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PubMed1998

Coarctation of Aorta Mimicking Aortic Arch Interruption and its Successful Dilatation by an Innovative Approach.

Balloon dilatation for coarctation of the aorta is an established alternative to surgery in older children and young adults with a high success rate and a low incidence of restenosis.1Ð4 However, balloon dilatation has to be performed with extreme caution when the coarct segment involves the major branches of the aortic arch or when the coarct has an atypical anatomy. Herein, we report an unusual case which was suggestive of aortic arch interruption on descending thoracic aortography and could not be crossed retrogradely. Brachial approach for ascending aortography revealed that this was indeed a coarct with a distorted anatomy and also made possible crossing of the coarct antegradely. After exteriorizing the guide wire across the coarct with the help of a snare device advanced through the femoral arterial sheath, the coarct could be dilated from the femoral route as is routinely done.

Journal Article↗
PubMed1992

[A case of reoperation of coarctation of the aorta 13 years after corrective surgery of coarctation of the aorta, ventricular septal defect and pulmonary hypertension in infancy].

A 13-year-old boy underwent corrective surgery of CoA + VSD + PH at 50-day. Vascular murmur and hypertension was present so that he was admitted to our hospital. Systemic pressure was 164/106 mmHg (right arm) and systolic blood pressure at right leg was 70 mmHg. The systolic pressure gradient was 94 mmHg. The intracardiac pressure was within normal limit and there was no shunt. And the stenosis of descending aorta was present at the distal of subclavian branch and that pressure gradient was 76 mmHg. The diagnosis was established recurrent coarctation and operation was performed. The recurrent coarctation was 8 mm in diameter and longitudinal incision was made and woven Dacron patch aortoplasty was done. Aortic cross clamping time was 43 minutes. Postoperative clinical course was smooth. At 4 weeks after aortography was performed and no appreciable stenosis of the descending aorta was revealed. The pressure gradient decreased from 76 mmHg to 11 mmHg.

Adolescent↗
PubMed2004

[Epidemiology of hypertensive retinopathy in young patients after coarctation of the aorta repair].

PURPOSE: Coarctation of the aorta is a cause of childhood hypertension. In some patients hypertension persists after coarctation repair. We evaluated hypertensive retinopathy in patients after coarctation repair, factors correlated with retinopathy, specificity of retinal findings. MATERIAL AND METHODS: 54 patients (mean age of surgery 6 years, mean follow-up time 10 years), were studied. Hypertension was present in all subjects prior to operation. We used ambulatory blood pressure monitoring (ABPM) to follow blood pressure evaluation after repair. Direct ophtalmoscopy was performed in all subjects. RESULTS: Subjects were divided into two groups according to current blood pressure values: group I--normotensive--34 pts, group II--hypertensive--20 pts. Hypertensive angiopathy (I-II K-W) was found in 30% patients (9% in group I and 65% in group II). Subjects with angiopathy were mean 7 years older and had higher blood pressure values (24h mean systolic and load), than those without retinal changes. Patients with and without angiopathy did not differ significantly in preoperative blood pressure values. 81% subjects with angiopathy were hypertensive and 86% patients without retinal changes were normotensive. The most common fundus pathologies were arteriolar tortuosity (35%) and narrowing (28%). CONCLUSIONS: 1. There were no signs of persistent angiopathy in most normotensive patients, even though all of them suffered from hypertension in childhood. 2. In our study hypertensive angiopathy corresponded with present blood pressure values and patient's age. 3. All abnormalities were mild (I-II degree K-W), which also caused some diagnostic difficulties to distinguish between normal and pathological subjects.

Adolescent↗
PubMed2004

Coarctation of aorta repair at the National Heart Institute (1983-1994).

This retrospective study illustrates our approach to this problem over the years, from performing subclavian flap aortoplasty initially to the more accepted procedure now, which is resection and end-to-end anastomosis. Coarctation of aorta in our population is seen in a varying age groups and are also associated with other cardiac anomalies including both acyanotic and cyanotic congenital cardiac defects. Therefore a wide variety of surgical procedures were performed including resection of the coarcted segment and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty and synthetic tube graft interposition. Subclavian flap aortoplasty is not widely practised anymore in favour of resection with end-to-end anastomosis. Fifty four point four percent of patients had isolated coarctation, 10.5% had associated valvular defects, 28.1% had other simple congenital defects and 7.0% had associated complex cyanotic congenital defects. Perioperative mortality was 5.26% and is correlated with the younger age of patients at time of surgery and severity of cardiac failure at time of presentation. We did not see any difference in mortality for patients with complex congenital disease or between the different surgical procedures. However, we did find that in the early period when resection with end-to-end anastomosis was performed, there was a significantly higher incidence of morbidities.

Adolescent↗
PubMed1990

Coarctation of aorta coexisting with pheochromocytoma: report of a case.

A patient was admitted for a study of his hypertension because coarctation of the aorta (COA) was suspected. His history also provided clues of pheochromocytoma. A computed tomography (CT) scan revealed a right-side supraadrenal tumor. A study of urine catecholamine showed a strong positive result. Cardiac catheterization revealed that the patient had a postductal COA and a supraadrenal tumor. Surgery and pathology confirmed that the patient had pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1995

Balloon-expandable stent repair of severe coarctation of aorta.

Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. This study evaluates the feasibility and immediate results of balloon-expandable stent implantation in 10 patients with severe coarctation of aorta. The ages of the patients ranged from 1 month to 43 years; 1 was an infant, 8 were children (mean age 5.3 +/- 4 years), and 1 was an adult. All had an unfavorable anatomy for balloon angioplasty; 9 had isthmus hypoplasia. Balloon predilation was first performed and its immediate effect evaluated. Then a balloon-expandable stent that was 30 mm long and covered the isthmus and coarctation levels was deployed, and it was further expanded to the preselected final diameter (12 +/- 4 mm). A final hemodynamic and angiographic evaluation was then obtained. Full deployment of an incompletely expanded and distally displaced stent in the infant led to aortic disruption that was controlled by a second stent covering the disrupted zone and the isthmus. After balloon angioplasty alone was done, the mean gradient (43 +/- 12 vs 31 +/- 10 mm Hg) and the percentage stenosis (72% +/- 11% vs 54% +/- 11%) had an insufficient decrease. However, after stent implantation was done, the gradient almost disappeared (mean 2 +/- 3 mm Hg). The angiographic stenosis disappeared in 7 patients and was markedly reduced in 3. The ratio of isthmus/descending aorta changed from 0.65 +/- 0.14 to 1 +/- 0.08 (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2003

Staged biventricular repair of Taussig-Bing anomaly with subaortic stenosis and coarctation of aorta.

We present successful procedures for 2 infants who had the Taussig-Bing anomaly with subaortic stenosis and coarctation of the aorta. The initial procedure was coarctoplasty and the Damus-Kaye-Stansel procedure with modified Blalock-Taussig shunt. The second procedure was intraventricular repair (Kawashima procedure), Damus-Kaye-Stansel take-down and the reuse of native aortic and pulmonary valves 19 and 25 months later. Both patients survived the operations and postoperative hemodynamics were excellent at both 28 and 59 months follow-ups.

Aortic Coarctation↗
PubMed1980

Blood pressure and effect of exercise in children before and after surgical correction of coarctation of aorta.

Systolic blood pressure was measured at rest and during exercise in 43 children who had undergone operation for correction of coarctation of the aorta, five children awaiting surgery for coaractation, and 22 control children. Ages ranged from 2 to 15 years, mean 7-6 years. The mean blood pressure of children with coarctation in both the pre- and postoperative groups was significantly higher at rest than in the controls. Of 43 postoperative patients, 15 (35%) were hypertensive (systolic blood pressure more than 95th centile), and 12 of these had a gradient between the upper and lower limb. Seven of the 28 normotensive patients also had a gradient postoperatively. Exercise increased the blood pressure more in children with coarctation than in controls, but there was much individual variability and this difference was not significant. Some children with coarctation developed very high blood pressures on exercise, but this was not related to the presence of a gradient. The mean interval after operation was significantly shorter in the hypertensive group, independent of the age at operation. Hypertension with or without a gradient commonly persists despite apparent successful surgical correction, but exercise is of limited value in its assessment in this age group.

Adolescent↗
PubMed1994

Resection+carotid flap plasty. A new surgical technique for newborn children with coarctation of the aorta and critical hypoplasia of the aortic arch.

Coarctation of the aorta with critical hypoplasia of the aortic arch is a ductus dependent malformation-complex often combined with severe intracardiac malformations with a common denominator: there is a predominance of the pulmonary circulation and a flow restriction through the ascending aorta. Coarctation of the aorta with critical hypoplasia of the aortic arch may be looked upon as a malformation bordering on hypoplastic left heart syndrome. The degree of aortic arch hypoplasia seems to mirror the severity of the intracardiac malformation. The first objective in reconstructing these hearts is to create an unobstructed flow through the aortic arch. Resection of the coarcted segment combined with carotid flap plasty is a surgical alternative which fulfils this objective. We have used the technique in premature-born and severely ill neonates where one-step total correction was considered contraindicated. Thirteen neonates were operated upon, there were no cerebral consequences referable to the carotid artery ligation and no recoarctations.

Anastomosis, Surgical↗