 for both) comparing with controls. Acd was higher in cAoCo than rAoCo (p = 0.045). Higher Ares was associated with higher Aoratio (p = 0.002), and lower Acd with higher Dgrad (0.014). EF and GLS were not different among groups. Young patients with effectively corrected aortic coarctation have persistent changes in diastolic function parameters (E/E' and atrial strain), and these are affected by anatomical sequelae. These patients' physiology is closer to patients with recoarctation, than to healthy individuals. This provides rationale for a stronger prevention, and treatment, of arterial dysfunction and high left ventricular afterload in these patients.
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Affiliation(s)
- Mariana Lemos
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - João Rato
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal.
| | - Miguel Fogaça da Mata
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Mafalda Sequeira
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Susana Cordeiro Mendes
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
| | - Rui Anjos
- Pediatric Cardiology Department, Hospital Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Portugal
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Egbe AC, Abozied O, Miranda WR, Connolly HM, Deshmukh AJ. Relationship between left atrial myopathy and atrial fibrillation in adults with coarctation of aorta. Am Heart J Plus 2023; 27:100284. [PMID: 38511091 PMCID: PMC10945908 DOI: 10.1016/j.ahjo.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/22/2024]
Abstract
Background Although patients with coarctation of aorta (COA) have clinical risk factors for atrial fibrillation (AF), there are limited data about AF prevalence, and role of left atrial (LA) indices for risk stratification in this population. We hypothesized that LA indices (LA reservoir strain and LA volume index) were associated with AF, and would identify patients at risk for AF progression. Methods We analyzed electrocardiograms/Holters, and echocardiograms of adult COA patients at Mayo Clinic (2000-2018). Results Of 776 patients, 726(94 %), 46(5.9 %) and 4(0.5 %) had no history of AF, paroxysmal AF, and persistent AF respectively; yielding AF prevalence of 6.4 %. LA reservoir strain (AUC 0.782 [0.751-0.808]) had more robust association with AF as compared to LA volume index (AUC difference -0.115, p < 0.001).Among 726 patients without prior AF, 25(3.4 %) had new-onset AF during follow-up. LA reservoir strain <25 % and LA volume index >34 ml/m2 were independent predictors of new-onset AF (HR 1.81 [1.15-3.85], and HR 1.41 [1.03-4.78], respectively). Of 46 patients with paroxysmal AF, 22(48 %) had recurrent AF, and LA reservoir strain <25 % was an independent predictor of recurrent AF (HR 1.94 [1.41-4.17]). LV pressure overload and stiffness indices were associated with progressive LA dysfunction and new-onset AF. Conclusions Collectively, these data suggest that LA strain can potentially be used for AF risk stratification. Further studies are required to determine whether LA strain can proactively identify patients that will respond favorably to different antiarrhythmic therapies, and whether interventions to reduce LV pressure overload will improve LA function and reduce AF progression.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Abhishek J. Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
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10
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Sagar P, Puthiyedath T, Sivakumar K. First-in-man use of an Indian-made balloon-expandable covered Zephyr stent and intermediate-term follow-up. Ann Pediatr Cardiol 2023; 16:48-51. [PMID: 37287848 PMCID: PMC10243650 DOI: 10.4103/apc.apc_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 06/09/2023] Open
Abstract
Covered stent is used in large-vessel angioplasty in anticipation of vessel wall injury. Apart from aortic coarctation, they are also used in dysfunctional right ventricular outflow conduits and find a recent role in transcatheter sinus venosus defect closure. Different methods of covering stents include glue fixation, sutureless lamination, sandwich, and sintering lamination. Covered Zephyr (Sahajanand laser technology limited, Gandhinagar, India) is a new Indian-made expanded polytetrafluoroethylene-covered balloon expandable cobalt-chromium stent. Its unique C and S links prevent foreshortening. We report the first-in-man use of this new stent in severe discrete postsubclavian coarctation of aorta and its short-term follow-up imaging.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Thejaswi Puthiyedath
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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11
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Kim DH, Choi ES, Kwon BS, Yun TJ, Yang DH, Park CS. The Usefulness of Computed Tomography in Predicting Left Ventricular Outflow Tract Obstruction After Neonatal Arch Repair. Semin Thorac Cardiovasc Surg 2023; 35:127-137. [PMID: 35278666 DOI: 10.1053/j.semtcvs.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022]
Abstract
This study investigated the outcome after neonatal arch repair, and the usefulness of computed tomography (CT) in predicting the development of left ventricular outflow tract (LVOT) obstruction (LVOTO). A total of 150 neonates who underwent arch repair between 2008 and 2019 were included. The diameters of the aortic valve annulus (AVA) and LVOT in millimeters were measured with transthoracic echocardiography (TTE) or CT and indexed by subtracting body weight in kilograms. The outcomes of interest were the development of LVOTO (peak flow velocity > 3 m/s on TTE) and reintervention or reoperation for LVOTO. The median follow-up duration was 3.6 years. The rates of overall survival, freedom from reintervention for LVOTO, and freedom from the LVOTO development at 7 years were 93.7%, 88.2%, and 81.0%, respectively. In univariable Cox regression analysis, weight-indexed CT-measured LVOT diameter (concordance index [C-index] = 0.73, P = 0.002) and weight-indexed TTE-measured AVA diameter (C-index = 0.69, P = 0.001) were significant predictors of LVOTO. The maximal chi-square test identified the following cutoff values for predicting LVOTO: 1.4 for weight-indexed CT-measured LVOT diameter and 1.6 for weight-indexed TTE-measured AVA diameter. The high-risk group (both measures lower than the cutoff values) had a significantly lower rate of freedom from LVOTO development than the low-risk group (both measures higher than the cutoff values) (P < 0.001). The weight-indexed CT-measured LVOT diameter could be used to predict LVOTO development after neonatal arch repair, as an independent measure or complementary to traditional measures.
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Affiliation(s)
- Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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12
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Homsi M, El Khoury M, Hmedeh C, Arabi M, El Rassi I, Bulbul Z, Sawaya F, Bitar F, Haddad F. Endovascular Stent Repair of Aortic Coarctation in a Developing Country: A Single-Center Experience. Cardiovasc Revasc Med 2022; 39:66-72. [PMID: 34916158 DOI: 10.1016/j.carrev.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/10/2021] [Accepted: 10/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks. MATERIALS/METHODS A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done. RESULTS 18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p < 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications. CONCLUSIONS Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.
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Affiliation(s)
- Mouafak Homsi
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Maya El Khoury
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Caroline Hmedeh
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon
| | - Mariam Arabi
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Issam El Rassi
- American University of Beirut Medical Center, Department of surgery, Children Heart Center, Lebanon
| | - Ziad Bulbul
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fadi Sawaya
- American University of Beirut Medical Center, Department of Medicine, Lebanon
| | - Fadi Bitar
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Children Heart Center, Lebanon
| | - Fady Haddad
- American University of Beirut Medical Center, Department of Vascular Surgery, Lebanon.
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Zhou N, Lluri G. Coronary Artery Dominance and Cardiovascular Pathologies in Patients with Bicuspid Aortic Valve. Am J Med Sci 2022; 363:147-150. [PMID: 34260957 DOI: 10.1016/j.amjms.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/17/2021] [Accepted: 06/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is the most common congenital heart defect and is associated with a number of cardiac pathologies including coarctation of the aorta (CoA), aortic dilation, aortic stenosis, and premature coronary artery disease (CAD). Furthermore, BAV has been associated with left dominant coronary artery anatomy but there is still much debate regarding this association. To date, no study has investigated the association between coronary artery dominance and cardiac pathologies in patients with BAV. METHODS A total of 45 patients with BAV who underwent coronary computed tomography angiography (CTA) and/or cardiac catheterization at a single center were included. Coronary artery dominance, presence of CAD, CoA, and aortic dilation was determined from coronary CTA and/or cardiac catheterization reports. Incidence of aortic valve stenosis and aortic valve regurgitation was determined from echo reports. RESULTS Of the 45 patients with BAV, 80% (36) had right dominant coronary artery circulations. Patients with BAV with left dominant circulations had a significantly (p = 0.04) higher incidence of CoA compared to patients with right dominant circulations (44% vs. 14%). There was no significant difference when comparing the incidences of aortic dilation, aortic valve stenosis, aortic valve regurgitation and CAD in right and left dominant patients. CONCLUSIONS Our study found a predominance of right dominant coronary artery circulation in patients with BAV, similar to the general population. Interestingly, left dominance was significantly associated with CoA in patients with BAV. This observation highlights the importance of further studies regarding how coronary artery dominance can be associated with other cardiovascular pathologies in patients with BAV.
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Affiliation(s)
- Nanruoyi Zhou
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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14
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Akam-Venkata J, Ikemba CM, Martinez J, Pruszynski J, Heistein L, Pirolli TJ, Forbess JM. Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta. Pediatr Cardiol 2022; 43:1645-1652. [PMID: 35637360 PMCID: PMC9150633 DOI: 10.1007/s00246-022-02895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/24/2022] [Indexed: 01/28/2023]
Abstract
Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the optimal approach remains controversial. Eighteen CoA-AVSD patients who underwent single-stage repair 2005-2015 by a single surgeon were retrospectively analyzed. Fifteen patients had complete and three had partial AVSD. Birth weight was 3.19 kg (2.17-4.08). Age at surgery was 16 days (6-127). One- and ten-year survival were 80% and 69%. Freedom from reintervention was 60% and 40% at one and ten-year respectively. Reinterventions included relief of left ventricular outflow tract obstruction (LVOTO) (n = 4), repair of cleft LAVV (n = 3), and LAVV and aortic valve replacement (n = 1). Freedom from LAVV reintervention was 85.6% and 66% at 1 and 10 years respectively. There were four deaths: two post-operative and two following hospital discharge. Mortality was due to sepsis in three patients, and heart failure related to LVOTO and LAVV insufficiency in one. At 68-month (0.6-144) follow-up the majority had mild or less LAVV regurgitation, and all had normal LV dimension and systolic function. There was no recurrent arch obstruction. Single-stage surgical repair of CoA-AVSD is feasible and reasonable. Survival and freedom from reintervention in our cohort approximate those outcomes of two-stage repair with durable left AV valve function and no recurrent arch obstruction. These patients are frequently syndromic and demonstrate mortality risk from non-cardiac causes. Consideration of a single-staged approach is warranted for appropriate patients with CoA-AVSD.
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Affiliation(s)
- Jyothsna Akam-Venkata
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS, 39216, USA.
| | - Catherine M. Ikemba
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Joseph Martinez
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Jessica Pruszynski
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Lisa Heistein
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Timothy J. Pirolli
- Department of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Joseph M. Forbess
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
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15
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Khajali Z, Seilani P, Pouraliakbar H, Parsaee M, Akbari Parsa N. A case of Takayasu arteritis mimicking aortic coarctation. J Cardiol Cases 2021; 24:237-239. [PMID: 34868405 DOI: 10.1016/j.jccase.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022] Open
Abstract
A 23-year-old woman with history of tetralogy of Fallot presented with new hypertension and constitutional symptoms first diagnosed as coartation of aorta based on primary imaging but that turned out to be Takayasu arteritis after more evaluation by laboratory data and complementary imaging modalities . <Learning objective: Inflammatory vasculitis involving large vessels such as Takayasu arteritis might mimic congenital structural heart diseases like aortic coarctation in rare cases due to post inflammatory strictures in thoracic aorta and aortic arch main branches. This report demonstrates the importance of history taking, physical examination, and using different imaging modalities for the most accurate diagnosis.>.
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Affiliation(s)
- Zahra Khajali
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
| | - Parisa Seilani
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
| | | | - Mozhgan Parsaee
- Rajaee Cardiovascular Medical and Research Center, Tehran, Iran
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16
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Schoeneberg L, Prodhan P, Spray B, Akmyradov C, Zakaria D. Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta. Pediatr Cardiol 2021; 42:1567-1574. [PMID: 34052859 DOI: 10.1007/s00246-021-02641-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
Coarctation of the aorta is a relatively common congenital heart disease occurring in 0.4-0.6 per 1000 live births with a low mortality rate. This is a retrospective study, with data abstracted from the Pediatric Health Information System database (PHIS). The study sample included pediatric patients less than or equal to 3 months of age discharged from a PHIS participating hospital between January 1, 2004 and December 31, 2018 who underwent surgical repair of isolated COA. The primary outcome for the study was post-operative hospital length of stay (PH-LOS), and the secondary outcome was in-hospital mortality. Patient demographics, comorbidities, procedures, and outcomes were assessed for statistical differences between eras. A total of 5354 patients were included in the study. The study highlights an increasing trend in PH-LOS and NICU hospital length of stay (NICU-LOS) across the investigated eras. Prematurity (before 37 weeks gestation) was an independent risk factor associated with both longer post-operative length of the stay and higher mortality. In addition, congenital anomalies, respiratory and abdominal surgeries have a significant impact on the post-operative hospital stay. In conclusion, this study is the largest published systematic assessment of PH-LOS in patients with isolated COA repair during infancy to date and identifies independent risk factors of increased PH-LOS.
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Affiliation(s)
- Laura Schoeneberg
- Department of Pediatrics (Cardiology and Pediatric Intensive Care), University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-1, Little Rock, AR, 72202, USA
| | - Parthak Prodhan
- Department of Pediatrics (Cardiology and Pediatric Intensive Care), University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-1, Little Rock, AR, 72202, USA
| | - Beverly Spray
- Arkansas Children's Research Institute (Biostatistics), Little Rock, USA
| | - Chary Akmyradov
- Arkansas Children's Research Institute (Biostatistics), Little Rock, USA
| | - Dala Zakaria
- Department of Pediatrics (Cardiology and Pediatric Intensive Care), University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-1, Little Rock, AR, 72202, USA.
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Choudhary P, Strugnell W, Puranik R, Hamilton-Craig C, Kutty S, Celermajer DS. LV non-compaction in patients with coarctation of the aorta: prevalence and effects on cardiac function. Cardiol Young 2021; 31:1445-50. [PMID: 33632344 DOI: 10.1017/S104795112100038X] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left ventricular non-compaction has been associated with heart failure, arrhythmia, thromboembolism and sudden death. The prevalence of non-compaction in patients with coarctation of the aorta and its clinical significance remains unknown, although obstructive left heart disease is common in patients with non-compaction. We sought to evaluate the prevalence of left ventricular non-compaction in patients with repaired aortic coarctation as well as its effect on left ventricular size and systolic function. METHODS AND RESULTS In total, 268 patients (Mean age 26 (inter-quartile range 21-37) years, 63% male) undergoing cardiac magnetic resonance imaging for clinical follow-up were included from three tertiary centres for adult congenital heart disease. Clinical data was obtained from medical records and correlated with ventricular volumes and function. Left ventricular non-compaction was defined as a diastolic non-compacted:compacted dimension ratio >2.3 in the worst affected segment on a long-axis view. Left ventricular non-compaction was present in 8.2% of patients with repaired coarctation. Left ventricular end-diastolic volumes and stroke volumes were significantly higher in patients with non-compaction compared to those without. There were no significant differences in ventricular mass or ejection fraction in these two groups. CONCLUSIONS Left ventricular non-compaction is relatively common in patients with repaired coarctation of the aorta and correlates with increased left ventricular end-diastolic volumes.
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18
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Gorito V, Baptista C, Santos P, Costa AM, Carvalho J. Coarctation of Aorta in Turner Mosaicism. Int J Pediatr Adolesc Med 2021; 8:268-270. [PMID: 34401454 PMCID: PMC8356104 DOI: 10.1016/j.ijpam.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/08/2020] [Accepted: 03/16/2020] [Indexed: 10/31/2022]
Abstract
The prevalence of hypertension in the pediatric age range is estimated at 1-5% worldwide, with higher rates in adolescence. Although primary hypertension is more common, due to the increasing prevalence of obesity and metabolic syndrome among adolescents, secondary hypertension should be always considered and excluded. We present the case of an adolescent with secondary hypertension and a challenging diagnosis associated with coarctation of aorta and Turner Mosaicism.
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Affiliation(s)
- Vanessa Gorito
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Paulo Santos
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
| | | | - Joana Carvalho
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal
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Vallabhajosyula S, Vallabhajosyula S, Yang LT, Rabinstein AA, Enriquez-Sarano M, Michelena HI. Frequency of intracranial aneurysms and sub-arachnoid hemorrhage is significantly lesser in bicuspid aortic valve than aortic coarctation. Int J Cardiol 2021; 330:229-231. [PMID: 33516839 DOI: 10.1016/j.ijcard.2021.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bicuspid aortic valve(BAV) is common. Some studies suggest that all BAV patients require screening for intracranial aneurysm(IA) in order to prevent sub-arachnoid hemorrhage(SAH). Aortic coarctation(CoA) carries high-risk of both IA and SAH. Using a nationally-representative population, we assessed the frequency of IA and SAH in admissions with BAV-without-CoA versus admissions with CoA(with or without BAV). METHODS Between 2000 and 2016, adult admissions with a primary/secondary diagnosis of BAV and/or CoA were identified using the National Inpatient Sample. Admissions with traumatic SAH and inter-hospital transfers were excluded. Outcomes were frequency of IA and SAH, and in-hospital mortality in BAV-without-CoA versus CoA. RESULTS In this 17-year period, 254,675 admissions met inclusion criteria and 236,930(93.0%) had BAV-without-CoA. BAV-with-CoA was present in 2846(1.1%) and isolated-CoA in 14,899(5.9%), for a total of 17,745(7%) with CoA. IA was noted in 405 admissions(0.2%) overall, BAV-without-CoA versus CoA having 293(0.1%) versus 112(0.6%), p < 0.001. SAH was noted in 910 admissions(0.4%) overall, with BAV-without-CoA versus CoA having 760(0.3%) versus 150(0.9%), p < 0.001. CONCLUSIONS In this study, BAV-without-CoA admissions had 0.1%(6-times lower than CoA) and 0.3%(3-times lower that CoA) IA and SAH, respectively, which is comparable to the general population. This suggests that BAV-without-CoA patients likely do not require routine surveillance for IA.
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Affiliation(s)
| | | | - Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Diwakar A, Chalam KS, Hiremath CS, Dash PK. Pulsatile flow in descending aorta: Can coarctation of aorta be ruled out by transesophageal echocardiography? Ann Card Anaesth 2021; 24:253-255. [PMID: 33884989 PMCID: PMC8253035 DOI: 10.4103/aca.aca_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 5-year-old child with L posed great arteries, large subpulmonic ventricular septal defect (VSD), atrial septal defect (ASD), and a large patent ductus arteriosus (PDA) with mild isthmic narrowing was scheduled for surgical correction. Intraoperatively, it was a case of anatomically corrected malposition of great arteries. Due to abnormal positioning of great vessels, the isthmus was ligated instead of the large PDA. The postoperative transesophageal echocardiography showed pulsatile flow in descending aorta as it was being filled by large PDA, and thus iatrogenic coarctation (CoA) was missed. It was detected in the intensive care unit due to the onset of acidosis on blood gas analysis and the presence of gradient between radial and femoral arterial line pressures. The patient was taken for redo surgery, the PDA was then ligated, resection of the isthmic narrowing and repair by end-to-end anastomosis was done.
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Affiliation(s)
- Anitha Diwakar
- Department of Anaesthesia, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Kolli S Chalam
- Department of Anaesthesia, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - C S Hiremath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - P K Dash
- Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Sagar P, Sivakumar K. A covered stent used in aortic coarctation migrates proximally during deployment causing transverse arch obstruction: Transcatheter repositioning after one month. J Cardiol Cases 2020; 24:23-26. [PMID: 34257756 DOI: 10.1016/j.jccase.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
Stent angioplasty with covered stents to avoid risk of aortic injury is the preferred mode of management of coarctation of aorta in adults and older children. Severe isthmic coarctation in an adult male with uncontrolled systemic hypertension was managed at another institution using a covered stent. A proximal stent migration during deployment resulted in obstruction of transverse aortic arch and left subclavian artery and was recognized one month after the procedure. This resulted in significant aortic gradients and left arm hypoperfusion. It was managed successfully by use of snares and additional overlapping stents, the first of this type in literature. Awareness of factors leading to stent migration and techniques involved in repositioning these stents may help cardiologists who deal with these interventions. <Learning objective: Distal stent migration is a known complication of coarctation stenting, often managed by expanding the stent in descending thoracic aorta where there are no major branches. However, proximal migration of covered stent leads to aortic arch obstruction including occlusion of arch branches. Techniques of delayed percutaneous repositioning of covered stent are described in this report.>.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
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22
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Bansal N, Forbes TJ, Aggarwal S. Saccular "Cauliflower" aneurysm of coarctation of aorta: a hybrid management. Cardiol Young 2020; 30:1360-2. [PMID: 32741395 DOI: 10.1017/S1047951120002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysm formation around the site of coarctation of aortic arch is a well-recognised complication of untreated coarctation and is associated with an increased risk of aortic rupture and mortality. We present a rare case in a teenage girl with the combination of significant aortic arch coarctation, a "cauliflower-like" saccular aneurysm, and stenosis at the origin of the left subclavian artery. She was successfully managed with a hybrid approach, which is a combination of an endovascular surgical repair (a bypass graft placement from left carotid artery to subclavian artery by a vascular surgeon) and a transcatheter covered stent placement across the stenosis and aneurysm. This case highlights the successful role of a hybrid approach in patient's who present with a combination of coarctation of the aorta and aortic arch aneurysms. This approach avoids the conventional surgical aortoplasty, which carries a higher mortality and morbidity risk in teenage patients.
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Ağbaş A, Gökalp S, Canpolat N, Çalışkan S, Öztunç F. Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls? Cardiol Young 2020; 30:1305-12. [PMID: 32693850 DOI: 10.1017/S104795112000205X] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cardiovascular morbidity is high in patients with coarctation of aorta even after successful repair. This study aimed to assess the frequency of late hypertension and the relationship between ambulatory hypertension and cardiovascular target organ damage in children and adolescents after early and successful repair of coarctation of the aorta. METHODS Twenty-five children and adolescents (mean age 13.5 ± 3.43 years) with repaired coarctation of the aorta (median age at repair 4 months, arm-leg gradient <20 mmHg) and 16 healthy controls were included. Office and ambulatory blood pressure, pulse wave velocity, and left ventricular mass index were assessed. RESULTS Both day- and night-time systolic blood pressure standard deviation score and left ventricular mass index were significantly higher in patients compared to controls (p ≤ 0.001 for all), whereas pulse wave velocity did not differ. The prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy were 40, 28, and 24%, respectively. Left ventricular mass index was higher in patients with sustained hypertension, masked hypertension, and normotension compared to controls (p < 0.05). In multivariate analysis, higher night-time systolic blood pressure standard deviation score was the only independent predictor of left ventricular mass index. CONCLUSION The present study reveals a high prevalence of masked hypertension, isolated nocturnal hypertension, and left ventricular hypertrophy in children and adolescents with coarctation of the aorta even after early and successful repair. Ambulatory blood pressure monitoring should be considered to diagnose hypertension. All coarctation of aorta patients should be followed up lifelong and encouraged to establish a healthy lifestyle starting from childhood.
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Sasikumar D, Sasidharan B, Rashid A, Ayyappan A, Goplakrishnan A, Krishnamoorthy KM, Sivasubramonian S. Early and late outcome of covered and non-covered stents in the treatment of coarctation of aorta- A single centre experience. Indian Heart J 2020; 72:278-282. [PMID: 32861383 PMCID: PMC7474103 DOI: 10.1016/j.ihj.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/24/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Stenting of coarctation of aorta with covered or uncovered stents is the accepted modality of treatment in older children and adults. The indications which mandate the use of covered stents are still unclear. We attempted to study the early and late outcomes after stenting of native and recurrent coarctation of aorta with uncovered and covered stents. Method This is a retrospective study of patients who underwent stenting for coarctation of aorta with covered or non-covered stents at our institute. Early and late outcome for both the groups were studied. Results Twenty patients underwent implantation of covered stent and twenty five patients had uncovered stent implantation. Patients in the covered stent group were older and had greater basal pressure gradient. More patients in the covered stent group had residual gradient >10 mm Hg after the procedure. There was no mortality or aortic wall injury in either group. Four patients in the covered stent group underwent planned re-intervention and two had unplanned re-intervention. None of the patients in the uncovered stent group had re-intervention. Higher incidence of late lumen loss was noted in the covered stent group. Conclusion Uncovered stents can be safely implanted with minimal risk of aortic wall injury in patients with low risk anatomic features. Covered stent implantation is associated with higher incidence of planned and unplanned re-intervention.
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Affiliation(s)
- Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Aamir Rashid
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Arun Goplakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kavasseri M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Egbe AC, Miranda WR, Connolly HM. Increased prevalence of left ventricular diastolic dysfunction in adults with repaired coarctation of aorta. Int J Cardiol Heart Vasc 2020; 28:100530. [PMID: 32462075 PMCID: PMC7240224 DOI: 10.1016/j.ijcha.2020.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/28/2023]
Abstract
Background Left ventricular (LV) pressure overload and coronary artery disease are common in patients with coarctation of aorta (COA), and they are risk factors for LV diastolic dysfunction. Patients with COA may have aortic vasculopathy that can result in LV pressure overload even in the absence of hemodynamically significant COA. We therefore hypothesized that patients with mild COA (without hemodynamically significant COA) will have more LV diastolic dysfunction compared to controls. Methods Adult patients with mild COA (Doppler peak velocity < 2.5 m/s) were matched 1:1 to patients without structural heart disease using propensity score method based on age, sex, body mass index, hypertension and blood pressure. The objective was to compare LV diastolic dysfunction (defined as E/e′ > 2 standard deviations above age-specific normative values) between adults with repaired COA and controls. Results Of 204 COA and 204 control patients (age 35 ± 12 years), patients with COA had higher septal and lateral E/e′ ratio (12 ± 4 vs 9 ± 4, p = 0.009) and (10 ± 3 vs 7 ± 3, p < 0.001), respectively. Compared to controls, the prevalence of LV diastolic dysfunction was higher in patients with COA for every age group: <40 years (63% vs 13%, p < 0.001); 41–60 years (87% vs 33%, p < 0.001); age > 60 years (82% vs 56%, p = 0.076). Left ventricular mass index (LVMI) was the strongest determinant of E/e′ (β = 2.71 per 10 g/m2, standard error = 1.25, p < 0.001). Conclusion LV diastolic dysfunction was common in patients with COA, and the association with LVMI suggests that patients with COA may have ongoing LV pressure overload in the absence of hemodynamically significant re-coarctation.
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Affiliation(s)
- Alexander C Egbe
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - William R Miranda
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Heidi M Connolly
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States
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26
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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: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Bhat V, Gadabanahalli K. Subpleural Lung Changes Adjacent to Enlarged Internal Mammary Artery in Patients with Coarctation of Aorta and Pulmonary Hypoplasia: Some Thoughts on an Interesting Observation. J Clin Imaging Sci 2020; 10:14. [PMID: 32257590 PMCID: PMC7110062 DOI: 10.25259/jcis_166_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/16/2020] [Indexed: 11/16/2022] Open
Abstract
Irregular pleural interface, minimally reduced lung density and/or focal subpleural cystic lung changes were noted in two patients with coarctation of aorta and in a patient with the right pulmonary hypoplasia. Lesions were distributed in the anterior segments of upper lobes, adjacent to internal mammary arteries (IMA). In view of unusual location of lung changes with unique distribution pattern prompted us to look for ‘cause and effect’ relation of events specific to long standing vascular pulsations, thus explaining the lung changes. While there are multiple factors for cystic lung disease, special distribution the lung changes seen in our patients leads us to explore mechanical process such as water hammer effect by dilated tortuous pulsatile IMA on the lungs as an additional etiology. A brief note on clinical and imaging appearance of our patients and discussion regarding water hammer theory are presented.
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28
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Róg B, Okólska M, Dziedzic-Oleksy H, Sałapa K, Rubiś P, Kopeć G, Podolec P, Tomkiewicz-Pająk L. Arterial stiffness in adult patients after coarctation of aorta repair and with bicuspid aortic valve. Acta Cardiol 2019; 74:517-524. [PMID: 30507296 DOI: 10.1080/00015385.2018.1530084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The coarctation of aorta is commonly related to bicuspid aortic valve. The aim of the study was to assess arterial stiffness in adults after aortic coarctation repair and to evaluate an impact of bicuspid aortic valve concomitance on arterial stiffness results.Methods: Fifty-eight patients after coarctation of aorta repair, 36 male, median age of 27.46 ± 10.57, were compared to 30 with bicuspid aortic valve and to 30 healthy, sex, age and BMI matched volunteers. Physical examination, laboratory analysis and non-invasive assessment of arterial stiffness were performed.Results: CoA patients and BAV patients have higher central arterial stiffness parameters in comparison to healthy controls: AP (7.86 ± 6.56 vs 7.68 ± 5.96 vs 1.41 ± 3.82 mmHg, p < 0.001, p = 0.011, respectively) and AIx (18.81 ± 14.94 vs 18.06 ± 13.38 vs 4.41 ± 10.82%, p < 0.001, p = 0.006, respectively). There were no differences of PWV between CoA patients, BAV patients and healthy controls (6.07 ± 1.20 vs 5.95 ± 1.20 vs 5.67 ± 0.73 m/s, p = 0.099, p = 0.278, respectively). In CoA group, there was correlation of PWV with age (r = 0.55 p < 0.001), BMI (r = 0.29, p = 0.025), fibrinogen (r = 0.31, p = 0.039), glucose (r = 0.58, p < 0.001), ascending aorta diameter (r = 0.29, p = 0.026) and age at operation (r = 0.27, p = 0.041). Among group of BAV, there was a correlation of PWV with age (r = 0.58, p < 0.001), central AP with total cholesterol (r = 0.38, p = 0.036) and fibrinogen (r = 0.41, p = 0.024).Conclusions: The increased arterial stiffness occurs in both groups: patients after aortic coarctation repair and patients with bicuspid aortic valve. Concomitance of coarctation of the aorta and bicuspid aortic valve has no influence on arterial stiffness augmentation.
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Affiliation(s)
- Beata Róg
- Department of Cardiovascular Diseases, Cardiological Outpatient Clinic, John Paul II Hospital, Krakow, Poland
| | - Magdalena Okólska
- Department of Cardiovascular Diseases, Cardiological Outpatient Clinic, John Paul II Hospital, Krakow, Poland
| | - Hanna Dziedzic-Oleksy
- Department of Cardiovascular Diseases, Cardiological Outpatient Clinic, John Paul II Hospital, Krakow, Poland
| | - Kinga Sałapa
- Department of Bioinformatics and Telemedicine, Jagiellonian University, Krakow, Poland
| | - Paweł Rubiś
- Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Kopeć
- Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Lidia Tomkiewicz-Pająk
- Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Ghaderian M, Sabri MR. Report of a Coarctation of Aorta Stenting in an Infant. Adv Biomed Res 2019; 8:10. [PMID: 30820431 PMCID: PMC6385562 DOI: 10.4103/abr.abr_232_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Coarctation of aorta (CoA) is a congenital heart disease that can lead to heart failure during infancy and neonatal period. Several treatments have been proposed for this disease, including surgery and balloon angioplasty. The experiences of using stents in small infants or neonatal patients are very low. In this article, we report a 3 months old age infant who after balloon angioplasty, his CoA symptoms had return and stenting of CoA was performed for him.
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Affiliation(s)
- Mehdi Ghaderian
- Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sabri
- Pediatric Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Varghese R, Sheth R, Kothandam S. Descending aortic translocation procedure for relief of bronchial compression in left aortic arch and right descending aorta. Ann Pediatr Cardiol 2018; 11:278-281. [PMID: 30271018 PMCID: PMC6146846 DOI: 10.4103/apc.apc_151_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Compression of the left bronchus by a right-sided descending aorta arising from a left aortic arch constitutes an exceedingly rare form of vascular ring. This manuscript describes the surgical technique that involves translocation of the descending aorta directly to the proximal ascending aorta, thereby relieving the bronchial compression.
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Affiliation(s)
- Roy Varghese
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Ronak Sheth
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Sivakumar Kothandam
- Department of Pediatric Cardiac Surgery and Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Shaik A, Praveen Kumar KV, Chiranjeevi P, Khader SA. Corkscrewing of retinal arterioles leading to diagnosis of coarctation of aorta. J Postgrad Med 2018; 64:253-254. [PMID: 30264739 PMCID: PMC6198698 DOI: 10.4103/jpgm.jpgm_137_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Coarctation of aorta (CoA) usually leads to elevation of blood pressure above the site of obstruction and this elevated blood pressure probably gets transferred and is reflected in the retinal arterioles producing certain signs of hypertensive retinopathy. Fundus examination helps in differentiating hypertension due to CoA from other causes of juvenile hypertension, as corkscrewing of retinal arterioles is seen only in CoA but not in other conditions. A 16 year hypertensive male who was on antihypertensive treatment presented for routine checkup. On examination his visual acuity was 6/6 in both eyes. Funduscopy of both eyes revealed a normal optic disc with generalised narrowing of arterioles and broadened light reflex. The arterioles showed corkscrew tortuosity (U shaped arterioles). Based on the fundus findings, CoA was suspected and the patient was referred for cardiac evaluation. Echocardiogram revealed post ductal CoA. In juvenile hypertension, careful examination of the fundus can provide a clue to the systemic diagnosis and this case highlights the importance of ophthalmoscopic examination in diagnosing a potentially fatal systemic disease.
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Affiliation(s)
- A Shaik
- Department of Ophthalmology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - K V Praveen Kumar
- Department of Ophthalmology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - P Chiranjeevi
- Department of Ophthalmology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - S Abdul Khader
- Department of Ophthalmology, Narayana Medical College, Nellore, Andhra Pradesh, India
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Fallatah R, Elasfar A, Amoudi O, Ajaz M, AlHarbi I, Abuelatta R. Endovascular repair of severe aortic coarctation, transcatheter aortic valve replacement for severe aortic stenosis, and percutaneous coronary intervention in an elderly patient with long term follow-up. J Saudi Heart Assoc 2018; 30:271-5. [PMID: 29989068 DOI: 10.1016/j.jsha.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/15/2018] [Accepted: 01/28/2018] [Indexed: 01/05/2023] Open
Abstract
To the best of our knowledge, there have not been any reports of total transcatheter approach including stenting of severe coarctation of the aorta (CoA), transcatheter aortic valve replacement (TAVR) for concomitant severe aortic valve stenosis, and percutaneous coronary intervention (PCI) to treat significant coronary artery disease in a single patient. We report a 70-year-old female, who presented with uncontrolled hypertension and acute decompensated heart failure (ADHF) and was found to have severe CoA, severe bicuspid aortic valve (BAV) stenosis, and significant proximal left anterior descending (LAD) coronary artery disease. In a multidisciplinary heart team meeting, we decided to perform an endovascular repair of both cardiac and vascular pathologies using a two-stage approach due to the significant comorbidities; mainly uncontrolled hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and severe calcifications of the ascending aorta. The procedures were successfully performed and the patient was asymptomatic 30 months later at follow-up and was without any significant gradients across the coarctation or the aortic valve.
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Al Qbandi M, Thinakar Vel M. Transcatheter therapy of partial anomalous pulmonary venous connection with dual drainage and coarctation of the aorta in a single patient. J Saudi Heart Assoc 2018; 30:311-315. [PMID: 30072840 PMCID: PMC6068332 DOI: 10.1016/j.jsha.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/21/2018] [Accepted: 06/02/2018] [Indexed: 12/01/2022] Open
Abstract
A 12-year-old boy was found to have aortic coarctation and a partial anomalous pulmonary venous connection. Historically, multiple cardiac pathologies, such as in the present case, required a surgical approach. We describe transcatheter treatment of the coarctation with a stent and occlusion of the partial anomalous pulmonary venous connection with an Amplatzer vascular plug in a single patient without complications.
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Affiliation(s)
- Mustafa Al Qbandi
- Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, KuwaitaKuwait
- Corresponding author at: Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, P.O. Box 4081, Safat 13041, Kuwait.
| | - Mariappa Thinakar Vel
- Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, KuwaitaKuwait
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Gendera K, Cleuziou J, Tanase D. Coarctation of the aorta-stenting via Glidesheath Slender in a newborn with recoarctation early after a Norwood operation. Cardiol Young 2018; 28:347-50. [PMID: 29081324 DOI: 10.1017/S1047951117001883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this article, we report on a newborn with hypoplastic left heart syndrome in whom recoarctation of the aorta was treated with a bare metal stent (Cook Formula 414 Stent) in the early postoperative period after a Norwood procedure. To reduce the risk for scarring and occluding the femoral artery the stent was implanted via 5F Glidesheath Slender sheath.
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35
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Delmo Walter EM, Javier MFDM, Hetzer R. Extra-anatomical bypass in complex and recurrent aortic coarctation and hypoplastic arch. Interact Cardiovasc Thorac Surg 2017; 25:400-406. [PMID: 28498910 DOI: 10.1093/icvts/ivx115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/15/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to report the selection schemes, technical variations and long-term outcome of extra-anatomical bypass to correct complex, recurrent aortic coarctation and hypoplastic aortic arch. METHODS Between 1989 and 2012, 53 patients (mean age 13.2 ± 4.3, median 11.6, range 9-23 years) with complex aortic coarctation (n = 33; long-segment hypoplastic aortic arch in 15), recurrent coarctation (n = 20; anastomosic pseudoaneurysm in 10), underwent correction using extra-anatomical bypass, either with (n = 18: femoral bypass = 13, left heart bypass = 5) or without (n = 35) extracorporeal circulation via a left lateral thoracotomy (n= 48) and combined median sternotomy and median laparotomy (n = 5). The decision to use extracorporeal circulation was based on the anatomical location of the coarctation, the length of the hypoplasia and a history of previous repair. Preoperatively, mean systolic blood pressure was 130 ± 30 mmHg at rest and 180 ± 40 mmHg during exercise, with a mean pressure gradient of 80 ± 11.6 (range 40-120) mmHg. RESULTS Various extra-anatomical bypass strategies included left subclavian artery to descending aorta (n = 38), ascending aorta to left subclavian artery (n = 3), ascending aorta to descending aorta (n = 4), aortic arch to descending aorta (n = 3) and ascending aorta to abdominal aorta (n = 5). Graft size (median 18, range 10-26, mm) was chosen according to the diameter of the vessel proximal and distal to the planned graft. No operative deaths, paraplegia or abdominal malperfusion occurred. The mean reduction in systolic blood pressure was 60 ± 25 mmHg without pressure gradients. During a mean follow-up of 18.3 ± 3.7 years, there were no reoperations, graft complications or pseudoaneurysm formation on anastomotic sites. Seven (11.6%) patients are on antihypertensive medications. No patient presented with claudication nor did anyone experience orthostatic problems from the steal phenomenon. CONCLUSIONS Extra-anatomical bypass is safe, an effective technique, and achieves satisfactory long-term results.
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Affiliation(s)
- Eva Maria Delmo Walter
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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Tomar GS, Goyal K, Chandran R, Luthra A, Chauhan V, Kumar N. Aneurysmal hemorrhage in a pregnant patient with coarctation of aorta: An anesthetic challenge. J Clin Anesth 2017; 37:176-8. [PMID: 28235521 DOI: 10.1016/j.jclinane.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022]
Abstract
A 25years old female patient with pregnancy of 16weeks (G2 P1), diagnosed to have distal anterior cerebral artery aneurysm (DACA) with Hunt & Hess grade I, subarachnoid hemorrhage (SAH) and coexisting atretic type of aortic coarctation posted for aneurysmal clipping under general anesthesia is a challenge to anesthesiologists in perioperative period. Hypertensive surges in a pregnant patient may result in rupture of aneurysms. Mortality in the mothers with CoA has been reported to be in the range of 0 to 9%. Anesthetic management of a pregnancy with CoA and SAH has never been reported.
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Abstract
We present a case of 13-year-old female with Turner syndrome (TS), who presented with unexplained lower limbs swelling and ejection systolic murmur at the left second intercostal space. Suspicion of mild aortic coarctation was made by echocardiography. Computed tomography angiography (CTA) showed a complete interruption of the aortic arch (IAA) below the left subclavian artery with persistent left superior vena cava (PLSVC) and absent right SVC, defined as an isolated PLSVC. The patient underwent successful surgical correction after unsuccessful trial of transcatheter stent placement. We present this case of asymptomatic IAA to draw attention to the importance of CTA in diagnosing such rare anomalies and ruling out asymptomatic major cardiovascular abnormalities in patient with TS.
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Affiliation(s)
- M Obadah Kattea
- Department of Cardiology, Prince Sultan Cardiac Centre, Al-Qassim, Buraydah, Saudi Arabia
| | - Osama A Smettei
- Department of Cardiology, Prince Sultan Cardiac Centre, Al-Qassim, Buraydah, Saudi Arabia; Department of Cardiac Imaging, Prince Sultan Cardiac Centre, Al-Qassim, Buraydah, Saudi Arabia
| | - Abdulrahman Kattea
- Department of Internal Medicine, Northwestern Air Force Hospital, Tabuk, Saudi Arabia
| | - Rami M Abazid
- Department of Cardiology, Prince Sultan Cardiac Centre, Al-Qassim, Buraydah, Saudi Arabia; Department of Cardiac Imaging, Prince Sultan Cardiac Centre, Al-Qassim, Buraydah, Saudi Arabia
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Sugimoto A, Ota N, Murata M, Sakamoto K. Pulmonary root translocation for borderline complex coarctation of aorta and multiple ventricular septal defects. Interact Cardiovasc Thorac Surg 2016; 24:129-131. [PMID: 27624356 DOI: 10.1093/icvts/ivw294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/14/2022] Open
Abstract
We describe a case of complex left ventricular outflow tract obstruction, multiple muscular ventricular septal defects, aortic coarctation and a hypoplastic aortic arch, where staged biventricular repair was performed successfully using pulmonary root translocation.
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Affiliation(s)
- Ai Sugimoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Noritaka Ota
- Department of Cardiovascular Surgery, Yokohama Kanagawa Children's Medical Center, Yokohama, Japan
| | - Masaya Murata
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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Bhat V, Belaval V, Gadabanahalli K, Raj V, Shah S. Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part II: Acyanotic Congenital Heart Disease and Extracardiac Abnormalities. J Clin Diagn Res 2016; 10:TE01-6. [PMID: 27504381 DOI: 10.7860/jcdr/2016/21442.8040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 04/02/2016] [Indexed: 11/24/2022]
Abstract
Acyanotic heart disease constitutes a significant majority of patient who may present with non-cardiac symptoms. Either they are detected incidentally or present with respiratory complaints. Equipped with knowledge of anatomy by echocardiography and radiographic methods described in previous part of this presentation, diagnosis may be confidently attempted. On plain radiography acyanotic congenital heart diseases have variable appearance depending upon severity of disease. Cardiac size, chamber enlargement and pulmonary vascular pattern are key elements. Typically left to right shunts with large volume flow are associated with pulmonary plethora. Plain radiography has an important role in detecting manifestation of pulmonary arterial hypertension. Severe stenosis of pulmonary valve is associated with pulmonary oligemia. Small intra-cardiac shunts and anomalies of coronary arteries generally present with normal cardiac size and pulmonary arterial pattern. Disease spectrum presented in this illustration demands thorough scrutiny of pulmonary, osseous and abdominal abnormalities. This section illustrates some commonly encountered spectrum of acyanotic cardiac disease.
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Affiliation(s)
- Venkatraman Bhat
- Director of Imaging Services, Head of Radiology, Department of Radiology and Imaging services, Narayana Health, Narayana Hrudayalaya, Multispeciality Hospital-Shaw Mazumdar Medical Centre , Bengaluru, India
| | - Vinay Belaval
- Junior Consultant, Department of Radiology and Imaging services, Narayana Health, Narayana Hrudayalaya, Multispeciality Hospital-Shaw Mazumdar Medical Centre , Bengaluru, India
| | - Karthik Gadabanahalli
- Consultant Radiology, Department of Radiology and Imaging services, Narayana Health, Narayana Hrudayalaya, Multispeciality Hospital-Shaw Mazumdar Medical Centre , Bengaluru, India
| | - Vimal Raj
- Consultant Radiology, Department of Radiology and Imaging services, Narayana Health, Narayana Hrudayalaya, Multispeciality Hospital-Shaw Mazumdar Medical Centre , Bengaluru, India
| | - Sejal Shah
- Senior Consultant Paediatric Cardiology, Department of Pediatric cardiology, Narayana Health, Narayana Hrudayalaya , Bengaluru, India
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Abstract
Shone's anomaly is a very rare congenital cardiac malformation characterized by four serial obstructive lesions of the left side of the heart (i) Supravalvular mitral membrane (ii) parachute mitral valve (iii) muscular or membranous subaortic stenosis and (iv) coarctation of aorta. We report a unique presentation of Shone's complex in a 14-year-old adolescent male. In addition to the four characteristic lesions the patient had bicuspid aortic valve, aneurysm of sinus of valsalva, patent ductus arteriosus, ventricular septal defect, persistent left superior vena cava opening into coronary sinus and severe pulmonary artery hypertension. This case report highlights the importance of a strong clinical suspicion of the coexistence of multiple congenital cardiac anomalies in Shone's complex and the significance of a careful comprehensive echocardiography.
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Affiliation(s)
- Neeraj K Ganju
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Arvind Kandoria
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Suresh Thakur
- Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sunite A Ganju
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Conservatively, ten million people in the USA alone may suffer from RH and may be similarly prevalent elsewhere. Given the strong linear correlation between hypertension and cardiovascular outcomes, better control is paramount. We favor a multi-pronged approach. It may not suffice to address this by pharmacologic means only. Careful attention to modifiable risk factors, particularly sodium intake, adhering to a proper diet (i.e. DASH), and avoiding agents, i.e. non-steroidals, that can elevate the blood pressure, is key. Frequent follow up to establish the right treatment regimen and home blood pressuring monitoring can have a strong impact on control. Finally, consideration of device therapy may be a more viable option in the future.
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Affiliation(s)
- Debbie Valsan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
| | - Umber Burhan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
| | - Geoffrey Teehan
- Lankenau Medical Center, Lancaster Avenue, Suite 130, Wynnewood, PA, USA, 19096
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43
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Hamid T, Jamallulail SI, Clarke B, Mahadevan VS. Dual Arterial Access for Stenting of Aortic Coarctation in Patients with Near-Total Descending Aortic Interruption. Cardiol Ther 2015; 4:203-7. [PMID: 26387128 PMCID: PMC4675754 DOI: 10.1007/s40119-015-0048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/29/2022] Open
Abstract
Endovascular stenting is a recognized treatment strategy for the treatment of coarctation of aorta (COA) in adults. The aortic coarctation is usually crossed retrogradely from the descending aorta via the femoral approach. We report three patients who had near-total descending aortic interruption and underwent successful stenting of severe COA using a combined radial/brachial and femoral approach due to difficulty in crossing the lesion retrogradely via a femoral approach. There were no procedural complications and no adverse events during 6 months of follow-up.
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Talwar S, Chandra D, Choudhary SK, Airan B. Repair of coarctation of aorta with preservation of blood supply to upper limb. Indian Heart J 2015; 67:368-70. [PMID: 26304571 DOI: 10.1016/j.ihj.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/10/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022] Open
Abstract
In this report, we present a modified technique of extended resection and end-to-end anastomosis of aorta for repair of coarctation of aorta. The advantages of this technique are a larger tension free anastomosis without compromising the blood supply into the left subclavian artery.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India; Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Dinesh Chandra
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Balram Airan
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi 110029, India
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45
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Galiñanes EL, Krajcer Z. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly. Aorta (Stamford) 2015; 3:136-9. [PMID: 27069944 DOI: 10.12945/j.aorta.2015.14.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 07/24/2015] [Indexed: 11/18/2022]
Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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46
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Abstract
A coronary cameral fistula (CCF) involves a sizable communication between a coronary artery and a cardiac chamber. We present a case of giant coronary cameral fistula associated with coarctation of aorta in a 13 days old neonate.
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Affiliation(s)
- Neeraj Awasthy
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Rajesh Sharma
- Department of Pediatric Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi, India
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47
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Seo DM, Park J, Goo HW, Kim YH, Ko JK, Jhang WK. Surgical modification for preventing a gothic arch after aortic arch repair without the use of foreign material. Interact Cardiovasc Thorac Surg 2015; 20:504-9. [PMID: 25583648 DOI: 10.1093/icvts/ivu442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Systemic hypertension is the main late complication after arch reconstruction in patients with arch obstruction. Gothic arch geometry is suspected to be one of its possible causes. Accordingly, we evaluated here if a modified arch repair technique using an autologous pulmonary patch is effective in preventing gothic arch development. METHODS Fifty infants who underwent arch repair with either a modified (n = 17) or conventional (n = 33) technique between January 2006 and August 2012 by a single surgeon were retrospectively reviewed. Arch geometry was compared using three categories (gothic, crenel or roman), classified by the height/width (H/W) ratio and the arch angle measured in computed tomography. RESULTS No gothic arch geometry was observed in the modified group, whereas it was observed in 9 cases in the conventional group (P = 0.005). Moreover, reintervention for arch restenosis was performed only in the conventional group (n = 4; P = 0.29). No associated complications were observed, although the selective cerebral perfusion time was longer in the modified group than in the conventional group (28.5 ± 6.2 vs 17.1 ± 9.9 min; P < 0.001). Otherwise, there were no significant differences in clinical variables between the groups. The mean follow-up duration was 55.3 ± 26.7 months. Significant systemic hypertension was not observed in our study cohort. CONCLUSIONS Our modified technique was proven to be not only highly effective in preventing gothic arch geometry, but also as equally safe in terms of early clinical outcomes as conventional arch reconstruction techniques.
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Affiliation(s)
- Dong-Man Seo
- Department of Cardiothoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jiyoung Park
- Department of Cardiothoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Woo Goo
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Young Hwue Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, Korea
| | - Jae-Kon Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan, College of Medicine, Seoul, Korea
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Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Henein MY. Left ventricular response to pressure afterload in children: aortic stenosis and coarctation: a systematic review of the current evidence. Int J Cardiol 2015; 178:203-9. [PMID: 25464254 DOI: 10.1016/j.ijcard.2014.10.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 02/05/2023]
Abstract
Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent two forms of pressure afterload that affect the left ventricle (LV), hence require regular echocardiographic monitoring. Subclinical dysfunction of the LV exists even in asymptomatic patients with preserved left ventricular ejection fraction (EF), implying low sensitivity of EF in predicting optimum time for intervention. In this article we review patterns of LV myocardial deformation before and after correction of CAS and CoA in infants, children and adolescents, showing their important role in monitoring the course of LV dysfunction. A systematic search using PubMed was performed and suitable studies are presented on a narrative form. Normal EF and/or fractional shortening (FS), with subclinical myocardial dysfunction are reported in all studies before intervention. The short-term results, after intervention, were related to the type of procedure, with no improvement or further deterioration related to surgery but immediate improvement after balloon intervention. Long term follow-up showed further improvement but still subnormal function. Thus correction of CAS and CoA before irreversible LV dysfunction is vital, and requires longitudinal studies in order to identify the most accurate parameter for function prognostication. Until then, conventional echocardiographic parameters together with myocardial velocities and deformation parameters should continue to provide follow-up reproducible measures of ventricular function.
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Affiliation(s)
- Haki Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Umeå University, Sweden
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.
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49
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Firdouse M, Agarwal A, Mondal T. Vein of Galen arteriovenous malformation mimicking coarctation of the aorta. J Ultrasound 2014; 17:297-301. [PMID: 25368688 DOI: 10.1007/s40477-014-0080-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/06/2014] [Indexed: 11/25/2022] Open
Abstract
Arteriovenous malformation of the vein of Galen is a rare congenital intracranial anomaly lacking a capillary bed and subsequent aneurysmal enlargement of the arterial and venous system, warranting careful management due to associated morbidity and mortality. Coarctations of aorta demonstrate similar neonatal echocardiographic signs to the vein of Galen arterial malformation (VGAM). We present a boy at 37 weeks of gestation whose initial ultrasound and echocardiographic investigations showed a dominant right ventricle and isthmal hypoplasia, suggestive of coarctation of aorta. Follow-up ultrasound and echocardiography revealed an arteriovenous malformation involving middle and posterior cerebral artery branches, eliminating coarctation of aorta. VGAM was confirmed by further ultrasound and angiographic investigation, which demonstrated a tangle of cerebral and choroidal arterial branches centrally feeding into an enlarged vein of Galen. The boy's hemodynamic and neurological statuses were confirmed to be stable despite increased venous pressure. Elective embolization at 7 months of age was complicated by a cerebrovascular accident, resulting in right hemiparesis despite no residual cardiac issues. This case demonstrates that rarely, arteriovenous malformations such as the vein of Galen malformations may be the primary cause of patients presenting with coarctation of aorta. The rarity of this condition and its guarded prognosis make our case of special interest to cardiologists and the perinatal care team.
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Affiliation(s)
- Mohammed Firdouse
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 4077 Tea Garden Circle, Mississauga, ON L5B 2W5 Canada
| | - Arnav Agarwal
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 252 Macedonia Crescent, Mississauga, ON L5B 3R7 Canada
| | - Tapas Mondal
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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50
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Ural AV, Caglar IM, Caglar FNT, Ciftci S, Karakaya O. Single therapeutic catheterization for treatment of late diagnosed native coarctation of aorta using a covered stent. J Clin Diagn Res 2014; 8:153-5. [PMID: 24783116 PMCID: PMC4003620 DOI: 10.7860/jcdr/2014/7520.4144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/22/2014] [Indexed: 11/24/2022]
Abstract
Here in we are reporting a 35-year-old pregnant, hypertensive woman with a strict descending aorta coarctation. She had two missing pregnancies which were complicated with hypertension, but which were not diagnosed for any pathologies before. We diagnosed coarctation of aorta, but however postponed her treatment after delivery of baby, because hypertension was under control with medical treatment and she had no complication. She had an uneventful delivery. MRI angiography revealed coarctation of aorta and it was successfully treated by using an endovascular covered stent during a single cardiac catheterization. Endovascular covered stent implantation is an easy, safe and effective method for treating coarctation of aorta in adults.
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Affiliation(s)
- Alper V Ural
- Faculty, Department of Cardiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
| | - Ilker Murat Caglar
- Faculty, Department of Cardiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
| | | | - Serkan Ciftci
- Faculty, Department of Cardiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
| | - Osman Karakaya
- Faculty, Department of Cardiology, Bakirkoy Education and Research Hospital, Istanbul, Turkey
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