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At least 19 recordsLinked to original sources

Aortic coarctation, aortic valvular stenosis, and coronary artery disease: combined one-stage surgical therapy operation.

The presentation of simultaneous severe coarctation of the descending aorta and severe aortic valve disease is uncommon. We describe the management of simultaneous association of aortic coarctation, aortic valve disease, and ischemic cardiomyopathy and describe a one-stage surgical approach for the correction of all pathologies. After performing the aortic valve replacement and myocardial revascularization, coarctation was solved by means of a prosthesis between the ascending aorta and the abdominal aorta. There were no evidence of myocardial ischemia during exercise testing and the blood pressure is normal.

Aorta, Abdominal↗

Changes in regional vascular resistance in canine aortic coarctation.

Aortic coarctation was created experimentally in dogs and regional blood flows were measured at various times thereafter with radioactive microspheres in the conscious state. Mean arterial pressure increased moderately proximal to the stenosis, whereas distally it was reduced below control immediately, returning progressively toward control over 28 days. Blood flows were compared in tissues that are found both proximally and distally (skeletal muscles, skin and bones). In several groups of muscles located in the anterior part of the body, vascular conductance increased during the first hours after coarctation, then decreased below control. A similar pattern was observed in muscles of the hind leg. In the skin and in the bones of the front leg and of the hind leg, vascular conductance also increased in the early stages and decreased during the late stages. It therefore appears that aortic coarctation in dogs is characterized by a late generalized decrease in vascular conductance that extends to tissues which are never exposed to increased arterial pressure. These findings suggest that a systemic vasoconstrictor influence (possibly the measured increase in plasma renin activity) overrides local mechanisms in the control of regional circulations.

Animals↗

Klippel-Feil syndrome associated with aortic coarctation.

Aortic coarctation was diagnosed in a 27-year-old man with Klippel-Feil syndrome, an inborn skeletal defect of the vertebral column associated with anomalies of various organs. The presented findings are discussed in the context to the theory of vascular artery supply disruption sequence during embryogenisis as a potential explanation for the pathogenesis of morphological defects of Klippel-Feil and associated syndromes.

Adult↗

Single-stage treatment of aortic coarctation and aortic valve disease.

Surgical management of thoracic aortic coarctation associated with severe aortic valve disease is difficult in most cases. As staged procedures are associated with a higher rate of morbidity and mortality, simultaneous operative management of both lesions is desirable. From 1997 to 2001, 9 patients (8 males and 1 female with a mean age of 30.1 +/- 10.4 years) with this condition underwent simultaneous ascending aorta-infrarenal abdominal aorta bypass graft and aortic valve replacement. One patient died from failure of the extracorporeal circulation during the operation. Another patient suffered from partial intestinal obstruction in the early postoperative period but was successfully treated. The underlying pathology was successfully corrected in the 8 surviving patients, whose blood pressure in the upper limbs was reduced while that in the lower limbs rose. Being easier to manage, the single-stage approach with extraanatomic bypass is safe and effective for managing this aortic complication.

Adolescent↗

Abdominal aortic coarctation inducing aortic occlusion and renovascular hypertension.

Abdominal aortic coarctation is a rare, non-atherosclerotic disease. It is a functionally significant at an early age when associated with aortic branch stenosis and renovascular hypertension. The pathogenesis of aortic constrictive lesions remains unknown, but may be related to developmental error or aortic growth arrest and various hypotheses have been reported. When the renal arteries are involved by the coarctation, severe hypertension is common at an early age and in untreated patients, life-threatening complications commonly occur. Patients who reach the age of 40 years generally have the coarctation below the renal arteries but even when the renal arteries are not involved by the coarctation, renovascular disease may still occur due to secondary atherosclerosis. Aortic thrombosis secondary to abdominal aortic coarctation with renovascular disease and lower limb ischemia, occurring in a 63-year old woman, is reported.

Aorta, Abdominal↗

Effects of aortic coarctation on aortic antioxidant enzymes and NADPH oxidase protein expression.

Abdominal aortic coarctation above the renal arteries leads to severe hypertension above the stenotic site and provides a model for simultaneous testing of the effects of increased and decreased pressure and consequently shear stress in the same animal. The effects of increased pressure, per se, on oxidative stress and antioxidant enzyme expression is unknown. We studied the protein expressions of antioxidant enzymes and NADPH oxidase (gp91phox subunit) in the aortic segments above and below the stenosis site in sham-operated control and aortic-banded rats at four weeks postoperatively. Compared with the control group, the banded group showed significant up-regulation of NADPH oxidase, catalase (CAT), Cu/Zn superoxide dismutase (SOD) and Mn SOD protein content in the thoracic aorta. In contrast, Mn SOD, Cu/Zn SOD and NADPH oxidase protein abundance were unchanged in the abdominal aortic segment below the stricture where blood pressure is not elevated, whereas CAT protein abundance was also elevated in the abdominal aorta. No changes were noted for glutathione peroxidase (GPX) protein content either in the thoracic or abdominal aortic segments. Coarctation-induced hypertension is associated with increased aortic CAT, Cu/Zn SOD, Mn SOD and NADPH oxidase protein expression. The up-regulation of NADPH oxidase increases reactive oxygen species (ROS) generation noted in the present study and contributes to inactivation of nitric oxide (NO) as shown previously in this model. Upregulation of antioxidant enzymes may be a compensatory response in the face of elevated pressure and oxidative stress. The normality of protein abundance in the abdominal aorta wherein blood pressure is not elevated points to the role of baromechanical factors, as opposed to circulating humoral factors that were similar in both segments, as a mechanism responsible for increased antioxidant enzyme expression.

Animals↗

Usefulness of MRI in the follow-up of patients with repaired aortic coarctation and bicuspid aortic valve.

BACKGROUND: The long-term outcome of repaired aortic coarctation may be complicated by dilatation of the ascending aorta notably in patients with bicuspid aortic valve. Magnetic resonance imaging was used to compare the size of the ascending aorta in patients with bicuspid or tricuspid aortic valve. METHODS: In 50 patients with a repair of aortic coarctation, the size of the ascending aorta was measured in a bicuspid aortic valve group (n=11) and a tricuspid aortic valve group (n=39). The aortic diameter was measured at the level of the sinus of Valsalva and at the widest part of the ascending aorta using magnetic resonance imaging. RESULTS: The mean age of patients at surgical repair was respectively 2.2+/-3.3 years for the bicuspid aortic valve group and 2.5+/-3.5 years for the tricuspid aortic valve group (p=NS) and the mean age at the time of the magnetic resonance imaging was 10.2+/-4.7 years and 9.3+/-5.9 years (p=NS) respectively. A significant difference in the aortic diameter was found between the bicuspid aortic valve group and the tricuspid aortic group both at the level of sinus of Valsalva (34.8+/-8.2 mm, 19.5+/-4.4 mm, respectively, p<0.01) and at the level of the ascending aorta (36.8+/-7.2 mm, 16.9+/-3.4 mm, respectively, p<0.01). CONCLUSIONS: The occurrence of ascending aortic dilatation is significantly associated with the presence of a bicuspid aortic valve. This requires long-term follow-up, which can be effectively performed by magnetic resonance imaging.

Aorta↗

Complications following reparative surgery for aortic coarctation or interrupted aortic arch.

Repair of aortic coarctation or interrupted aortic arch continues to be associated with major long-term morbidity. Thus, we conducted a review of 87 consecutive patients who underwent aortic arch repairs, focusing particular attention on the complications that developed. A two-stage strategy was employed if cardiac lesions were associated. The median age at surgery was 1.5 months with a range of 12 h to 56 years. The aortic arch was repaired using end-to-end anastomosis, subclavian flap aortoplasty, subclavian arterial turning-down aortoplasty, patch aortoplasty, tube graft interposition, or other methods. There were 10 patients who died soon after repair, and all of whom had complex cardiac anomalies. Of the remaining 77 patients, 8 developed recurrent stenosis. These 8 patients were all similar in age, being under 3 months old, and weighing 4 kg or less. A multivariable analysis of the infants identified interrupted aortic arch as an independent risk factor for the development of this complication with an odds ratio of 6.45. Complications following prosthesis-free techniques were similar in prevalence and timing. All reinterventions were mortality-free, but catheter dilation and patch aortoplasty were not always successful. Three extraanatomic bypasses were successfully performed, and one adult who had undergone a previous graft and pseudoaneurysm operation was successfully treated with an extraanatomic bypass. These findings led us to conclude that the initial repair should be performed without a prosthesis, and that reintervention for stenosis should combine catheter dilation and extraanatomic bypass.

Adolescent↗

Cor triatriatum sinistrum, aortic coarctation and bicuspid aortic stenosis in an adult.

Cardiac anomalies are usually diagnosed early in life, which is particularly true for their various combinations. The diagnosis in adulthood is rare. Here we report the case of a young man with an aortic coarctation corrected at the age of 16, however the associated stenotic bicuspid aortic valve and cor triatriatum sinistrum were corrected after Streptococcus viridans endocarditis 7 years later.

Abnormalities, Multiple↗

Influence of age on survival, late hypertension, and recoarctation in elective aortic coarctation repair. Including long-term results after elective aortic coarctation repair with a follow-up from 25 to 44 years.

The optimal age for elective repair of aortic coarctation is controversial. The optimal age should be associated with a minimal risk of recoarctation, late hypertension, and other cardiovascular disorders. The purpose of this retrospective study is to determine the actuarial survival after aortic coarctation repair 25 years or more after operation and to calculate the optimal age for elective aortic coarctation repair. From 1948 to 1966, 120 consecutive patients underwent aortic coarctation repair. Eighty-seven were male (72.5%). The mean age at operation was 15.5 years (SD +/- 9.1 years). Resection and end-to-end anastomosis was performed in 103 patients (85.8%). Early mortality occurred in 6 patients as a result of surgical problems, whereas late mortality in 15 patients was predominantly caused by cardiac causes. The mean follow-up period was 32 years (range 25 to 44.2 years). Ninety-two patients 96.8%) were in New York Heart Association class I. The probability of survival 44 years after operation was 73%. Patients younger than 10 years at operation had the highest probability of survival at 97%. Multivariate analysis produced age at operation as the only incremental risk factor for the occurrence of recoarctation, of late hypertension, and of premature death. So that these sequelae can be avoided, elective aortic coarctation repair should be performed around 1.5 years of age. At that age, the probability of recoarctation will have decreased to less than 3%, and the probability of upper body normotension and long-term survival will be optimal.

Actuarial Analysis↗