Stent dilatation of atretic aortic coarctation in an adult-case report and literature review

Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51-0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72-2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97-4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24-14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88-0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29-0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86-1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.

Implantation of Covered Stent for Coarctation of the Aorta and Secondary Hypertension in Adolescents—Case Report

Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta is a congenital cardiovascular anomaly with high morbidity and mortality rates. Arterial hypertension, heart failure, and aortic dissection are complications of this pathology, some of them being sometimes direct consequences of secondary hypertension. Periodic cardiology follow up after the procedure is mandatory to assess the hemodynamic response, to identify potential complications, and to stratify the cardiovascular risk.

Coarctation of the Aorta Complicated with Intracranial Aneurysm: A Case Report and Literature Review

BACKGROUND

Coarctation of the aorta (CoA) complicated with rupture and hemorrhage of intracranial aneurysms is not commonly seen in clinical practice. Here we report a middle-aged female patient who presented with acute severe headache.

CASE DESCRIPTION

Head computed tomography (CT) demonstrated an extensive subarachnoid hemorrhage. Digital subtraction angiography demonstrated coarctation and occlusion of the proximal thoracic aorta and occlusion of the terminal aortic arch. Aortic-intracranial CT angiography (CTA) confirmed a CoA complicated with an anterior communicating artery aneurysm. Clipping of the anterior communicating artery aneurysm was performed via a left lateral orbital approach. Postoperative intracranial CTA showed complete clipping of the aneurysm. The patient was discharged postoperatively with good recovery.

CONCLUSIONS

The pathophysiological mechanism of CoA complicated with intracranial aneurysm remains unclear, but attention should be given to the relationship between the 2 entities in clinical practice, and effective treatment should be provided according to specific conditions.