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At least 307 records · Page 17Linked to original sources
PubMed2005

Role of surgery in the management of the adult patient with coarctation of the aorta.

Adult patients with coarctation of the aorta have a range of clinical presentations. These include the presence of additional cardiovascular anomalies (predominantly aortic valve abnormality) and presentation with complications after coarctation repair in childhood (such as recurrent coarctation or aneurysm formation). Developments in endovascular technology over the past decade may potentially reduce the morbidity from open surgical repair. However, some cases are unsuitable for endovascular repair and open surgical techniques continue to play a part in the management of these patients. The number of adult patients with coarctation is very small and a trial comparing surgical and endovascular repair techniques would be difficult to arrange. A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) is best equipped to manage the unique and complex problems that affect these patients. The current surgical options and factors governing the choice of approach are reviewed.

Adult↗
PubMed1982

Management of ascending aortic aneurysm complicating coarctation of the aorta.

Four patients with coarctation of the aorta complicated by an aneurysm of the ascending aorta are described. One patient, treated only medically, died suddenly. For the 3 patients who underwent operation, management was similar. Pharmacological control of blood pressure and repair of the aortic coarctation to achieve anatomical reduction in afterload (stage I) were followed after an interval of one to five weeks by surgical repair of the ascending aortic aneurysm (stage II). Initial repair of the coarctation relieves proximal hypertension, thereby decreasing the chance of progressive dissection or rupture of the aneurysm. It also permits safe arterial cannulation for perfusion during correction of the aneurysm in the second stage. In patients not requiring valve replacement in stage II, continued long-term follow-up for progression of aortic valvular disease appears to be necessary.

Adolescent↗
PubMed1992

[The endovascular correction of aortic coarctation].

The endovascular balloon dilatation of the aorta coarctation performed on indications and at the optimal terms is the radical correction of the defect with a pronounced positive effect in 90% of 43 patients. No aneurysms and restenoses were found. Retained collaterals allow avoidance of the abdominal syndrome and paradoxical hypertension. Contraindications for catheter angioplasty are thought to include agenesia or considerable hypoplasia of the aorta, the absence of the aorta lumen in the zone of coarctation, its considerable length and the presence of prestenotic aneurysms. A short and noncomplicated postoperative period makes the method sufficiently economical.

Adolescent↗
PubMed1986

Balloon dilation angioplasty for coarctation of the aorta.

Eleven patients with coarctation of the aorta (C of A) underwent balloon dilation angioplasty at the University of Arizona from November 1983 to January 1985. Eight had previously undergone surgery and 3 had native C of A. Two operations were considered unsuccessful: 1 in a patient who underwent tube graft--descending aortic anastomosis narrowing and 1 in a patient with a native wedge type of C of A. Overall mean gradient fell from 47 to 13 mm Hg immediately after the procedure. Mean gradient at repeat catheterization in 7 patients (mean 8 months after angioplasty) was 6 mm Hg. Five patients showed a transient increase in the gradient measured on the day after angioplasty, with 3 showing a fairly marked increase. Values returned to levels equal to or less than gradients measured immediately after the procedure. Angiographic findings at follow-up catheterization in 7 patients showed no evidence of aneurysm formation in either the operative group or in the 2 patients with native C of A who had a membrane type of deformity. Mean C of A to ascending aortic diameter ratios increased from 0.44 to 0.80. At repeat angiography, the mean ratio was 0.76 in the 7 patients studied. Further longitudinal studies in these patients are necessary before reaching conclusions about the advantage of this procedure over surgery, but these early longitudinal results are encouraging for the populations studied: postoperative patients and patients with native membrane types of C of A.

Adolescent↗
PubMed1994

Balloon angioplasty with stent implantation in experimental coarctation of the aorta.

BACKGROUND: Balloon angioplasty of coarctation of the aorta is an effective method of treatment but is complicated by tearing of the aortic intima, formation of aneurysms, and restenosis. Stent placement at the time of balloon dilation could prevent restenosis and could also prevent progression of intimal tears to aneurysms. The purpose of this study was to evaluate the feasibility of balloon dilation and implantation of balloon-expandable stents in an experimental model of coarctation and to examine the effect of stent placement at the site of surgically created stenosis. METHODS AND RESULTS: Coarctation of the aorta was surgically produced in 11 juvenile swine. Simultaneous coarctation angioplasty and stent implantation was performed in 10 animals 34 +/- 7.8 days after surgery. Repeat catheterization was performed 59 +/- 6 days after stent implantation. Five animals underwent reexpansion of stents with subsequent follow-up catheterization. Aortic specimens were examined by light microscopy and scanning electron microscopy. Coarctation angioplasty with stent implantation was successful in all, with an increase in coarctation diameter from 46 +/- 8.5% to 90 +/- 12.2% of proximal aortic diameter (P = .0001). Systolic pressure gradient decreased from 32 +/- 19.8 to 0.5 +/- 2.8 mm Hg (P < .001). All stents were patent at follow-up catheterization, with no evidence of intraluminal thrombosis. Reexpansion in five animals increased the stent diameter from a mean of 77.4 +/- 12.1% to 93 +/- 11.0% of proximal aortic diameter (P = .02). Gross examination of aortic specimens demonstrated formation of neointima over the stent wherever the stent struts were in contact with the aortic wall. The stent occupied a subintimal position and produced minimal compression of the underlying media. Medial compression was noted immediately beneath stent struts, but there was no evidence of intimal or medial dissection. CONCLUSIONS: Balloon angioplasty with simultaneous implantation of balloon-expandable stents is effective in relieving aortic obstruction in experimental coarctation. Reexpansion of the rigid stent can be performed in an area of surgical aortotomy and coarctation without significant intimal or medial injury. Stent implantation may be useful in preventing restenosis and aneurysm formation after angioplasty of coarctation.

Angioplasty, Balloon↗
PubMed1985

Therapeutic effect of propranolol on paradoxical hypertension after repair of coarctation of the aorta.

Patients undergoing repair of coarctation of the aorta often have self-limited but severe hypertension in the first week after surgery (paradoxical hypertension). We conducted a controlled trial of treatment with propranolol before repair of coarctation of the aorta in 14 children to determine whether the drug would prevent paradoxical hypertension. Seven patients were randomly assigned to receive propranolol for two weeks before surgery and throughout the first postoperative week, and seven patients were assigned to receive standard postoperative care. Both groups had a similar significant (P less than 0.05) increase in the plasma norepinephrine level in response to surgery; however, when compared with no treatment, treatment with propranolol reduced not only the rise in systolic (P = 0.004) and diastolic (P = 0.003) blood pressure but also the postoperative increase in plasma renin activity (P less than 0.01). We conclude that prophylactic propranolol can prevent paradoxical hypertension and should therefore become a routine part of the operative care of patients with coarctation of the aorta.

Aortic Coarctation↗
PubMedDate not supplied

[The status of the adenylate cyclase system in rat myocardium in dystrophic degeneration].

Development of myocardial dystrophy, occurred after left-lateral vagotomy, aorta coarctation and novodrine administration, was accompanied by impairments in the adenylate cyclase system of rat myocardium at the step of secondary messenger production (cAMP) managed by adenylate cyclase of outer membranes. Dystrophic degenerations appear to depend on the type of deteriorations in intracellular enzymatic systems, which are regulated by cAMP, as shown by dissimilar response of myocardium to the agonist effect; this effect was increased in dystrophy caused by denervation and was altered only slightly after aorta coarctation and novodrine administration.

Adenylyl Cyclases↗
PubMed1987

Postoperative hypertension after repair of coarctation of aorta in children: protective effect of propranolol?

The effects of the nonselective beta blocker, propranolol, on coarctectomy-induced hypertension were evaluated relative to changes in cardiac function, sympathetic tone, and plasma renin activity (PRA). A randomized, placebo-controlled, double-blind, age-stratified design was employed. Propranolol (n = 11, mean age 9.4 years) or placebo (n = 12, mean age 10.2 years) was started 2 days before surgery and continued until 6 days after surgery. In patients on placebo, systolic and diastolic blood pressure, heart rate, and cardiac index increased rapidly and peaked within 1 day after surgery. Over the ensuing days these increases gradually abated. Plasma epinephrine and PRA increased markedly within 12 hours after surgery, but returned quickly toward preoperative levels. In contrast, plasma norepinephrine increased more gradually and remained elevated longer. In patients on propranolol, systolic blood pressure, heart rate, cardiac index and PRA showed only negligible increases. However, diastolic blood pressure, increased even faster with propranolol than with placebo but to the same extent. Plasma catecholamines showed similar increases on the two treatments. Only in the placebo group was the code broken in the intensive care unit because of hypertension uncontrolled by sodium nitroprusside; this occurred in 6 of 12 patients. We conclude that nonselective beta blockade ameliorates the hyperdynamic circulation and increase in systolic blood pressure following coarctectomy. The initial increase in diastolic blood pressure following surgery in the propranolol group may have been caused by vascular beta-2-receptor blockade resulting in unopposed alpha-receptor-mediated vasoconstriction.

Adolescent↗
PubMed1989

[A case of spinal artery aneurysm presenting transverse myelopathy associated with coarctation of the aorta].

We report a case of spinal artery aneurysm, secondary to the coarctation of aorta, who presented with initial signs of transverse myelopathy. A 45-year-old woman was admitted to the hospital because of quadriplegia. She had a history of subarachnoid hemorrhage traced to unknown origin. Physical examination revealed hypertension of upper limbs, but any artery of the lower limbs was not palpable. On neurological examination, she was alert, quadriplegic, and anesthetic below C4 level. Neck was stiff and meningeal signs were presented. The liquor was bloody. Myelography demonstrated complete block at C5-6. The right retrograde brachial angiography showed an aneurysm of cervical spinal artery. Digital subtraction angiography demonstrated a coarctation of the aorta. Coarctation of the aorta was considered to have caused spinal artery aneurysm, and is the first reported case in Japan.

Aneurysm↗
PubMedDate not supplied

Doppler echocardiography during exercise to predict residual narrowing of the aorta after coarctation resection.

Blood pressure measurements and Doppler echocardiography at rest and during exercise were performed in 36 patients at an average 17 years after coarctation resection. Interest focused on the study of Doppler systolic and diastolic gradients and half-times during exercise. Blood pressure gradients and Doppler values were compared with the degree of narrowing at the site of the anastomosis measured by magnetic resonance imaging. A systolic half-time of >110 ms together with a diastolic gradient of >/=17 mmHg on exercise Doppler sonography predicted a residual isthmic narrowing of >30%. We propose the use of this noninvasive method for identifying patients with narrowing of >30% at the site of the anastomosis after coarctation resection. In these cases evaluation by an imaging technique is necessary to confirm the need for surgery.

Adolescent↗
PubMed1986

The surgical anatomy of the heart in tubular hypoplasia of the transverse aorta (preductal coarctation).

Two hundred nineteen hearts with preductal coarctation (tubular hypoplasia) were analyzed in the laboratory to aid in surgical correction. One hundred fourteen were without and 105 were with ventricular septal defect. We believe the following anatomic findings may be responsible for the mortality and morbidity in surgical repair. The smallness and thinness of the left atrium (40% in those hearts without and 24% in those with ventricular septal defect); the smallness and thinness of the left ventricle (46% in those without and 32% in those with ventricular septal defect); the presence of mitral stenosis (35% in those without and 24% in those with ventricular septal defect); the presence of unicuspid or bicuspid dysplastic aortic valve (49% in those without and 50% in those with ventricular septal defect); the presence of a combination of aortic and mitral stenosis (22% in those without and 9% in those with ventricular septal defect); the location of the ventricular septal defect when present; and the possibility of stenosis or insufficiency of the dysplastic aortic valve in the late postoperative period.

Aortic Coarctation↗