Long-term follow-up of aortic coarctation in infants, children and adults

1993 ◽  
Vol 3 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Prasad Mathew ◽  
Douglas Moodie ◽  
Gary Blechman ◽  
Carl C. Gill
Keyword(s):  
Aortic Coarctation ◽  
Operative Mortality ◽  
Postoperative Mortality ◽  
Cardiovascular Complications ◽  
Long Term Follow Up ◽  
Cardiac Lesions ◽  
Discharge From Hospital ◽  
Age Range

AbstractWe have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.

scholarly journals Two decades of aortic coarctation treatment in children; evaluating techniques

2020 ◽  
Author(s):  
E. J. Dijkema ◽  
L. Dik ◽  
J. M. P. Breur ◽  
G. T. Sieswerda ◽  
F. Haas ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
Free Survival ◽  
Surgical Interventions ◽  
Treatment Techniques ◽  
Complex Patients ◽  
Long Term Follow Up ◽  
Cardiac Lesions ◽  
Study Population

Abstract Objective This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity. Methods This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews. Results The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5‑year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheter-based interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.04–3.00, p = 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27–3.55, p = 0.003). Hypertension was present in one out of five patients. Conclusion Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheter-based intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive.

scholarly journals Jeune syndrome with renal failure

2017 ◽  
Vol 145 (3-4) ◽  
pp. 147-152
Author(s):  
Amira Peco-Antic ◽  
Mirjana Kostic ◽  
Brankica Spasojevic ◽  
Gordana Milosevski-Lomic ◽  
Dusan Paripovic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Growth Failure ◽  
Term Survival ◽  
Jeune Syndrome ◽  
Long Term Follow Up ◽  
The University ◽  
Age Range

Introduction/Objective. Jeune syndrome (JS) is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF), hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods. This is a retrospective study of pediatric patients with JS and CRF who were treated at the University Children?s Hospital between January 1980 and December 2014. The patients? data were retrospectively reviewed from the medical records. Results. There were thirteen patients from 11 families, five girls and eight boys mean aged 4.3 years at the time of diagnosis. All of the patients had characteristic skeletal findings, retinal degeneration and an early onset of CRF at age range from 1.5 to 7 years. Five patients had neonatal respiratory distress and congenital liver fibrosis was diagnosed in five patients. One patient died due to complications of CRF, while others survived during follow-up of mean 11 years. IFT140 mutations were found in four genetically tested patients. Conclusion. The average incidence rate of JS with renal phenotype in Serbia was about 0.2 per one million of child population. Long-term survival of JS patients depends on renal replacement therapy, while skeletal dysplasia, growth failure, respiratory and eyes problems have impact on the patients? quality of life.

scholarly journals Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients

2019 ◽  
Author(s):  
Elio Martín Gutiérrez ◽  
Mario Castaño ◽  
Javier Gualis ◽  
José Manuel Martínez-Comendador ◽  
Pasquale Maiorano ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Beneficial Effect ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Atrial Appendage ◽  
Long Term Follow Up

Abstract In non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is thought to be the source of embolism in 90% of the strokes. Thus, as recent clinical trials have shown the non-inferiority of percutaneous LAA closure (LAAc) in comparison to medical treatment, and despite a IIb recommendation in the latest guidelines for concomitant surgical LAAc, we sought to investigate the beneficial effect of LAAc in the surgical population. A meta-analysis model was performed comparing studies including any cardiac surgery with or without concomitant surgical LAAc reporting stoke/embolic events and/or mortality, from inception to January 2019. Twenty-two studies (280 585 patients) were included in the model. Stroke/embolic events both in the perioperative period [relative risk (RR) 0.66, 95% confidence interval (CI) 0.53–0.82; P = 0.0001] and during follow-up of >2 years (RR 0.67, 95% CI 0.51–0.89; P < 0.005) were significantly reduced in patients who underwent surgical LAAc (RR 0.71, 95% CI 0.58–0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc showed protective effect against stroke/embolic events in studies with >70% preoperative AF (RR 0.64, 95% CI 0.53–0.77; P < 0.00001) but no benefit in the studies with <30% of preoperative AF (RR 0.77, 95% CI 0.46–1.28; P = 0.31). Postoperative mortality was also significantly lower in surgical patients with LAAc at the mid- and long-term follow-up. (RR 0.72, 95% CI 0.67–0.78; P < 0.00001; I2 = 0%). Based on these findings, concomitant surgical LAAc is associated with lower rates of embolic events and stroke in the postoperative period in patients with preoperative AF and also improves postoperative mortality in the mid- and long-term follow-up.

Neurocognitive outcomes in children following immersion: a long-term study

2018 ◽  
Vol 103 (8) ◽  
pp. 784-789
Author(s):  
Maria Patricia Manglick ◽  
Frank I Ross ◽  
Mary-Clare Waugh ◽  
Andrew J A Holland ◽  
Daniel T Cass ◽  
...  
Keyword(s):  
Executive Function ◽  
Well Being ◽  
Near Drowning ◽  
Long Term Study ◽  
Neurocognitive Outcomes ◽  
Behavior Rating Inventory ◽  
Long Term Follow Up ◽  
Discharge From Hospital

ObjectiveTo investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital.DesignA prospective cohort study of near-drowning children.Setting95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia.Participants23 children both met the criteria and had parental consent for the study.Main outcome measuresIdentification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF.Result95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up.ConclusionChildren admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.

scholarly journals Long-term follow-up after aortic coarctation repair: The unsolved issue of exercise-induced hypertension

2013 ◽  
Vol 32 (11) ◽  
pp. 879-883
Author(s):  
Ana Sofia Correia ◽  
Alexandra Gonçalves ◽  
Mariana Paiva ◽  
Alexandra Sousa ◽  
Sílvia Marta Oliveira ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
Coarctation Repair ◽  
Induced Hypertension ◽  
Long Term Follow Up ◽  
Exercise Induced ◽  
Unsolved Issue

scholarly journals Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo

2018 ◽  
Vol 89 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Michael Knösel ◽  
Amely Eckstein ◽  
Hans-Joachim Helms
Keyword(s):  
Controlled Trial ◽  
White Spot ◽  
White Spot Lesions ◽  
Significance Level ◽  
Resin Infiltration ◽  
Long Term Follow Up ◽  
Age Range

ABSTRACT Objectives: To reassess the long-term camouflage effects of resin infiltration (Icon, DMG, Hamburg, Germany) of white spot lesions (WSL) and sound adjacent enamel (SAE) achieved in a previous trial. The null hypothesis was tested that there were no significantly different CIE-L*a*b*-ΔE-values between WSL and SAE areas of assessment after at least 24 months (T24) compared to those at baseline (T0). Materials and Methods: Of twenty subjects who received previous resin infiltration treatment of nteeth = 111 nonrestored, noncavitated postorthodontic WSL after multibracket treatment during a randomized controlled trial and were contacted 20 months after baseline, eight subjects (trial teeth nteeth = 40; m/f ratio 1/7; age range (mean; SD) 12–17 [15.25; 2.12] years); response rate: 40%) were available for follow-up after at least 24 months (T24). CIE-L*a*b* differences between summarized color and lightness values (ΔEWSL/SAE) of WSL and SAE were assessed using a spectrophotometer and compared to baseline data assessed prior to infiltration (T0), and those after 6 (T6), and 12 (T12) months using paired t tests at a significance level of α = 5%. Results: T24 assessments were performed after a mean 33.86 (SD: 8.64; Min: 24; Max: 45) months following T0. Mean (SD) ΔEWSL/SAE units of available teeth were 8.76 (5.33) at baseline; 5.5 (2.75) at T6; 5.2 (2.41) at T12; and 5.57 (2.6) at T24. Comparisons of T6, T12, and T24 with T0 yielded highly significant differences, whereas T6–T24 and T12–T24 differences were found to be not significant. Conclusions: Assimilation of infiltrated WSL to the color of adjacent enamel by resin infiltration is considered to be suitable for the long-term improvement in the esthetic appearance of postorthodontic WSL.

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