Balloon expandable stent implantation for native and recurrent coarctation of the aorta--prospective computed tomography assessment of stent integrity, aneurysm formation and stenosis relief

Background: Covered stent implantation for treatment of coarctation of the aorta (CoA) is effective and can prevent aortic wall injury. Prospective studies with long-term follow-up, including imaging, are lacking. We report the acute and long-term outcomes for use of the Large Diameter Advanta V12 covered stent for treatment of native and recurrent CoA. Methods: A prospective, multicenter, nonrandomized study was performed including 70 patients (43 male), median age 17 years, median weight 57.4 kg with CoA who underwent implantation of the Large Diameter Advanta V12 covered stent. Annual follow-up for 5 years included Doppler echocardiography to calculate diastolic velocity: systolic velocity ratio. Results: CoA diameter increased from 5.6±3.6 to 14.9±3.9 mm ( P <0.0001) and the pressure gradient decreased from 35.8±16.2 to 5.6±7.9 mm Hg ( P <0.0001). Preimplantation diastolic velocity:systolic velocity of 0.6±0.16 dropped to 0.34±0.13 ( P <0.0001) and was maintained at 5 years. Computed tomography angiograms at 12 months postimplantation demonstrated the stent:transverse arch diameter to be similar, 0.91±0.09 to postprocedure 0.86±0.14. Major adverse vascular events at 30 days and 12 months were 1.4% and 4.3%, respectively. Significant adverse events included three patients who required stent implantation to treat infolding. There were no mortalities. Conclusions: The Large Diameter Advanta V12 covered stent is safe and effective for the treatment of CoA with an immediate and sustained reduction of the pressure gradient over 12 months and 5 years as assessed by preimplantation and postimplantation Doppler echocardiography and 12-month computed tomography angiography. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00978952. URL: http://www.anzctr.org.au ; Unique identifier: ACTRN12612000013864.

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Infectious stentitis after treatment of coarctation of the aorta: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa081 ◽

2020 ◽

Vol 4 (3) ◽

pp. 1-5

Author(s):

Heleen B van der Zwaan ◽

Gertjan Tj Sieswerda ◽

Gregor J Krings ◽

Michiel Voskuil

Keyword(s):

Computed Tomography ◽

Stent Implantation ◽

Clinical Signs ◽

Imaging Study ◽

Coarctation Of The Aorta ◽

Rare Condition ◽

Congenital Vascular Malformation ◽

Markers Of Inflammation ◽

Positron Emission ◽

Pet Ct

Abstract Background Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs. Case summary We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography–computed tomography (PET–CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients’ functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal. Discussion Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET–CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.

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Arachnodactyly Heart

PEDIATRICS ◽

10.1542/peds.24.4.522 ◽

1959 ◽

Vol 24 (4) ◽

pp. 522-522

Author(s):

S. G.

Keyword(s):

Myocardial Hypertrophy ◽

Coarctation Of The Aorta ◽

Hereditary Disease ◽

Pathologic Finding ◽

Cardiovascular Pathology ◽

Cardiac Malformations ◽

Septal Defects ◽

Aneurysm Formation ◽

Cardiac Decompensation ◽

Myocardial Pathology

Cardiovascular lesions are known to be frequently associated with arachnodactyly. The most common pathologic finding is cystic medionecrosis, particularly affecting the aorta, which often gives rise to aneurysm formation. Congenital cardiac malformations have also been described in patients with arachnodactyly; the more common lesions encountered are coarctation of the aorta and septal defects. From his experience at the Gronigen Clinic, Netherlands, the author reports another, but less frequently observed, finding of myocardial hypertrophy and fibrosis, in the absence of other cardiovascular pathology; this lesion leads eventually to cardiac decompensation and demise. The term "arachnodactyly heart" is proposed to designate the primary myocardial pathology in this hereditary disease.

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