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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] [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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Jiang Q, Hu R, Dong W, Guo Y, Zhang W, Hu J, Zhang H. Outcomes of Arch Reintervention for Recurrent Coarctation in Young Children. Thorac Cardiovasc Surg 2021; 70:26-32. [PMID: 34521137 DOI: 10.1055/s-0041-1731825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the outcomes of reintervention for postrepair recoarctation in young children. METHODS Between January 2011 and December 2020, all consecutive patients aged ≤3 years who were treated for postrepair recoarctation were included. Recoarctations were classified into two morphological types by three-dimensional imaging. Two methods, namely, surgical repair and balloon angioplasty (BA), were used to treat recoarctation. RESULTS This study included 50 patients with a median age of 10.5 months (range, 2.0-36.0 months) and a mean weight of 9.3 ± 3.1 kg. Hypoplastic recoarctation occurred most frequently in patients who had undergone patch aortoplasty at initial repair (p = 0.001). No hospital mortality occurred, and all patients achieved an increased diameter (p < 0.001) and a decreased pressure gradient (p < 0.001) at the recoarctation site immediately after reintervention. The median follow-up time after reintervention was 3.5 years (range, 16.0 days-9.6 years). Late mortality occurred in four patients (8.0%): two in the surgical group and two in the BA group (chi-square test= 0.414, p = 0.520). There was no difference in arch reobstruction after reintervention between the surgical and BA groups (chi-square test = 1.383, p = 0.240). Recoarctation with a hypoplastic morphology was the leading risk factor for arch reobstruction after reintervention (hazard ratio, 6.552; 95% confidence interval, 2.045-20.992; p = 0.002). CONCLUSION Reintervention for recoarctation has favorable early outcomes in young children. However, late mortality is not rare, and arch reobstruction is common during close follow-up. For young children, recoarctation with hypoplastic morphology is the leading risk factor for reobstruction, while the choice of reintervention method exerts little effect on the outcomes of arch reintervention.
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Affiliation(s)
- Qi Jiang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Renjie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Wei Dong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Ying Guo
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jie Hu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Goto T, Nishi H, Kitahara M, Sakakibara S, Kakizawa Y. Successful hybrid TEVAR for distal anastomotic pseudoaneurysm and coarctation following previous palliative left subclavian artery to descending aorta bypass: A case report. Int J Surg Case Rep 2020; 74:124-127. [PMID: 32836206 PMCID: PMC7452679 DOI: 10.1016/j.ijscr.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
We performed a hybrid TEVAR for concomitant anastomotic pseudoaneurysm and CoA. TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive. TEVAR can be an alternative option for young patients who have to resume work early after surgery.
Introduction Anastomotic pseudoaneurysm is one of the most common but catastrophic complications in coarctation of the aorta (CoA); this is equally true even if the initial surgery is not directly related to the coarctation. Redo open heart surgery is usually required for the pseudoaneurysm; however, redo surgery remains challenging with high morbidity and mortality rates. Presentation of case A 38-year-old woman with CoA, who had undergone left subclavian artery (LSCA) to descending aorta bypass 21 years prior, was referred to us for the treatment of distal anastomotic pseudoaneurysm. Zone 2 thoracic endovascular aortic repair (TEVAR) with LSCA debranching was performed to exclude the distal anastomotic pseudoaneurysm and expand the CoA using a stent graft. The patient completely recovered and resumed work without delay. Discussion In patients who require surgical treatment for both pseudoaneurysm and CoA, hybrid TEVAR can be an alternative surgical option instead of conventional open repair. Conclusion TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive, especially for young patients who have to resume work early after surgery.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Satoshi Sakakibara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yumi Kakizawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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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] [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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Rajbanshi BG, Joshi D, Pradhan S, Gautam NC, Timala R, Shakya U, Sharma A, Biswakarma G, Sharma J. Primary surgical repair of coarctation of the aorta in adolescents and adults: intermediate results and consequences of hypertension. Eur J Cardiothorac Surg 2019; 55:323-330. [PMID: 29933438 DOI: 10.1093/ejcts/ezy228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/13/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Coarctation of the aorta is known to present with hypertension in older patients; we reviewed our experience and assessed the outcome of hypertension following surgical correction. METHODS From April 2004 to date, 43 patients above the age of 12 underwent coarctation of the aorta repair. The mean age was 20.4 + 9.7 years (maximum 56 years); 21 (48.8%) were older than 18 years and 28 (65.1%) were men. Thirty (69.8%) patients had hypertension. Fourteen (32.6%) had a bicuspid aortic valve; 11 (25.6%) had patent ductus arteriosus; 6 (14%) had myxomatous mitral valve; 4 (9.3%) had ascending aortic aneurysms; and 2 (4.7%) had descending aneurysms. RESULTS Surgical correction included resection and interposition of a tube graft in 31 (72.1%), an end-to-end anastomosis in 6 (14%) and patch aortoplasty in 3 (7%). Three (7%) patients required an extra-anatomical bypass: 1 had a long segment coarctation of the aorta, and 2 had a Bentall procedure with an ascending-to-descending aortic bypass. Staged procedures were done for concomitant disease in 4 (9.3%). There was 1 death: a 56-year-old woman died of refractory ventricular fibrillation during surgery. Thirty (69.8%) patients were discharged with antihypertensive medication. At a follow-up of 2.8 ± 2.2 years (maximum 9.2 years), the number of hypertensive patients decreased (17/36; 47.2%) (P = 0.042). Univariable predictors for persistence of hypertension revealed the use of an interpositional tube graft for repair (odds ratio 13.855, confidence interval 0.000-0.001; P = 0.001) as an indicator, whereas there were no independent predictors for persistence of hypertension. CONCLUSIONS Surgical intervention is warranted irrespective of age and helps correct and control hypertension better; however, significant numbers of patients still require antihypertensive medication and regular monitoring. Intervention using an interposition tube graft may affect the prevalence of hypertension.
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Affiliation(s)
- Bijoy G Rajbanshi
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal.,Department of Cardiovascular and Thoracic Surgery, Nepal Mediciti, Lalitpur, Nepal
| | - Dikshya Joshi
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | - Sidhartha Pradhan
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | - Navin C Gautam
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | - Rabindra Timala
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | - Urmila Shakya
- Division of Pediatric Cardiology, Department of Cardiology, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | - Apurb Sharma
- Department of Anesthesiology, Shahid Gangalal National Heart Center, Kathmandu, Nepal
| | | | - Jyotindra Sharma
- Department of Cardiovascular Surgery, Shahid Gangalal National Heart Center, Kathmandu, Nepal
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Woldmichael KG, Aklilu TM. Mission-based cardiac surgery and catheter treatment of coarctation of aorta in the young and older children: a facility based review of cases in Addis Ababa. Pan Afr Med J 2019; 34:160. [PMID: 32153700 PMCID: PMC7046100 DOI: 10.11604/pamj.2019.34.160.19406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Coarctation of the aorta is a congenital narrowing of the descending aorta. Hemodynamic derangement will be corrected with reopening of the narrowing either by surgery or catheter ballooning. There are few reports of post-operative cases in developing countries. The goal of this review is to describe the follow-up profile of cases in a setting with limited resource. METHODS Data from a retrospective facility-based chart review of cases within a single institution in Addis Ababa, were analyzed to quantify procedure, timing and post-operative blood pressure outcomes. RESULTS Thirty-two locally, and seven abroad operated cases, for a total of thirty-nine post-operative cases were analyzed. Balloon angioplasty with or without stent insertion, resection with end-to-end anastomosis and patch arthroplasty accounted for twenty, fourteen, and five cases respectively. Rebound hypertension occurred more frequently in the surgical group compared to the catheter group (P value < 0.01). The mean systolic blood pressures between pre and post-intervention differed significantly (P value = 0.001). Post-operative hypertension was observed in one-third of cases. Diagnosis and intervention time were late in majority of cases. A high rate of loss to follow-up was also observed. CONCLUSION Delayed diagnosis of cases coupled with a delay in intervention after diagnosis, is hypothesized to account at least in part for the findings. The challenges related to early diagnosis and intervention of case with congenital heart disease was discussed. Early diagnosis and referral of cases is recommended.
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Affiliation(s)
- Kalkidan Gebremeskel Woldmichael
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa university, Addis Ababa, Ethiopia
| | - Tamirat Moges Aklilu
- Department of Pediatrics and child Health Cardiology Unit, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Egbe AC, Rihal CS, Thomas A, Boler A, Mehra N, Andersen K, Kothapalli S, Taggart NW, Connolly HM. Coronary Artery Disease in Adults With Coarctation of Aorta: Incidence, Risk Factors, and Outcomes. J Am Heart Assoc 2019; 8:e012056. [PMID: 31195876 PMCID: PMC6645630 DOI: 10.1161/jaha.119.012056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Premature coronary artery disease (CAD) is common in patients with coarctation of aorta (COA), but there are limited data about any direct relationship (or lack thereof) between COA and CAD. We hypothesized that atherosclerotic cardiovascular disease risk factors, rather than COA diagnosis, was the primary determinant of CAD occurrence in patients with COA. Methods and Results This is a retrospective study of 654 COA patients and a control group of 876 patients with valvular pulmonic stenosis and tetralogy of Fallot to determine prevalence and independent risk factors for CAD. There was no evidence of a difference in the unadjusted CAD prevalence between the COA and control groups (7.8% versus 6.3%, P=0.247), but premature CAD was more common in COA patients (4.4% versus 1.8%, P=0.002). In the analysis of a propensity‐matched cohort of 126 COA and 126 control patients, there was no evidence of a difference in overall CAD prevalence (6.3% versus 5.6% versus P=0.742) and premature CAD prevalence (4.8% versus 3.2%, P=0.518). The multivariable risk factors for CAD were hypertension (odds ratio [OR] 2.14; 95% CI 1.36–3.38), hyperlipidemia (OR 3.33; 95% CI 2.02–5.47), diabetes mellitus (OR 1.98; 95% CI 1.31–3.61), male sex (OR 2.05; 95% CI 1.33–3.17), and older age per year (OR 1.06; 95% CI 1.04–1.07). Conclusions After adjusting for atherosclerotic cardiovascular disease risk factors, we did not find evidence of a difference in CAD risk between the patients with COA and other patients with congenital heart disease.
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Affiliation(s)
- Alexander C Egbe
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Amber Boler
- 2 Mayo Medical School Mayo Clinic Rochester MN
| | | | | | | | | | - Heidi M Connolly
- 1 Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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Sophocleous F, Biffi B, Milano EG, Bruse J, Caputo M, Rajakaruna C, Schievano S, Emanueli C, Bucciarelli-Ducci C, Biglino G. Aortic morphological variability in patients with bicuspid aortic valve and aortic coarctation. Eur J Cardiothorac Surg 2019; 55:704-713. [PMID: 30380029 PMCID: PMC6459283 DOI: 10.1093/ejcts/ezy339] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/10/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Benedetta Biffi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Elena Giulia Milano
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK.,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jan Bruse
- Vicomtech-IK4, Data Intelligence for Energy and Industrial Processes, Donostia/San Sebastián, Spain
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Cha Rajakaruna
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Costanza Emanueli
- Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Careddu L, Petridis FD, Angeli E, Balducci A, Buia F, Lovato L, Gargiulo GD. Endovascular repair in extra-anatomic bypass after hypoplastic aortic arch repair. J Cardiovasc Med (Hagerstown) 2019; 20:261-263. [PMID: 30664070 DOI: 10.2459/jcm.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Francesco Buia
- Cardiovascular Radiology Department, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luigi Lovato
- Cardiovascular Radiology Department, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Ma ZL, Yan J, Li SJ, Hua ZD, Yan FX, Wang X, Wang Q. Coarctation of the Aorta with Aortic Arch Hypoplasia: Midterm Outcomes of Aortic Arch Reconstruction with Autologous Pulmonary Artery Patch. Chin Med J (Engl) 2018; 130:2802-2807. [PMID: 28936993 PMCID: PMC5717858 DOI: 10.4103/0366-6999.215279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Coarctation of the aorta (CoA) with aortic arch hypoplasia (AAH) is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch (AA) reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH. Methods: Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 (Q1, Q3: 2.0, 14.0) months and the median body weight was 5.75 (Q1, Q3: 4.10, 9.38) kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test. Results: No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg (1 mmHg = 0.133 kPa), which was smaller than the preoperative pressure difference (48.30 ± 15.73 mmHg; t = −10.119, P < 0.001). The median follow-up time was 29.0 (Q1, Q3: 15.5, 57.3) months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity. Conclusion: AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.
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Affiliation(s)
- Zhi-Ling Ma
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Yan
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shou-Jun Li
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhong-Dong Hua
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fu-Xia Yan
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xu Wang
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qiang Wang
- Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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11
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Prognostic Role of Hypertensive Response to Exercise in Patients With Repaired Coarctation of Aorta. Can J Cardiol 2018; 34:676-682. [DOI: 10.1016/j.cjca.2018.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 11/21/2022] Open
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12
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Beckmann E, Jassar AS. Coarctation repair-redo challenges in the adults: what to do? J Vis Surg 2018; 4:76. [PMID: 29780722 DOI: 10.21037/jovs.2018.04.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.
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Affiliation(s)
- Erik Beckmann
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Outcomes of thoracic endovascular aortic repair in adult coarctation patients. J Vasc Surg 2018; 67:369-381.e2. [DOI: 10.1016/j.jvs.2017.06.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/17/2017] [Indexed: 12/17/2022]
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14
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Lee MGY, Allen SL, Koleff J, Brink J, Konstantinov IE, Cheung MMH, Brizard CP, d’Udekem Y. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair†. Eur J Cardiothorac Surg 2017; 53:531-537. [DOI: 10.1093/ejcts/ezx360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/11/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Melissa G Y Lee
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah L Allen
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Koleff
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Johann Brink
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Pater C, Brown NM, Goldstein BH. Far From the Septum: Transcatheter Cardioform Septal Occluder Device Closure of a Descending Aortic Pseudoaneurysm Late After Interrupted Aortic Arch Repair. JACC Cardiovasc Interv 2017; 10:e163-e166. [PMID: 28823776 DOI: 10.1016/j.jcin.2017.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022]
MESH Headings
- Adult
- Anastomosis, Surgical
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aorta, Thoracic/abnormalities
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/surgery
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/etiology
- Aortic Aneurysm, Thoracic/surgery
- Blood Vessel Prosthesis Implantation/adverse effects
- Endovascular Procedures/instrumentation
- Female
- Humans
- Prosthesis Design
- Septal Occluder Device
- Stents
- Treatment Outcome
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Affiliation(s)
- Colleen Pater
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicole M Brown
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bryan H Goldstein
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Abstract
Techniques for repair of the aorta currently include open and endovascular methods, hybrid approaches, minimally-invasive techniques, and aortic branch vessel reimplantation or bypass. Collaboration among radiologists and vascular and cardiothoracic surgeons is essential. An awareness of the various surgical techniques, expected postoperative appearance, and potential complications is essential for radiologists. This review will cover the postoperative appearance of the thoracic aorta with a focus on the ascending aorta. The value of three-dimensional image evaluation will also be emphasized.
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17
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Spratt JR, Shumway SJ. Historical perspectives of The American Association for Thoracic Surgery: Hartzell V. Schaff, MD. J Thorac Cardiovasc Surg 2017; 154:1-6. [PMID: 28366547 DOI: 10.1016/j.jtcvs.2017.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Affiliation(s)
- John R Spratt
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Sara J Shumway
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn.
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Wen S, Cen J, Chen J, Xu G, He B, Teng Y, Zhuang J. The application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly. J Thorac Dis 2017; 8:3301-3306. [PMID: 28066610 DOI: 10.21037/jtd.2016.11.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the patients with longer-segment aortic arch hypoplasia or interruption with ventricular septal defect, surgery with homograft vessel or autologous pericardial patch to augment descending aortic arch will not result in adverse reactions caused by end-to-end anastomosis. In this study, we retrospectively analyzed primary experience of surgical correction of complicated aortic arch anomaly with autologous main pulmonary artery. METHODS From July 2010 to March 2016, the twenty-one cases of aortic arch complex anomalies were reconstructed with autologous main pulmonary artery. There were 5 patients with interrupted aortic arch and 16 patients with coarctation of aorta. In patients with interrupted aortic arch, anterior wall of main pulmonary artery was excised to form a conduit whose diameter varied according to the area of patient's body surface. Both ends of the conduit were anastomosed to aortic arch and descending aorta, respectively. In other patients with coarctation of aorta, aortic arch was augmented with tailored pulmonary artery patch in oval shape. The defect of main pulmonary artery was repaired with autologous pericardial patch. RESULTS There was only one patient died of multiple organ failure postoperatively. The other twenty patients survived without any neurologic complications. Differences of blood pressure between upper and lower limbs were not significant in all cases. During follow-up period, the echocardiography for all patients in the third, sixth, twelfth, and twenty-fourth months showed that blood flow in the descending aortic arch was fluent and there was no obvious blood pressure gradient. CONCLUSIONS Autologous main pulmonary artery can be used to repair complicated aortic arch anomalies completely without any anastomotic tension or bronchial obstruction postoperatively. This procedure is feasible and possesses predominant early and mid-term effects, and autologous main pulmonary artery can retain growth capacity during follow-up period. Of course, it is necessary to draw a definite conclusion of this technique during long-term follow-up period.
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Affiliation(s)
- Shusheng Wen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Jianzheng Cen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Gang Xu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Biaochuan He
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Yun Teng
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China
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Chiariello GA, Bruno P, Mazza A, Luciani M, Glieca F, Massetti M. Presentación clínica aguda de seudoaneurisma y fístula aortopulmonar como complicación tardía de la reparación quirúrgica de la coartación de aorta. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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21
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Grøndahl C, Pedersen TAL, Hjortdal VE. The Medium-Term Effects of Treatment for Mild Aortic Recoarctation. World J Pediatr Congenit Heart Surg 2016; 8:55-61. [DOI: 10.1177/2150135116668334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess medium-term effects of treatment for mild to moderate recoarctation in an adult population. Design: We identified all patients who had coarctation repair between 1965 and 1985 in our institution. They were all (n = 156) invited to a thorough outpatient examination, which was accepted by 133. Eleven (median age 36 [28-53] years) were identified with isolated mild to moderate recoarctation and received reintervention. They comprise the patient population of the current study. We performed bicycle exercise testing, transthoracic echocardiography, magnetic resonance imaging, and 24-hour blood pressure monitoring before and 14 to 29 months after reintervention. Results: Compared to the values before reintervention, 24-hour blood pressures were reduced, but only significantly so for nighttime values. On echocardiography, wall thickness was reduced (1.2 ± 0.3 vs 1.1 ± 0.2, P > .05), and maximum flow velocity in the distal aortic arch decreased (2.8 ± 0.5 m/s vs 2.1 ± 0.4 m/s, P < .05). The invasive coarctation gradient was significantly reduced (15 ± 7 mm Hg vs 5 ± 9 mm Hg, P < .05), and the diameter at the coarctation site was increased (11 ± 3 mm vs 15 ± 3 mm, P < .05). Maximum achieved workload increased (182 ± 51 W vs 205 ± 65 W, P < .05). Cardiac symptoms were overall reduced. Conclusion: Reintervention was overall beneficial in increasing exercise capacity and reducing symptoms in the medium term, but the effects on established myocardial hypertrophy and blood pressures were less profound. Larger studies are needed in order to establish the definite role of reintervention for patients with milder recoarctation.
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Affiliation(s)
- Camilla Grøndahl
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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22
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Acute Clinical Presentation of Pseudoaneurysm and Aortopulmonary Fistula as a Very Late Complication of Aortic Coarctation Patch Repair. ACTA ACUST UNITED AC 2016; 70:57-58. [PMID: 27659858 DOI: 10.1016/j.rec.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/07/2016] [Indexed: 11/24/2022]
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23
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Roselli EE. If the shoe fits, choose it: Tailored strategy for postcoarctation complications. J Thorac Cardiovasc Surg 2016; 151:1764-5. [PMID: 26997102 DOI: 10.1016/j.jtcvs.2016.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Eric E Roselli
- Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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24
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Yu Z, Wu S, Li C, Zou Y, Ma L. One stage surgical treatment of aortic valve disease and aortic coarctation with aortic bypass grafting through the diaphragm and aortic valve replacement. J Cardiothorac Surg 2015; 10:160. [PMID: 26555654 PMCID: PMC4640222 DOI: 10.1186/s13019-015-0338-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To validate ascending aorta-lower abdominal aorta bypass grafting treatment for patients with descending aortic coarctation and an aortic valve disease. METHODS The three patients in whom a descending atypical aortic coarctation was associated with an aortic valve disease were treated with one stage surgical treatment with aortic bypass grafting through the diaphragm and aortic valve replacement in our heart center. Operative technique consisted of performing ascending aorta-lower abdominal aorta bypass grafting through diaphragm muscle and implementing aortic valve replacement. The mean time for extracorporeal circulation and occluding clamp of aorta was recorded. Blood pressure data for pre- and post-operation was measured in the limbs. Computer-enhanced transvenous angiograms of pre- and post-operation were applied for detection of aortic stenosis. The other adverse events were noticed in outpatient service during a follow-up period. RESULTS The mean extracorporeal circulation time was 54 ± 11 min. The mean time for occluding clamp of aorta was 34 ± 6 min. An arterial pressure gradient was totally corrected after surgical treatment. Post-operation computer-enhanced transvenous angiograms showed the grafts to be open with a fluent flow. The patients had no gastrointestinal tract complications. No adverse event was noticed during a follow-up period in outpatient service. CONCLUSIONS Treatment of ascending aorta-lower abdominal aorta bypass is advisable for patients with descending aortic coarctation and an aortic valve disease.
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Affiliation(s)
- Zipu Yu
- Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, 79 Qingchun road, Hangzhou, Zhejiang, China
| | - Shengjun Wu
- Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, 79 Qingchun road, Hangzhou, Zhejiang, China
| | - Chengchen Li
- Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, 79 Qingchun road, Hangzhou, Zhejiang, China
| | - Yu Zou
- Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, 79 Qingchun road, Hangzhou, Zhejiang, China
| | - Liang Ma
- Department of Cardiac Surgery, 1st Affiliated Hospital, Zhejiang University, 79 Qingchun road, Hangzhou, Zhejiang, China.
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Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm After Previous Coarctation Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:370-2. [PMID: 26536079 DOI: 10.1097/imi.0000000000000195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.
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Brunkwall S, Ahmad W, Mylonas S, Sharkawy M, Wippermann J, Brunkwall J. The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR. J Endovasc Ther 2015; 22:934-7. [PMID: 26394811 DOI: 10.1177/1526602815607441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment. CASE REPORT A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak. CONCLUSION A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.
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Affiliation(s)
- Silke Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Mohamed Sharkawy
- Department of Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo, Egypt
| | - Jens Wippermann
- Department of Cardiovascular Surgery, University of Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
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Tretter JT, Jones TK, McElhinney DB. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation. Circ Cardiovasc Interv 2015; 8:e002840. [DOI: 10.1161/circinterventions.115.002840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Justin T. Tretter
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
| | - Thomas K. Jones
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
| | - Doff B. McElhinney
- From the Department of Pediatrics, New York University Langone Medical Center (J.T.T.); Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (T.K.J.); and Lucille Packard Children’s Hospital Stanford Heart Center Clinical and Translational Research Program, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (D.B.M.)
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Hörer T, Toivola A. Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm after Previous Coarctation Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tal Hörer
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital and (Orebro University, Orebro, Sweden
| | - Asko Toivola
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital and (Orebro University, Orebro, Sweden
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Abstract
Coarctation of the aorta is a common congenital heart defect through which management has rapidly evolved over the last few decades. The role of transcatheter-based therapies is expanding and seems to be an effective treatment option for coarctation, especially in adults. Patients with prior coarctation repair are at risk of long-term complications related to prior surgeries and associated congenital heart defects, in particular, the risk of restenosis and aortic aneurysm development related to the timing and mode of prior intervention. This article outlines the evaluation and management of adults with unrepaired coarctation and patients after coarctation repair.
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Affiliation(s)
- Lan Nguyen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, University of Pittsburgh, Scaife Hall S560.1, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stephen C Cook
- Department of Pediatrics, The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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30
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Repair of primary or complicated aortic coarctation in the adult with cardiopulmonary bypass and hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2015; 149:S83-5. [DOI: 10.1016/j.jtcvs.2014.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/24/2014] [Indexed: 11/21/2022]
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31
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Coarctation of the aorta: management, indications for intervention, and advances in care. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:341. [PMID: 25143119 DOI: 10.1007/s11936-014-0341-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OPINION STATEMENT Coarctation of the aorta (CoAo) accounts for 9 % of congenital heart defects. Balloon angioplasty has been the conventional endovascular treatment of choice for both native and recurrent coarctation in adults. Recent advancement in stent technology with the development of the covered stents has enhanced the scope for percutaneous management of both native CoAo and post-surgical CoAo. Stent implantation provides better hemodynamic results with larger acute diameter gain and better long-term hemodynamic benefit. Stenting also decreases the incidence of aneurysm formation. The development of biodegradable stents may revolutionize the percutaneous management of coarctation, as the degradation of the stent scaffold within 6 months of implantation will further decrease the incidence of restenosis. In the future stenting may suffice and obviate the need for open repair. Until then, surgical repair of CoAo is the preferred method in both infants and complicated lesions, leaving stenting to adults with focal and uncomplicated disease.
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32
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Perera AH, Rudarakanchana N, Hamady M, Kashef E, Mireskandari M, Uebing A, Cheshire NJ, Bicknell CD. New-generation stent grafts for endovascular management of thoracic pseudoaneurysms after aortic coarctation repair. J Vasc Surg 2014; 60:330-6. [PMID: 24767711 DOI: 10.1016/j.jvs.2014.02.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/23/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Late thoracic aneurysms develop in 5% to 12% of patients having undergone open repair for coarctation of the aorta (CoA). We report our early results for thoracic endovascular aortic repair for pseudoaneurysms after CoA repair. METHODS From 2008 to 2013, data regarding demographics, aneurysm morphology, procedure, and follow-up were collected prospectively on all patients treated for pseudoaneurysms after CoA repair. Retrospective analysis of identified patients was then performed. RESULTS Thirteen patients (six men, seven women) were treated. Patients were a median age, 45 years (interquartile range (IQR), 39-56; range, 27-66 years, and the median time after CoA repair to aneurysm treatment was 34 years (IQR, 24-40 years). All patients had saccular pseudoaneurysms of the aortic arch, with a median aneurysm size of 4.1 cm (IQR, 3.4-5.1 cm). The left subclavian artery (LSCA) was involved in 10 patients and was occluded at presentation in three. Four patients had concurrent LSCA revascularization with carotid-subclavian bypass, one had aortic arch hybrid repair, and the LSCA was intentionally covered in two patients. Patients underwent thoracic endovascular aortic repair using the conformable TAG (6 of 13; W. L. Gore & Associates, Flagstaff, Ariz), Valiant device (4 of 13; Medtronic, Minneapolis, Minn), and a custom-made Relay endograft with LSCA scallop (4 of 13; Bolton Medical, Barcelona, Spain). Technical success was 100%, with satisfactory deployment of the stent grafts in all patients. There was no 30-day mortality, stroke, or paraplegia. Median follow-up was 15 months (IQR, 9-19 months; range, 1-67 months). Two type II endoleaks from an intercostal artery were managed conservatively, and one type Ib endoleak was treated successfully with distal stent extension. CONCLUSIONS In this cohort, new-generation stent grafts have good early clinical and radiologic outcomes, avoiding the need for redo open surgery. Management of the LSCA can be tailored to individual patients with new stent graft technology. Long-term follow-up of these patients is crucial to understanding whether endovascular management of this cohort is acceptable.
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Affiliation(s)
- Anisha H Perera
- Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom
| | - Nung Rudarakanchana
- Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom
| | - Mohamad Hamady
- Department of Surgery, Imperial College London, London, United Kingdom; Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elika Kashef
- Department of Interventional Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Maziar Mireskandari
- Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Anselm Uebing
- Adult Congenital Heart Disease Centre, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Nicholas J Cheshire
- Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom
| | - Colin D Bicknell
- Imperial Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery, Imperial College London, London, United Kingdom.
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Vergales JE, Gangemi JJ, Rhueban KS, Lim DS. Coarctation of the aorta - the current state of surgical and transcatheter therapies. Curr Cardiol Rev 2014; 9:211-9. [PMID: 23909637 PMCID: PMC3780346 DOI: 10.2174/1573403x113099990032] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 01/20/2013] [Indexed: 12/11/2022] Open
Abstract
Aortic coarctation represents a distinct anatomic obstruction as blood moves from the ascending to the descending aorta and can present in a range of ages from infancy to adulthood. While it is often an isolated and discrete narrowing, it can also be seen in the more extreme scenario of severe arch hypoplasia as seen in the hypoplastic left heart syndrome or in conjunction with numerous other congenital heart defects. Since the first description of an anatomic surgical repair over sixty years ago, an evolution of both surgical and transcatheter therapies has occurred allowing clinicians to manage and treat this disease with excellent results and low morbidity and mortality. This review focuses on the current state of both transcatheter and surgical therapies, paying special attention to recent data on long-term follow-up of both approaches. Further, current thoughts will be explored about future therapeutic options that attempt to improve upon historical long-term outcomes.
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Affiliation(s)
- Jeffrey E Vergales
- Children’s Hospital Heart Center, Department of Pediatrics, University of Virginia, USA.
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Tabry IF, Zachariah ZP. Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump. Multimed Man Cardiothorac Surg 2014; 2013:mms021. [PMID: 24412999 DOI: 10.1093/mmcts/mms021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A previously described but rarely used surgical technique for the repair of complex or recurrent coarctation of the aorta through a right thoracotomy approach is presented in detail. It has the advantages of being simple and avoiding left chest re-entry, median sternotomy and cardiopulmonary bypass altogether.
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Harris KC, Du W, Cowley CG, Forbes TJ, Kim DW. A prospective observational multicenter study of balloon angioplasty for the treatment of native and recurrent coarctation of the aorta. Catheter Cardiovasc Interv 2013; 83:1116-23. [PMID: 24917074 DOI: 10.1002/ccd.25284] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Balloon angioplasty (BA) is an important treatment option for coarctation of the aorta. The congenital cardiovascular interventional study consortium (CCISC) represents a multi-institutional and multi-national effort to prospectively investigate congenital cardiac interventions. A prospective observational analysis of the efficacy and safety of balloon aortic angioplasty was conducted. METHODS Data were collected prospectively from 36 CCISC sites from 2004 to 2012. One hundred and thirty patients underwent BA for native (n = 76) and recurrent (n = 54) coarctation. Acute, short-term, and intermediate outcomes are described for BA performed in the setting of native and recurrent coarctation of the aorta. Outcome measures included residual upper to lower extremity blood pressure gradient (ULG), use of antihypertensive medications, aortic wall injury, reobstruction, and need for reintervention. RESULTS There was no procedural mortality. Acutely in native and recurrent coarctation, BA achieved an ULG less than 15 mm Hg in 73-80% and to less than 10 mm Hg in 54-68% of patients, respectively. At intermediate follow-up, ULG further improved, particularly for those who underwent initial reintervention for recurrent coarctation. No significant differences in aortic wall complications were seen and intervention free survival was similar for both groups. Following angioplasty, there was no significant difference in aortic wall complications; however follow up integrated imaging decreased over time. CONCLUSIONS BA is a safe and effective treatment for coarctation of the aorta acutely and at intermediate term. Although aortic injury occurred in patients with both native and recurrent coarctation, at intermediate follow-up, aneurysm was noted more often in those with initial intervention for native coarctation.
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Affiliation(s)
- Kevin C Harris
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
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Extra-anatomical bypass: a surgical option for recurrent aortic coarctation. Case Rep Vasc Med 2013; 2013:320132. [PMID: 23936724 PMCID: PMC3723055 DOI: 10.1155/2013/320132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/16/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. However, in patients with previous small size tube graft, an open surgical correction is mandatory and, in most cases, an anatomical aortic reconstruction is carried out. Methods. We present the case of a 48-year-old woman with recurrent aortic coarctation and systemic hypertension with systolic value around 190–200 mmHg and preoperative systolic pressure gradient 70 mmHg, submitted to an extra-anatomical bypass. Through a median sternotomy, an extra-anatomical bypass from ascending to descending aorta was performed. Results. No intra- or postoperative complications were observed. The postoperative pressure gradient was 10 mmHg and the systolic pressure ranged from 130 to 140 mmHg. Conclusion. The extra-anatomical bypass can be considered an effective and safe alternative to the anatomical aortic reconstruction in the cases with recurrent aortic coarctation unfit for endovascular treatment.
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Preventza O, Livesay JJ, Cooley DA, Krajcer Z, Cheong BY, Coselli JS. Coarctation-associated aneurysms: a localized disease or diffuse aortopathy. Ann Thorac Surg 2013; 95:1961-7; discussion 1967. [PMID: 23643549 DOI: 10.1016/j.athoracsur.2013.03.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND We evaluated the occurrence and treatment of aortic aneurysms in coarctation patients. METHODS During 1962 to 2011, 943 cases of coarctation were repaired. Aortic aneurysms were identified in 55 patients (5.8%). Forty-eight had prior coarctation repair (median 23 years earlier, interquartile range 18 to 26 years). Forty-two aneurysms were found in the descending thoracic aorta (76.4%), 18 in the ascending aorta (32.7%), 8 in the left subclavian artery (14.5%), and 1 each (1.8%) in the abdominal aorta, iliac artery, and innominate artery. Twenty-three patients (41.8%) had multiple aneurysms. Twenty-five patients (45.4%) had a bicuspid aortic valve. RESULTS Fifty-three patients' aneurysms were treated surgically. Thirty-five (66.0%) had descending thoracic aortic repair, of whom 11 had aorto-left subclavian bypass. Aortic cross-clamping alone was used in 23 patients, left heart bypass in 4, and circulatory arrest in 8. Eleven patients underwent endovascular repair (20.8%). Proximal aortic aneurysms were repaired in 7 patients (13.2%); 1 had simultaneous antegrade endostent delivery. Four patients had ascending-to-descending aortic bypass (7.3%). Concomitant valve-sparing root repair was performed in 2 patients, Bentall in 4, aortic valve replacement in 3, and coronary artery bypass in 1. One 30-day death occurred (1.9%). Three patients (5.7%) had transient neurologic deficits, 2 (3.8%) required tracheostomy, and 11 (20.8%) had vocal cord paralysis. CONCLUSIONS Coarctation is a marker for aortic aneurysm formation in adults and merits long-term surveillance. Anatomic complexity and associated conditions can complicate the surgical repair. Various open, extra-anatomic, and endovascular techniques may be used.
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Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital/Baylor College of Medicine, Houston, Texas, USA
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Roselli EE, Qureshi A, Idrees J, Lima B, Greenberg RK, Svensson LG, Pettersson G. Open, hybrid, and endovascular treatment for aortic coarctation and postrepair aneurysm in adolescents and adults. Ann Thorac Surg 2012; 94:751-6; discussion 757-8. [PMID: 22704801 DOI: 10.1016/j.athoracsur.2012.04.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 03/31/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Open, hybrid, and endovascular procedures are used for grown-up patients with aortic coarctation and complications after repair, an expanding population. We sought to characterize patients and procedures, assess early and late outcomes, and describe indications to guide treatment of these complex patients. METHODS Between May 1999 and January 2011, 110 patients underwent open (n=40), hybrid (n=11), or endovascular (n=59) repair of coarctation (n=43), recurrent aortic coarctation (n=42), or postrepair aneurysm (n=25). Mean age was 38±14 years. Sixty-eight had previous repairs (median 27 years earlier; range, 1 to 50). Twenty-two had prior cardiovascular operations other than coarctation and 50% had bicuspid valve. Fifty-nine concomitant procedures were performed in 45 patients (40%). Data were from the prospective database, chart review, and Social Security Death Index. RESULTS Technical success was achieved in 100%, with no hospital deaths, no strokes, and no paraplegia. Complications were uncommon and included respiratory failure (n=2, 1.8%), and temporary renal failure (n=2, 1.8%). Twenty-two patients required reinterventions, but half of those were planned. There was no difference in occurrence of unplanned reintervention between approaches (endovascular 12%, hybrid 18%, open 12.5%). Length of stay was 4.8±4.8 days. Transcoarct gradient fell from 37.6±18 mm Hg preoperatively to 7.0±6.9 mm Hg in coarctation patients. Postrepair aneurysm patients had no late ruptures, and maximum diameter shrunk from 5.9±1.3 cm preoperatively to 4.8±1.3 cm. Estimated survival at 1, 5, and 8 years was 95%, 95%, and 90%, respectively. CONCLUSIONS Coarctation, recurrent coarctation, and postrepair aneurysm/pseudoaneurysm in adolescent and adult patients can be safely and effectively managed with open, hybrid, or endovascular techniques. Optimal results are achievable in this complex population of patients with a multimodality approach tailored to surgical indication and anatomy. All survivors of coarctation repair require lifelong surveillance.
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Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195-5108, USA.
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Shaath GA, Jijeh A, Alkurdi A, Ismail S, Elbarbary M, Kabbani MS. Ultrasonography assessment of vocal cords mobility in children after cardiac surgery. J Saudi Heart Assoc 2012; 24:187-90. [PMID: 23960693 DOI: 10.1016/j.jsha.2012.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL). MATERIAL AND METHODS A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared. RESULTS Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study. Their mean ± SEM of weight and age were 4.6 ± 0.4 kg and 126.4 ± 51.4 days, respectively. All patients were referred to bedside US screening for vocal cord mobility. The results of US were compared subsequently with FL findings. Results were identical in nine (90%) patients and partially different in one (10%). Six patients showed abnormal glottal movement while the other four patients demonstrated normal vocal cords mobility by FL. Sensitivity of US was 100% and specificity of 80%. CONCLUSION US assessment of vocal cord is simple, non-invasive and reliable tool to assess vocal cords mobility in the critical care settings. This screening tool requires skills that can be easily obtained.
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Affiliation(s)
- Ghassan A Shaath
- Cardiac Science Department, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Mail Code 1420, P.O. Box 22490, Riyadh 11426
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Ogasawara T, Daitoku K, Taniguchi S, Suzuki Y, Fukuda I. Open Plugging and Extra-Anatomical Bypass for Iatrogenic Rupture of Coarctation of the Aorta. Ann Thorac Surg 2011; 92:1106-8. [DOI: 10.1016/j.athoracsur.2011.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/02/2011] [Accepted: 03/08/2011] [Indexed: 10/17/2022]
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Burkhart HM, Dearani JA, Connolly HM, Schaff HV. Ascending-descending posterior pericardial bypass of complex coarctation of the aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2011; 14:116-119. [PMID: 21444058 DOI: 10.1053/j.pcsu.2011.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recurrent coarctation or complex aortic arch obstruction can present a surgical challenge. The ascending-descending posterior pericardial aortic bypass offers a safe, reproducible solution for the surgical treatment of complex or recurrent coarctation of the aorta and facilitates concomitant cardiac surgery.
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Affiliation(s)
- Harold M Burkhart
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN, USA.
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