Aortic Wall Injury and Intimal Flap Formation After Neonatal Aortic Valvuloplasty: A Rare and Neglected Complication

AbstractWe report a case of aortic pseudoaneurysm associated with a fractured bare Cheatham-Platinum stent following stenting for aortic coarctation. These complications were recognised 6 years after the implantation procedure and were successfully managed by percutaneous stent graft implantation. Staged approach for stent dilatation might prevent development of aortic pseudoaneurysms. In addition, careful follow-up is warranted after stenting for aortic coarctation, particularly in patients with recognised aortic wall injury.

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A case report of aortic root repair using a pericardial autograft for type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01356-z ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yi Chang ◽

Hongwei Guo ◽

Xiangyang Qian ◽

Fang Fang

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Aortic Wall ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Intimal Flap ◽

Root Repair ◽

Coronary Ostia

Abstract Background Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues. Case presentation A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course. Conclusion Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.

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Immediate Outcomes of Covered Stent Placement for Treatment or Prevention of Aortic Wall Injury Associated With Coarctation of the Aorta (COAST II)

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2015.11.038 ◽

2016 ◽

Vol 9 (5) ◽

pp. 484-493 ◽

Cited By ~ 32

Author(s):

Nathaniel W. Taggart ◽

Matthew Minahan ◽

Allison K. Cabalka ◽

Frank Cetta ◽

Kudret Usmani ◽

...

Keyword(s):

Stent Placement ◽

Aortic Wall ◽

Coarctation Of The Aorta ◽

Covered Stent ◽

Wall Injury

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Long-Term Outcomes of the Coarctation of the Aorta Stent Trials

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010308 ◽

2021 ◽

Author(s):

Ralf J. Holzer ◽

Kimberlee Gauvreau ◽

Kerry McEnaney ◽

Hanano Watanabe ◽

Richard Ringel

Keyword(s):

Cumulative Incidence ◽

Antihypertensive Medication ◽

Aortic Wall ◽

Coarctation Of The Aorta ◽

Aortic Aneurysms ◽

Minimum Diameter ◽

Stent Diameter ◽

Wall Injury

Background: Long-term outcome data of stent-implantation for coarctation of the aorta are limited. We report up to 5 years of postimplant follow-up in patients enrolled into the COAST (Coarctation of the Aorta Stent Trial) and the COAST II trial (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta), evaluating the bare and Covered Cheatham-Platinum Stents for the treatment of coarctation of the aorta and associated aortic wall injury. Methods: Data was prospectively collected during the 2 multi-center studies, enrolling 248 patients (COAST: n=121, COAST II: n=127). Late follow-up data (48–60 month) was compared with immediate (1 month) and early (12 months) follow-up. Results: There was a notable decrease in the use of antihypertensive medication, from 53% at immediate, to 42% at early, and 29% at late follow-up. The cumulative incidence of stent fractures was 0% immediately, 2.9% at early, and 24.4% at late follow-up. Independent predictors for stent fractures at late follow-up were age <18 years, male sex, minimum stent diameter ≥12 mm, and use of bare metal stent. The cumulative incidence of reintervention was 1.6% at immediate, 5.1% at early, and 21.3% at late follow-up. Independent predictors for reinterventions at late follow-up were age <18 years, post implantation systolic arm-leg blood pressure gradient ≥10 mm Hg, minimum stent diameter at implantation <12 mm, and initial coarctation minimum diameter <6 mm. There were 13 patients with aortic aneurysms, with a cumulative incidence of 6.3% at late follow-up. Conclusions: Coarctation stenting is effective at maintaining obstruction relief up to 60 months postimplant with reduction in the number of patients requiring antihypertensive medication. However, an increase in-stent fractures and reinterventions were observed between medium and long-term follow-up. Covered stents appear to confer some protection from the development of stent fractures but do not provide complete protection from late aneurysm formation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT00552812 and NCT01278303.

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