Risk factors of mortality and recoarctation after coarctation repair in infancy

AbstractOBJECTIVESThe main challenge of aortic coarctation (CoA) repair in infants is to obtain durable results without morbidity. We aimed to describe predictors of aortic arch reintervention after aortic CoA repair.METHODSBetween January 2000 and March 2014, we retrospectively included consecutive infants with isolated CoA or CoA with ventricular septal defect (CoA + VSD) who had surgical repair of the aortic arch before 3 months of age.RESULTSFive hundred and thirty patients were included: 308 (58%) patients had isolated CoA and 222 (42%) patients had CoA + VSD. Three hundred and eighty-five patients (72.6%) had CoA repair, 51 patients (9.6%) had CoA repair with closure of VSD and 94 patients (17.8%) had CoA repair with pulmonary artery banding. Mean age at operation was 13 ± 1.6 days, with 294 patients (55.5%) operated on before 2 weeks. Median follow-up was 7.57 years. Sixty-one patients (11.5%) needed reintervention on the aortic arch. Freedom from aortic arch reintervention was 90% at 1 year and 88.5% at 5 years. Proportions of aortic arch reintervention were similar in the different surgical strategy groups (P = 0.80). However, in patients receiving prostaglandin E1 (PGE1), the end-to-end repair was at higher risk of recoarctation compared to the extended end-to-side repair (P = 0.033). The risk factors of aortic arch reintervention were age at repair <15 days (P = 0.034) and the need for PGE1 infusion at surgery (P = 0.0043).CONCLUSIONSCoA repair in young infants has an overall good outcome. The use of PGE1 may modify the aortic arch anatomy and mask the boundaries of the resection to be performed. PGE1 treatment should be studied more specifically in another study to improve preoperative management.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.918 ◽

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.

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Optimal surgical approach for repair of aortopulmonary window

Cardiology in the Young ◽

10.1017/s104795110100049x ◽

2001 ◽

Vol 11 (4) ◽

pp. 385-390 ◽

Cited By ~ 24

Author(s):

Chee-Chin Hew ◽

Emile A. Bacha ◽

David Zurakowski ◽

Pedro J. del Nido ◽

John E. Mayer ◽

...

Keyword(s):

Multivariate Analysis ◽

Coronary Artery ◽

Aortic Coarctation ◽

Septal Defect ◽

Surgical Repair ◽

Patient Survival ◽

Aortopulmonary Window ◽

Single Institution ◽

Hospital Deaths

Background: This is a review of the experience over 26 year in a single institution with surgical repair of aortopulmonary window. Methods: Between July 1973 and March 1999, 38 patients underwent surgery for aortopulmonary window at a median age of 5 weeks, and with a median weight of 3.9 kg. Median follow-up was 6.6 years, with a range from 0.8 to 26 years. Additional defects were present in 25 (65%) patients, including interruption of the aortic arch in 7, tetralogy of Fallot in 7, ventricular septal defect in 5, functionally univentricular anatomy in 3, aortic coarctation in 2, and anomalous origin of a coronary artery in 1. We approached via an aortotomy in 45%, an incision through the defect in 31%, and using a pulmonary arteriotomy in 24% of patients. Closure was achieved using a single patch in 30 patients (79%). Results: There were 3 (7.9%) in-hospital deaths. Actuarial patient survival was 88% at 10 years. Three patients required reinterventions for stenoses of the great arteries. Freedom from any reintervention was 70% at 10 years. By multivariate analysis, the approach through a pulmonary arteriotomy was shown to result in a higher need for reintervention (p = 0.01). Conclusions: Repair of aortopulmonary window can be done with excellent results. A pulmonary arteriotomy should be avoided.

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Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

Pediatric Cardiology ◽

10.1007/s00246-021-02685-z ◽

2021 ◽

Author(s):

Chiara Minotti ◽

Manuela Scioni ◽

Biagio Castaldi ◽

Alvise Guariento ◽

Roberta Biffanti ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Coarctation ◽

Surgical Repair ◽

Nyha Class ◽

Long Term Results ◽

Relative Risk Ratio ◽

Hypoplastic Aortic Arch ◽

Long Term Experience

AbstractTo evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

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Double outlet of both ventricles: morphological, echocardiographic and surgical considerations

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa378 ◽

2020 ◽

Author(s):

Krishna Subramony Iyer ◽

Ankit Garg ◽

Sumir Girotra ◽

Robert H Anderson ◽

Sushil Azad ◽

...

Keyword(s):

Left Ventricle ◽

Ventricular Septal Defect ◽

Surgical Management ◽

Aortic Coarctation ◽

Septal Defect ◽

Surgical Repair ◽

Ventricular Septum ◽

Unique Form ◽

Midterm Results

Abstract OBJECTIVES To describe the morphology, echocardiographic features and surgical management of the entity appropriately described as ‘double outlet of both ventricles’. METHODS Seven patients (5 males, age 0.5–7.5 months) were diagnosed to have a unique form of subarterial ventricular septal defect (VSD) and ventriculo-arterial connection, where a muscular outlet septum straddled the crest of the ventricular septum in a cruciate manner, such that both great arteries were equally committed to both ventricles. Diagnosis was established by echocardiography, with 6 patients submitted to surgical repair by means of intracardiac routing of the left ventricle to the aorta using 2 patches. RESULTS Surgical repair was successful in all 6 patients in whom it was attempted. In addition, 1 patient underwent concomitant repair of aortic coarctation, and 2 had closure of multiple VSDs. We lost 1 patient to follow-up after diagnosis. Follow-up with a range from 3 months to 8 years in the remaining patients revealed all to be clinically well with satisfactory growth of both outflow tracts. CONCLUSIONS We describe a series of patients with the ventriculo-arterial connection best described as ‘double outlet of both ventricles’. Diagnosis is readily established by echocardiography. Good early and midterm results can be expected subsequent to surgical repair using 2 patches for interventricular septation.

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Prospective study on a new therapeutic strategy for infants and children with aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951100011434 ◽

1995 ◽

Vol 5 (1) ◽

pp. 36-43 ◽

Cited By ~ 3

Author(s):

Toshihiro Ino ◽

Kei Nishimoto ◽

Katsumi Akimoto ◽

Mataichi Ohkubo ◽

Keijiro Yabuta ◽

...

Keyword(s):

Prospective Study ◽

Aortic Arch ◽

Aortic Coarctation ◽

Therapeutic Strategy ◽

Surgical Repair ◽

Balloon Dilation ◽

Systolic Pressure ◽

Pressure Gradients ◽

Therapeutic Protocol

AbstractThere is little information on the indications for balloon dilation angioplasty for aortic coarctation. To determine the indications for balloon dilation in aortic coarctation, we evaluated prospectively the outcome of children treated according to our therapeutic protocol. The protocol included patients with postoperative recoarctation and isolated native coarctation with risks for surgical repair as conditions for which balloon intervention was absolutely indicated, and native coarctation without a significant arterial duct as a condition possibly qualifying for balloon dilation. Patients with duct-dependent coarctation and diffuse hypoplasia of the aortic arch were not considered to require balloon intervention and were treated surgically. We entered 47 patients into this protocol between January 1988 and December 1993. In 21, dilation was performed successfully and provided significant relief of pressure gradients. The peak systolic pressure gradients across the coarcted site in native coarctation and postoperative recoarctation decreased significantly from 40±19 to 13±10 mm Hg (p<0.0001) and 38±24 to 14±75 mm Hg (p<0.01) immediately after the procedure, respectively. Similarly, the diameters of the coarcted site increased significantly from 3.8±1.8 to 6.6±2.43 mm (p<0.0001) and 4.6±1.9 to 6.0±2.0 mm (p<0.005), respectively. Five patients with native coarctation, and one with postoperative recoarctation, developed restenosis during the period of follow-up and were treated successfully with repeat dilation. It may be possible to change the therapeutic strategy for aortic coarctation with advances in the use of balloon dilation. Our protocol for this technique appears to be reasonable, but further evaluation of its indications is needed.

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Double aortic arch: an elusive diagnosis in a child with CHD

Cardiology in the Young ◽

10.1017/s1047951121004856 ◽

2021 ◽

pp. 1-3

Author(s):

Mariana Lemos ◽

Miguel Fogaça da Mata ◽

Ana Coutinho Santos

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Aortic Arch ◽

Ct Angiography ◽

Septal Defect ◽

Vascular Ring ◽

Pulmonary Atresia ◽

Double Aortic Arch ◽

Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

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Surgical repair of interrupted aortic arch with ventricular septal defect

Cardiology in the Young ◽

10.1017/s1047951100006119 ◽

1998 ◽

Vol 8 (2) ◽

pp. 217-220 ◽

Cited By ~ 2

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.

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Letters to the Editor

PEDIATRICS ◽

10.1542/peds.68.2.304b ◽

1981 ◽

Vol 68 (2) ◽

pp. 304-305

Author(s):

Michael A. Baron ◽

Howard D. Fink

Keyword(s):

Risk Factors ◽

High Risk ◽

Clinical Judgment ◽

Physical Sign ◽

Single Test ◽

Letters To The Editor ◽

Blood Tests ◽

Young Infants

We agree completely with Dr Mangravite'ss comments and have been advising parents as he suggests. Implicit in Mangravite's remarks is the observation that a single test is no more reliable for diagnosis than is any single historical datum or physical sign. The constant exercise of clinical judgment and careful follow-up of patients is therefore essential and can prevent excessive reliance on "blood tests." It should be kept in mind that young infants are at especially high risk for bacteremia; that this risk varies directly with temperature and inversely with age: and that one or many of the risk factors for bacteremia may be absent in culture-proven bacteremia.

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