Surgical Management of Congenital Aortic Stenosis in Children and Young Adults

Abstract OBJECTIVES In this study, we aimed to evaluate the early and mid-term outcomes of surgery for renovascular hypertension (RVH) at our institution, within the last 13 years. METHODS We retrospectively reviewed 19 patients who underwent surgery for RVH, between 2005 and 2017. The age at operation, clinical characteristics, cause of arterial stenosis, diagnostic workup, surgical management and outcomes during the follow-up were analysed. The continuous variables were expressed as mean ± standard deviation. RESULTS Twelve female and 7 male patients underwent surgery for RVH. Their mean age was 17.07 ± 11.9 years (range 4–42 years). Nine patients had renal arterial stenosis, and 10 patients had midaortic syndrome (MAS). Aortorenal bypass with the saphenous vein was performed in 6 patients with renal arterial stenosis and 1 patient with MAS. An isolated thoracic aorta-abdominal aortic bypass was performed in 1 patient with MAS, and thoracic aorta-abdominal aortic bypass combined with unilateral aortarenal bypass was performed in 9 patients with MAS. The other surgical procedures performed were 2 autotransplantations and 2 unilateral nephrectomies. Among the patients with MAS, 4 underwent reoperation. The mean follow-up duration was 45.58 ± 32.7 months. Hypertension was cured in 3 patients and improved in 14 patients. The postoperative follow-up creatinine levels were similar to preoperative creatinine levels. All bypasses were patent on mid-term follow-up. One patient who underwent aortorenal bypass died 14 months postoperatively. CONCLUSIONS Surgical management is a suitable option for patients with RVH, who were unresponsive to medical and/or endovascular management. Surgical methods are safe and effective in children and young adults with RVH.

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Surgical Management of Wilms Tumor (Nephroblastoma) and Renal Cell Carcinoma in Children and Young Adults

Surgical Oncology Clinics of North America ◽

10.1016/j.soc.2020.11.002 ◽

2021 ◽

Author(s):

Natalie M. Lopyan ◽

Peter F. Ehrlich

Keyword(s):

Renal Cell Carcinoma ◽

Young Adults ◽

Cell Carcinoma ◽

Surgical Management ◽

Renal Cell ◽

Wilms Tumor ◽

Children And Young Adults

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Current Surgical Management of Ascending Aortic Aneurysm in Children and Young Adults

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2009.06.036 ◽

2009 ◽

Vol 88 (5) ◽

pp. 1527-1533 ◽

Cited By ~ 6

Author(s):

Masamichi Ono ◽

Heidi Goerler ◽

Dietmar Boethig ◽

Mechthild Westhoff-Bleck ◽

Thomas Breymann

Keyword(s):

Young Adults ◽

Aortic Aneurysm ◽

Surgical Management ◽

Ascending Aortic Aneurysm ◽

Children And Young Adults

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Surgical management of children and young adults with marfan syndrome and pectus excavatum

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(88)80335-x ◽

1988 ◽

Vol 23 (12) ◽

pp. 1169-1172 ◽

Cited By ~ 46

Author(s):

L.R. Scherer ◽

Pamela H. Arn ◽

Delverne A. Dressel ◽

Reed M. Pyeritz ◽

J. Alex Haller

Keyword(s):

Young Adults ◽

Marfan Syndrome ◽

Surgical Management ◽

Pectus Excavatum ◽

Children And Young Adults

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Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

Indian Heart Journal ◽

10.1016/j.ihj.2016.03.001 ◽

2016 ◽

Vol 68 (5) ◽

pp. 604-611 ◽

Cited By ~ 6

Author(s):

Neeraj Awasthy ◽

Ria Garg ◽

S. Radhakrishnan ◽

Savitri Shrivastava

Keyword(s):

Young Adults ◽

Aortic Stenosis ◽

Adolescents And Young Adults ◽

Balloon Valvuloplasty ◽

Long Term Results ◽

Congenital Aortic Stenosis ◽

Percutaneous Balloon ◽

Percutaneous Balloon Valvuloplasty

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The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

Cardiology in the Young ◽

10.1017/s1047951116001864 ◽

2016 ◽

Vol 27 (5) ◽

pp. 929-935 ◽

Cited By ~ 2

Author(s):

Bojana Radnic ◽

Nemanja Radojevic ◽

Jelena Vucinic ◽

Natasa Duborija-Kovacevic

Keyword(s):

Young Adults ◽

Sudden Death ◽

Aortic Stenosis ◽

Ventricular Arrhythmias ◽

Young Patients ◽

Electrolyte Imbalance ◽

Unexpected Death ◽

Congenital Aortic Stenosis ◽

High Incidence ◽

Toxic Concentrations

AbstractMost young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

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