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At least 91 records · Page 5Linked to original sources
PubMed2005

Evidence of vascular dysfunction in young patients with successfully repaired coarctation of aorta.

It is well documented that in patients with coarctation of the aorta life expectancy is not normal even after successful coarctation repair (SCR), primarily due to cardiovascular events. We examined endothelial function in the forearm circulation, the mechanical properties and intima/media thickness in carotid and femoral arteries and the inflammatory process in normotensive patients, after coarctation repair. Fifteen patients, 29+/-2 years old, 12+/-2.9 years after SCR and 16 age- and sex-matched controls were enrolled in our study. Forearm blood flow was determined by gauge-strain plethysmography. Forearm vasodilatory response to reactive hyperemia was expressed as the %change from baseline to post-reactive hyperemia blood flow. High resolution ultrasound was used for determination of intima/media thickness and elastic properties of carotid and femoral arteries. Serum levels of soluble vascular adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), E-selectin, and interleukines 1b (IL-1b) and 6 (IL-6) were determined by ELISA. Reactive hyperemia was significantly decreased in patients compared to controls (p<0.01). Patients with SCR had higher intima/media thickness and decreased distensibility in the carotid arteries than controls (p<0.01 for both). Serum levels of sICAM-1, sSVCAM-1, E-selectin and IL-1b were higher in SCR group than in controls (p<0.05 for all). Adult patients after SCR have impaired endothelial function in the forearm circulation, increased intima/media thickness, decreased distensibility in the carotid arteries and increased levels of proinflammatory cytokines and adhesion molecules than healthy controls. These results may partly explain the high incidence of coronary artery disease in patients with repaired coarctation of the aorta.

Adult↗
PubMedDate not supplied

Repair of acute dissection of the ascending aorta, associated with coarctation of the thoracic aorta in a Jehovah's Witness.

A twenty-year-old white man, with acute dissection of the ascending aorta, underwent emergency resection with dacron graft replacement, utlizing cardiopulmonary bypass. Subsequent repair of coarctation of the thoracic aorta was performed. No blood was administered due to the patient's religious preference. The problems of emergency surgery in Jehovah's Witness patients are discussed.

Adult↗
PubMed1997

[A case of spinal hemorrhage associated with abdominal aortic coarctation].

We report a 59-year-old male with abdominal aortic coarctation presented as paraplegia due to spinal hemorrhage caused by the rupture of abnormally dilated spinal artery. In coarctation of aorta, coarctation is usually located in the aortic isthmus which could be the cause of cervical and upper thoracic myelopathy. However, there has been no report of abdominal aortic coarctation with hemorrhagic transverse myelopathy. In this case hemorrhage occurred after surgical treatment and prescribed warfarin may have exaggerated the outcome.

Aorta, Abdominal↗
PubMed1986

Temporal flow velocity profile in the descending aorta in coarctation.

The temporal blood flow velocity profile in the descending aorta at the diaphragm was investigated using pulsed Doppler echocardiography in patients with documented coarctation of the aorta and in control patients. The ratio of peak systolic to peak diastolic frequency shift, an angle-independent index of pulsatility derived from the Doppler curve, proved to be an excellent indicator of aortic arch obstruction in the absence of a patent ductus arteriosus. Control groups included patients with a systemic right ventricle, systemic ventricular dysfunction and aortic stenosis, to determine if these conditions would confound the test. None of these factors were found to influence significantly the frequency shift ratio. However, the Doppler curves in six patients with interrupted aortic arch or severe coarctation, whose descending aorta was supplied by way of a large patent ductus arteriosus, were similar to those seen in control patients. Two indexes of wave transmission velocity, the rate of acceleration and the time to peak velocity, discriminated less effectively between patients with coarctation and the control patients, particularly those with aortic stenosis. After surgery for coarctation, the Doppler indexes and contour of the Doppler curve discriminated completely between patients with and without residual coarctation.

Adolescent↗
PubMedDate not supplied

Balloon dilatation of native coarctation of aorta in infancy: immediate and follow up results.

We attempted balloon dilatation of native coarctation of aorta in 11 consecutive neonates and infants (age range 28 days-12 months, mean 4.6 +/- 4 months, all males) presenting with congestive heart failure. The peak to peak aorto-aortic systolic pressure gradient fell from 60 +/- 21 mmHg to 13 +/- 7 mmHg (range 0-30 mmHg) (p < 0.001). The diameter of coarcted segment increased from 2.5 +/- 0.65 mm (range 2-3.4 mm) to 5.4 +/- 0.9 mm (range 4-6.4 mm) (p < 0.001). No patient required surgical intervention. The peak instantaneous aorto-aortic systolic Doppler pressure gradient at 17.5 +/- 8.8 months (range 2-21 months) did not show any significant change (mean 17.5 +/- 8.89 mmHg range 0-30 mmHg). All patients except one showed improvement in congestive heart failure. None developed restenosis. On the basis of this experience we recommend that balloon dilatation of native coarctation of aorta in infants in congestive heart failure is a safe and effective procedure.

Angioplasty, Balloon↗
PubMed2003

Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults.

BACKGROUND: Balloon angioplasty for native coarctation of the aorta (CoA) in adults, though promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few studies available have reported on use of balloon-expandable stents in such a situation. We evaluated the use of self- and balloon-expandable stents in patients with suboptimal response to balloon angioplasty (BA). METHODS: Twenty-one hypertensive patients (age, 18 to 61 years; mean, 28.6 +/- 11.2 years) with native CoA and in whom results of BA were suboptimal (ie, residual peak systolic gradient [PSG] >20 mm Hg) underwent stent implantation. Balloon-expandable Palmaz stents were implanted in 5 patients (group A) and self-expandable nitinol aortic stents in the remaining 16 patients (group B). RESULTS: In group A, PSG decreased from 62.8 +/- 10.6 (53 to 80) mm Hg to 28.1 +/- 6.3 (22 to 39) mm Hg after BA. Systolic gradient further decreased to 8.3 +/- 3.9 (2 to 16) mm Hg (P <.001) after implantation of the balloon-expandable Palmaz stent. In group B, PSG decreased from 70.2 +/- 24.6 (40 to 110) mm Hg to 28.4 +/- 9.8 (22 to 42) mm Hg after BA and further reduced to 9.0 +/- 5.5 (4 to 16) mm Hg (P <.001). One of these patients had a nitinol self-expandable stent implanted after a Palmaz stent embolized immediately after deployment. Nitinol stents were easier to deploy and conformed better to aortic anatomy compared with balloon-expandable stents. In group A, the diameter of the coarcted segment increased from 3.8 +/- 0.8 mm to 13.3 +/- 0.8 mm (P <.001) after stent implantation and in group B it increased from 4.5 +/- 1.1 mm to 14.1 +/- 2.1 mm (P <.001). There was no significant difference between the two groups in the PSG and diameter of the coarcted segment before and after stent implantation. With the exception of one case, in which a Palmaz stent embolized, there was no other complication in our series. On follow-up of 12 to 71 months (mean, 40.7 +/- 5.8 months) all the implanted stents remained in their original position and none showed evidence of fracture. Improvement in hypertension was seen in 20 of 21(95.2%) of the patients. On recatheterization and angiography 1.2 +/- 0.6 years after implantation in 19 patients, one patient showed an increase in PSG to 27 mm Hg across the nitinol stent and underwent successful redilation. No increase in gradient was seen in other patients. Beneficial late remodeling was seen in 10 of 14(71.4%) of patients restudied after implantation of self-expandable stent. None of the patients showed aneurysm formation. CONCLUSIONS: Stent implantation is safe and effective in improving suboptimal results after BA for CoA. Self-expandable stents were easier to implant, adapted better to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation as balloon-expandable stents.

Adult↗
PubMedDate not supplied

Aortoarteritis presenting as coarctation of aorta.

An interesting case of Aortoarteritis with clinical features simulating congenital coarctation of aorta (COA) is presented. Clinical pointers of differentiation of these conditions are discussed. Relevant literature is reviewed.

Adult↗