Sudden death 10 years after patch aortoplasty for coarctation

1998 ◽  
Vol 8 (3) ◽  
pp. 383-385 ◽  
Author(s):  
Michael Hauser ◽  
James pollock ◽  
Neil Wilson
Keyword(s):  
General Practitioner ◽  
Sudden Death ◽  
Aortic Coarctation ◽  
Surgical Intervention ◽  
Coarctation Of The Aorta ◽  
Aortic Dilation ◽  
Initial Operation ◽  
Dacron Patch ◽  
Progressive Aortic Dilation

AbstractA 25-year-old man died 10 years after a Dacron patch was used to repair a coarctation of the aorta. Death was due to rupture of an unrecognized aneurysm at the site of the patch. After the initial operation at the age of 15 years, there had been no signs of residual or recurrent obstruction. He had no evidence of hypertension and was discharged some years later from regular hospital follow-up to the care of his general practitioner. We strongly recommend that patients who have undergone repair of aortic coarctation by patch aortoplasty should have lifelong follow-up in cardiac units with imaging facilities for monitoring aortic dilation. We would now recommend surgical intervention in the presence of progressive aortic dilation.

scholarly journals P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E A Khalifa ◽  
S Helmy ◽  
S F Mohamed ◽  
M Alkuwari
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Coarctation Repair ◽  
History Of ◽  
Dacron Patch

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

Remote congenital cerebral arteriovenous fistulae associated with aortic coarctation

1992 ◽  
Vol 76 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Francis H. Tomlinson ◽  
David G. Piepgras ◽  
Douglas A. Nichols ◽  
Daniel A. Rüfenacht ◽  
Sue C. Kaste
Keyword(s):  
Caesarean Section ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Vascular Lesions ◽  
Prenatal Ultrasonography ◽  
Arteriovenous Fistulae ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A neonate presented with anatomically discrete cerebral arteriovenous fistulae located in the right sylvian fissure and the cerebellar vermis that were initially detected by prenatal ultrasonography. Following delivery of the baby by Caesarean section, both malformations were treated by surgical obliteration. These intracranial vascular lesions were associated with cardiac anomalies and a periductal coarctation of the aorta, which was treated with a left subclavian rotational arterial pedicle repair. Follow-up examination of the infant at age 13 months demonstrated an excellent clinical result with normalization of the circulation. The pathophysiology of this syndrome is discussed and the literature reviewed.

scholarly journals For coarctation of the aorta in infants younger than three months

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 27-33
Author(s):  
Slobodan Ilic ◽  
Irena Vukovic ◽  
Djordje Hercog ◽  
Milan Vucicevic ◽  
Voja Parezanovic ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Subclavian Artery ◽  
Aortic Coarctation ◽  
Cox Regression ◽  
Coarctation Of The Aorta ◽  
Intimal Thickening ◽  
Young Infants ◽  
Arch Obstruction ◽  
The Mean

INTRODUCTION. Recurrent coarctation is a complication which is seen at a consistent rate following repair for coarctation of the aorta in young infants. OBJECTIVE. This retrospective analysis was carried out to compare the results between resection with end-to-end anastomosis (ETE), and resection with extended end-to-end anastomosis (E-ETE), in this age group during late follow-up period. The role of ductus arteriosus is not clearly defined and the second objective of this study was to analyze intimal thickening in aortic coarctation. MATERIAL AND METHODS. From 1999 to 2003, 45 patients less than 3 months of age un?derwent repair of aortic coarctation. Mean age was 24 days (2-89 days), average weight was 3.5?0.6 kg (2.4-5.2 kg). The method of repair was ETE in 14 (31.1%) patients, E-ETE in 29 (64.4%) patients and other techniques were applied in 2 cases. Demographic, morphometric, clinical and operative variables were analyzed for correlation with recurrent arch obstruction. In order to characterize the components of intimal thickening in coarctation, narrowed segments of aorta resected from 16 neonates during surgery were examined immunocytochemically and by electron microscopy. For light microscopy, the specimens were dehydrated in graded ethanol (70-100%), cleared in xylol and embedded in paraffin. Immunocytochemical staining was performed in 5 ?m sections from formaldehyde-fixed paraffin-embedded blocks, using a labeled streptavidin-biotin method with an LSkit (Dako). RESULTS. Early mortality was 6.7% (CI 95%, 2.9%-10.4%). All early deaths (3 patients) occurred in infants with associated ventricular septal defects (p<0.05). The mean follow-up for all patients was 30?21 months (range 1.5-63 months). During mean follow-up of 2 months, recurrent arch obstruction was diagnosed in 9 patients (21.4%). Two patients with associated complex heart defects died before reintervention, one had mild gradient on catheterization (20 mm Hg) and one is waiting for catheterization. Five patients were reoperated and the mean time to reintervention was 4 months (range 2.6-6 months). Kaplan-Meier freedom from recoarctation was 78.1?6.4% at 5 years in the whole group. Freedom from recoarctation was 60.6?15.4% at 25 months in ETE group and 86.2?6.4% at 60 months in E-ETE group (p=0.062). Factors associated with recoarctation, obtained by univariable Cox regression, included abnormal right subclavian artery (p=0.003), hypoplastic proximal transverse aortic arch (Z?-2, p=0.025) and weight at op?eration ?3 kg (p=0.02). Abnormal origin of the right subclavian artery was the only independent predictor of recoarctation obtained by multivariable Cox regression analysis. DISCUSSION. All examined specimens had intimal thickening of the posterior aortic wall, with accumulation of smooth muscle cells (SMC) with ? smooth muscle actin (?-SMA) and vimentin-immunoreactivity (but not desmin and MHC) and also expressed PCNA and S-100. In the inner media of the anteromedial wall of the aorta, all specimens had large number of SMC expressing desmin and MHC. SMC in the inner media exhibit contractile phenotype and their origin could be ductal. CONCLUSION. Both procedures are effective for coarctation repair in young infants. Risk of recoarctation is a function of the complex anatomy of the arch, while residual ductal tissue may play a significant role.

Aortic aneurysms after correction of aortic coarctation: A systematic review

VASA ◽  
2010 ◽  
Vol 39 (1) ◽  
pp. 3-16 ◽  
Author(s):  
von Kodolitsch ◽  
Aydin ◽  
Bernhardt ◽  
Habermann ◽  
Treede ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Aortic Coarctation ◽  
Significant Risk ◽  
Coarctation Of The Aorta ◽  
Aortic Aneurysms ◽  
Percutaneous Therapy ◽  
Presenting Symptoms

Despite advanced techniques for surgical or percutaneous therapy coarctation of the aorta continues to carry a high risk of aneurysmal formation. Mortality of these aneurysms ranges between <1 and >90%, reflecting remarkable differences in surgical strategies and the follow-up management of coarctation. We review the frequency, anatomical types, risk factors and mechanisms of aortic aneurysm forming late after surgical or percutaneous therapy of aortic coarctation. We emphasize that aneurysms do not form exclusively at the site of previous intervention, but also at remote locations such as the ascending aorta. Moreover, aneurysm formation may only in part be attributed to a specific technique of coarctation therapy, and we emphasize the role of a bicuspid aortic valve and inherent weakness of the aortic wall as significant risk factors for aneurysm after aortic coarctation. We report the presenting symptoms, follow-up protocols, and imaging criteria for local and proximal aneurysms. Finally, we discuss criteria for prophylactic intervention at the site of such aneurysms, and present therapeutic options for different types of aneurysms. With this systematic review, we wish to provide data for establishing more uniform strategies for preventing, diagnosing and treating aneurysms associated with aortic coarctation.

Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey

2013 ◽  
Vol 24 (4) ◽  
pp. 675-684 ◽  
Author(s):  
Ali Baykan ◽  
Nazmi Narin ◽  
Abdullah Ozyurt ◽  
Mustafa Argun ◽  
Ozge Pamukcu ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Aortic Coarctation ◽  
Antihypertensive Drugs ◽  
Coarctation Of The Aorta ◽  
Arterial Injury ◽  
Stent Migration ◽  
Long Term Results ◽  
Complication Rates ◽  
Significant Difference

AbstractObjectives: Our aim was to evaluate patients who were treated by percutaneous stent implantation. Methods: Patients with aortic coarctation (n = 35) who had been treated with 38 stents – 12 bare and 26 covered – were evaluated. The demographics and procedural and follow-up data were recorded from hospital registers and compared according to patient specifications, for example, weight and coarctation nature. Results: The procedure was successful in all patients. There was a statistically significant difference between the patients with native coarctation (n = 17) and those with recurrent coarctation (n = 18) in terms of pre-procedural blood pressures, systolic gradients, coarctation diameters, and the ratio of the coarctation site diameter to the descending aorta diameter. Although all patients received antihypertensive drugs before the procedure, the drug was discontinued in 26 patients during follow-up (p < 0.001). Stent migration was observed in four patients with recurrent coarctation (11.4%), and peripheral arterial injury was seen in three patients (8.5%). The mean follow-up time was 34 ± 16 months. On average, 21 (6–42) months after the procedure, six patients underwent cardiac catheterisation. At least 2 years after the procedure, tomography was performed in 20 patients (57.2%). Patients who were evaluated by multi-slice computerised tomography revealed no pathologies. There was no statistically significant difference between the five patients weighing less than 20 kg and the other 30 patients in terms of demographic and procedural characteristics, procedure success and complication rates, and follow-up data. Conclusion: Stent implantation for aortic coarctation is a method yielding satisfactory results in reducing coarctation gradients, efficient enlargement of the lesion area, and resolution of hypertension for children, including those weighing less than 20 kg.

Severe coarctation of the aorta in a 900 g donor of twin–twin transfusion newborn with successful repeated transcatheter angioplasty: a case report

2014 ◽  
Vol 25 (2) ◽  
pp. 394-397 ◽  
Author(s):  
Iyad Al-Ammouri ◽  
Saba Jaradat ◽  
Jinan Radwan
Keyword(s):  
Case Report ◽  
Femoral Artery ◽  
Aortic Coarctation ◽  
Umbilical Artery ◽  
Coarctation Of The Aorta

AbstractWe present a case of severe aortic coarctation in a donor of twin–twin transfusion syndrome. Patients underwent two angioplasty procedures at age 7 and 47 days, weighing 900 and 1500 g, respectively. Umbilical artery approach was used in the first procedure, and femoral artery approach was used in the second. Follow-up at the age of 13 months showed no recurrence of coarctation.

scholarly journals Surgical Management of a Case of Severe Coarctaton of Aorta with Biscuspic Aortic Valve

2018 ◽  
Vol 36 (1) ◽  
pp. 33-36
Author(s):  
Md Nazmul Hasan ◽  
Md Abu Siddique ◽  
Sajal Krishna Banerjee ◽  
Abu Sadique Abdullah
Keyword(s):  
Aortic Coarctation ◽  
Clinical Signs ◽  
Coarctation Of The Aorta ◽  
Cardiac Malformation ◽  
Exertional Dyspnea ◽  
Term Survival ◽  
Congenital Cardiac Malformation ◽  
Fourth Decade

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 45-year-old male. Our patient was relatively asymptomatic until he presented with exertional dyspnea and fatigue in his fourth decade of life. The patient was managed by surgery of aorta. After the 6 months follow-up visit, the patient was in good clinical condition.J Bangladesh Coll Phys Surg 2018; 36(1): 33-36

scholarly journals Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Brian A. Boe ◽  
Aimee K. Armstrong ◽  
Sarah A. Janse ◽  
Eméfah C. Loccoh ◽  
Katie Stockmaster ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Balloon Angioplasty ◽  
Surgical Intervention ◽  
Arterial Occlusion ◽  
Coarctation Of The Aorta ◽  
Stent Fracture ◽  
Single Center ◽  
Minimum Diameter ◽  
Technical Factors

Background: Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients. Methods: A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed. Results: Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3–7.9) years and 10 (5.5–20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18–42] to 0 mm Hg [IQR, 0–2]; P < 0.05) and median minimum diameter (3.6 mm [IQR, 2.4–4.8] to 7.7 mm [IQR, 6.5–9.4]; P <0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5–63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8–116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion. Conclusions: Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.

Restenosis after aortic stenting

2004 ◽  
Vol 14 (2) ◽  
pp. 210-211 ◽  
Author(s):  
Joydeep Mookerjee ◽  
Derek Roebuck ◽  
Graham Derrick
Keyword(s):  
Williams Syndrome ◽  
Aortic Coarctation ◽  
Proliferative Response ◽  
Aortic Wall ◽  
Coarctation Of The Aorta ◽  
Aortic Stenting ◽  
Primary Stenting

Aortic coarctation is a recognized arteriopathy in patients with Williams’ syndrome. We present an adolescent with Williams’ syndrome who developed rapid restenosis after primary stenting of coarctation of the aorta. We believe such restenosis within the stent is due to a proliferative response of the abnormal aortic wall. Attention should be paid to the potential for restenosis during follow-up after stenting of aortic coarctation in patients with Williams’ syndrome.

Sign in / Sign up

Export Citation Format

Share Document