Abstract
BackgroundIn some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs.MethodsThis study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair.ResultsFollow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure.ConclusionsThe long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.
Highlights
Aortic coarctation is a congenital stenosis at the level of the aortic isthmus, located between the left subclavian artery (LSA) and the arterial ligament
computed tomography angiography (CTA) and echocardiographic follow-up Based on follow-up CTA, three types of aortic arches were distinguished following surgical repair of coarctation
Gender [M/F] Agea [years 6 sd] Age [years 6 sd] Time: primary surgery to secondary aneurysm detection [years 6 sd] Total follow up periodb [years 6 sd] Patients without abnormalities [n(%)] Patients with thoracic aortic stenosis [n(%)] Patients with secondary aortic aneurysm formation [n(%)]
Summary
Aortic coarctation is a congenital stenosis at the level of the aortic isthmus, located between the left subclavian artery (LSA) and the arterial ligament It accounts for 5–10% of the congenital cardiac malformations that are treated surgically [1,2]. Late local complications such as peri-anastomotic aneurysms or recurrent coarctations are diagnosed even in asymptomatic patients [2,3,4,5]. Questions regarding the optimal timing of surgery for asymptomatic patients remains unresolved. In such a clinical scenario, we must balance the risk of any invasive procedures and the possible benefits. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs
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