Echocardiography of coarctation of the aorta, aortic arch hypoplasia, and arch interruption: strategies for evaluation of the aortic arch

2016 ◽  
Vol 26 (8) ◽  
pp. 1553-1562 ◽  
Author(s):  
Suma P. Goudar ◽  
Sanket S. Shah ◽  
Girish S. Shirali
Keyword(s):  
Aortic Arch ◽  
Coarctation Of The Aorta ◽  
The United States ◽  
Interrupted Aortic Arch ◽  
Hypoplastic Left Heart ◽  
Live Births ◽  
Additional Information ◽  
Non Invasive ◽  
Aortic Arch Hypoplasia

AimEchocardiography is the modality of choice for the diagnosis and serial follow-up of aortic arch pathology. In this article, we review the types of obstruction of the aortic arch, various classification schemes of coarctation of the aorta and interrupted aortic arch, methodology for optimal echocardiographic imaging of the aortic arch, and key echocardiographic measurements for accurate diagnosis of obstruction and hypoplasia of the aortic arch. Finally, we will discuss the limitations of echocardiography in optimal imaging of the aortic arch and the use of other non-invasive imaging modalities such as CT or MRI to provide additional information in these cases.BackgroundCoarctation of the aorta is the more common lesion of the two, with an estimated incidence of four in every 10,000 live births in the United States of America. Interrupted aortic arch is rarer, with an incidence of 19 per one million live births.1 There is a spectrum of pathology of obstruction of the aortic arch, ranging from coarctation of the aorta with and without hypoplasia of the arch to interrupted aortic arch. Both these lesions are frequently encountered in congenital cardiology practice, and will be discussed in the remainder of this article. Obstruction of the aortic arch in the setting of hypoplastic left heart structures or atresia of the aortic valve is beyond the scope of this review and will not be discussed further.

scholarly journals Safety and efficacy of stenting for aortic arch hypoplasia in patients with coarctation of the aorta

2019 ◽  
Vol 28 (3) ◽  
pp. 145-152
Author(s):  
E. G. Warmerdam ◽  
G. J. Krings ◽  
T. A. Meijs ◽  
A. C. Franken ◽  
B. W. Driesen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Aortic Arch ◽  
Retrospective Analysis ◽  
Medical Center ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Safety And Efficacy ◽  
Aortic Arch Hypoplasia

Abstract Background Despite a successful repair procedure for coarctation of the aorta (CoA), up to two-thirds of patients remain hypertensive. CoA is often seen in combination with abnormal aortic arch anatomy and morphology. This might be a substrate for persistent hypertension. Therefore, we performed endovascular aortic arch stent placement in patients with CoA and concomitant aortic arch hypoplasia or gothic arch morphology. The goal of this retrospective analysis was to investigate the safety and efficacy of aortic arch stenting. Methods A retrospective analysis was performed in patients who underwent stenting of the aortic arch at the University Medical Center Utrecht. Measurements collected included office blood pressure, use of antihypertensive medication, invasive peak-to-peak systolic pressure over the arch, and aortic diameters on three-dimensional angiography. Data on follow-up were obtained at the date of most recent outpatient visit. Results Twelve patients underwent stenting of the aortic arch. Mean follow-up duration was 14 ± 11 months. Mean peak-to-peak gradient across the arch decreased from 39 ± 13 mm Hg to 7 ± 8 mm Hg directly after stenting (p < 0.001). There were no major procedural complications. Mean systolic blood pressure decreased from 145 ± 16 mm Hg at baseline to 128 ± 9 mm Hg at latest follow-up (p = 0.014). Conclusion This retrospective study shows that stenting of the aortic arch is successful when carried out in a state-of-the-art manner. A direct optimal angiographic and haemodynamic result was shown. No major complications occurred during or after the procedure. At short- to medium-term follow-up a decrease in mean systolic blood pressure was observed.

scholarly journals Surgical correction of coarctation of the aorta with distal aortic arch hypoplasia in infants

2016 ◽  
Vol 20 (2) ◽  
pp. 66 ◽  
Author(s):  
I. A. Soynov ◽  
Yu. S. Sinelnikov ◽  
I. A. Kornilov ◽  
N. R. Nichay ◽  
E. N. Gasanov ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Aortic Arch ◽  
Postoperative Period ◽  
Coarctation Of The Aorta ◽  
Surgical Correction ◽  
Group I ◽  
Group Ii ◽  
Aortic Arch Hypoplasia ◽  
Late Postoperative Period

<p><strong>Aim:</strong> The paper focuses on assessment of the late results and causes of complications when repairing coarctation with distal aortic arch hypoplasia.<br /><strong>Methods:</strong> This prospective randomized study included 54 patients who underwent repair of coarctation of the aorta. All patients were divided in 2 groups depending on the correction type: reconstruction using the modified reverse left subclavian artery flap plasty (Group I, 27 pts) or extended end-to-end anastomosis (Group II, 27 pts).<br /><strong>Results:</strong> A postoperative follow-up period was 26 (21;31) months. Recoarctation of the aorta during long-term follow-up was found in 1 patient (3.84%) in Group I and in 2 patients (7.7%) in Group II (p=0.5). Two patients in the Group I (7.7%) and 8 patients in the Group II (30.8%) had arterial hypertension (p=0.03).<br /><strong>Conclusion:</strong> With modern types of surgical correction used, the anastomotic area tended to proportionally grow in different segments of the aortic arch and did not influence the postoperative complications rate. Endocardial fibroelastosis and ascending aortic wall rigidity could be considered as predictors of arterial hypertension in the late period after coarctation repair in infants. Low body weight before surgery is a factor of aortic recoarctation development in the late postoperative period. Arterial hypertension persistence depends on the correction type. One-stage reconstruction of the distal aortic arch allows for reducing the rate of arterial hypertension from 30.8% to 7.7%. Despite a range of complications in the late postoperative period, the infants’ quality of life was not affected and was high in both groups.</p>

One-Stage Repair of Cardiac and Arch Anomalies without Circulatory Arrest

2003 ◽  
Vol 11 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Kona Samba Murthy ◽  
Robert Coelho ◽  
Christopher Roy ◽  
Snehal Kulkarni ◽  
Benjamin Ninan ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Circulatory Arrest ◽  
Coarctation Of The Aorta ◽  
Innominate Artery ◽  
Double Outlet Right Ventricle ◽  
Interrupted Aortic Arch ◽  
Ischemic Time ◽  
Arch Obstruction

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1–43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.

scholarly journals Multi-detector computed tomography (MDCT) as a diagnostic tool in assessment of thoracic aortic anomalies in pediatric patients

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Dawlat Nader Eltatawy ◽  
Fatma Anas Elsharawy ◽  
Aly Aly Elbarbary ◽  
Raghda Ghonimy Elsheikh ◽  
Manal Ezzat Badawy
Keyword(s):  
Computed Tomography ◽  
Aortic Arch ◽  
Pediatric Patients ◽  
Interrupted Aortic Arch ◽  
Diagnostic Tools ◽  
Non Invasive ◽  
Branching Patterns ◽  
Anatomic Variants ◽  
Multi Detector Computed Tomography

Abstract Background A wide variety of congenital thoracic aortic variants and pathological anomalies could be assessed recently in diagnostic and interventional radiology. Multi-detector computed tomography (MDCT) is one of the most important non-invasive diagnostic tools for their detection. The aim of the study was to evaluate role of MDCT scanning for diagnosis of thoracic aortic anatomic variants and diseases in pediatric patients. Results Thirty patients (15 male and 15 female), mean age (8.49 ± 20.29 months) were diagnosed with different thoracic aortic anomalies by MDCT then confirmed by surgical results. MDCT was more sensitive than echocardiography in detection of hypo plastic arch, vascular rings, interrupted aortic arch anomalies, and aortic coarctation. Both MDCT and echocardiography showed 100% sensitivity in their detection of TGA, TOF, and PDA. MDCT detected 6 cases of right-sided aortic arch while echo missed 2 cases. Different aortic arch branching patterns and coronary origin were better demonstrated by MDCT. Conclusion 320-Multi-detector computed tomography is a reliable tool for optimal detection of thoracic aortic anomalies and preoperative planning.

scholarly journals Reconstruction of the Aortic Arch in Newborns and Infants Using an Extended End-to-End Anastomosis

2021 ◽  
pp. 63-68
Author(s):  
Iaroslav P. Truba ◽  
Ivan V. Dziuryi ◽  
Roman I. Sekelyk ◽  
Oleksandr S. Golovenko
Keyword(s):  
Hospital Mortality ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Mean ◽  
End To End ◽  
Aortic Arch Hypoplasia

The problem of the effectiveness of obstruction at the level of the aortic arch is still a matter of discus-sion in the modern literature. Traditionally, by excision of the coarctation part, in the presence of hypoplasia, the incision is extended to a narrowed area and a modification of the classical end-to-end anastomosis is applied in the form of an elongated or expanded variant. Recently, when proximal part is involved in the pathological process, cardiac surgeons have been more likely to use median sternotomy using other types of plastic surgery, including dilation of the narrowed area with a pericardial patch, or pulmonary artery tissue. Accordingly, the analysis of the results of the use of end-to-end anastomosis in young children with aortic arch hypoplasia, especially in view of long-term survival and the level of reoperation, is an important issue of neonatal cardiac surgery. The aim. To evaluate the effectiveness of the use of an extended end-to-end anastomosis after reconstruction of the aortic arch in children under 1 year of age. Materials and methods. The study material included 348 infants who underwent surgical correction of aortic arch hypoplasia through the method of extended end-to-end anastomosis from 2010 to 2020. The operations were performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and the Ukrainian Children’s Cardiac Center. The study group included only patients with two-ventricular physiology. There were 233 male patients (67%) and 115 female patients (33%). The mean age was 1.07 (0.20; 2.30) months, the mean weight was 3.89 (3.30; 4.90) kg, the mean body surface area was 0.23 (0.20; 0.28) m2. Diagnosis of aortic arch hypoplasia was based on two-dimensional echocardiography. Results. According to echocardiography, after surgery there was a significant decrease in the pressure gradient in the aortic arch from 48.3 ± 20.3 to 16 ± 6.9 (p<0.05), left ventricular PV increased significantly from 61.6 ± 12% to 66.3 ± 6.4% (p> 0.05). The hospital mortality was 1.7% (n = 6). The causes of mortality were not related to the end-to-end aortic arch technique. The duration of follow-up period ranged from 1 month to 9.3 years. Two deaths occurred in the follow-up period. Thirty-two (9.1%) patients developed aortic arch restenosis in the postoperative period. Balloon dilatation of restenosis was performed in 21 patients. Eleven patients underwent repeated aortic arch repair surgery through the median sternotomy. There were no central nervous system complications in the follow-up period. Conclusions. The use of an extended end-to-end anastomosis in the surgical treatment of aortic arch hypoplasia demon strates low hospital mortality and high long-term survival. Indications for the effective use of this type of reconstruction are hypoplasia of the isthmus and distal aortic arch.

Surgical repair of interrupted aortic arch with ventricular septal defect

1998 ◽  
Vol 8 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Lindsey D Allan ◽  
Howard D Apfel ◽  
Yosef Levenbrown ◽  
Jan M Quaegebeur
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Septal Defect ◽  
Ventricular Outflow Tract ◽  
Interrupted Aortic Arch ◽  
Left Ventricular ◽  
Subaortic Stenosis ◽  
Current Debate ◽  
Aortic Orifice

AbstractBackgroundInterrupted aortic arch is often associated with subaortic narrowing and hypoplasia of the aortic orifice. The best surgical strategy for the management of these additional lesions is a matter of current debate.Methods and ResultsBetween 1986 and 1996, 19 patients underwent repair of interrupted aortic arch with closure of ventricular septal defect in a single stage, with no attempt at subaortic resection, irrespective of the dimensions of the left ventricular outflow tract. There was no perioperative hospital mortality, and all patients were alive at 1 year. Follow-up ranges from 0.75 −10 years, with a mean 4.2 ± 3.0 years. Seven patients (37%) have required reintervention for relief of subaortic stenosis, 2 of whom have died.ConclusionsOur results suggest that primary one-stage biventricular repair can be accomplished with low perioperative mortality without addressing the subaortic region. Further long-term follow-up will determine whether this is accomplished at the expense of later morbidity and mortality.

Transcatheter mechanical thrombectomy of neonatal occlusive aortic thrombus using an Amplatzer Piccolo PDA occluder

2021 ◽  
pp. 1-3
Author(s):  
Christopher Herron ◽  
Stuart Covi ◽  
Athina Pappas ◽  
Daisuke Kobayashi
Keyword(s):  
Aortic Arch ◽  
Critical Condition ◽  
Mechanical Thrombectomy ◽  
Coarctation Of The Aorta ◽  
Premature Neonate ◽  
Interrupted Aortic Arch ◽  
Thromboembolic Events ◽  
Descending Aorta ◽  
Aortic Thrombus

Abstract Neonatal aortic thrombus is a rare and critical condition that can present mimicking severe coarctation of the aorta or interrupted aortic arch. Transcatheter thrombectomy for this lesion has not been well described. We report a premature neonate with an occlusive proximal descending aorta thrombus, who underwent transcatheter mechanical thrombectomy using an Amplatzer Piccolo PDA occluder (Abbott, North Chicago, IL, USA). The procedure was successful with no subsequent distal thromboembolic events.

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