Coarctation Of Aorta In Adults Research Articles

Surgical technical experience of adult aortic coarctation concomitant with poststenotic aneurysm or dissection.

Aortic coarctation (COA) in adults combined with poststenotic aneurysm (PA) or poststenotic dissection (PD) is rare and challenging to manage. The existence of multiple factors such as kinking, comorbidities, previous surgical history, and descending aortic lesions increases the difficulty of treatment, and there are currently few clinical reports. The purpose of this study was to present our surgical experience in dealing with such patients. A retrospective study was conducted on 20 consecutive patients with COA combined with PA or PD who were treated in our center from December 2015 to April 2019. The basic principles, methods, and short- and mid-term prognosis of surgery are present carefully. This paper introduces the individualized treatment scheme as well as its advantages and disadvantages in detail. The condition of the included patients was complicated, including 12 cases of PA and 8 of PD. Although different surgical schemes were adopted, procedural success rate was 100%. There were no other surgical complications except 2 cases of anastomotic bleeding and 1 case of spinal cord injury. The results of computed tomography angiography (CTA) demonstrated that 9 cases achieved anatomical correction, 10 cases of PA or PD were eliminated or thrombosed to varying degrees, and only 1 case of PA had no obvious change. Up to the follow-up period, except for 1 patient who had a slight cerebrovascular accident and 1 who had no change in PA underwent cheatham platinum (CP) stent surgery, no other cardiovascular adverse events occurred and all patients recovered well. The optimal surgical strategy developed collaboratively by cardiac surgeons and endovascular specialists has achieved satisfactory short- and mid-term results for COA patients combined with PA or PD. Further research is still necessary, due to the limited number of cases.

Exercise-induced hypertension after aortic coarctation repair: Our experience and a systematic review.

The exact prevalence and clinical significance of excessive increase in blood pressure in response to exercise in patients with repaired coarctation of aorta (CoA) remains unknown. This study aimed to investigate the impact of different definitions of exercise-induced hypertension (EIH) on the prevalence rates in our adult patients with repaired CoA. A systematic review of the available literature was also performed. We retrospectively analyzed exercise test data from adult patients with repaired CoA followed at the national referral center for adult congenital heart disease between 1998 and 2021. The three most reported definitions of EIH in patients with repaired CoA were used for the analysis of EIH prevalence. We also performed a systematic search of the PubMed electronic bibliographic database. Full-text versions of all potentially relevant articles on EIH in CoA were reviewed for relevance. Our registry included 161 adult CoA patients. Complete exercise test results were available in 74 patients (59% male, median age 39 years [range 20-68 years]). The prevalence of EIH in our cohort varied from 24 to 41%, depending on the definition used. We identified eleven eligible articles from 184 publications. The reported prevalence rate of EIH in the studies ranged from 13% to 82%. EIH is common in patients with repaired CoA; however, the rates of EIH vary greatly depending on the definition used. A standardized and uniform EIH definition is needed to accurately assess the prevalence and clinical relevance of EIH in this population.

Descending thoracic aortic dissection after covered stent for adult aortic coarctation: Technical or physiopathologic?

Covered stent graft implantation is currently the most commonly used modality for the management of adult aortic coarctation. Although the risk of descending thoracic aortic dissection after covered stent graft implantation is low, sometimes it may cause serious medical consequences or even death. We report one adult aortic coarctation patient with early postoperative descending thoracic aortic dissection after covered stent graft implantation. The patient underwent second operation of thoracic endovascular aortic reconstruction and was discharged 6 days after the operation. This case is not rare, but we hope that the complete diagnosis and treatment process of this case and discussion pertaining to surgical treatment method and its complications could serve as a reference for clinicians in dealing with such situations.

Utility of computational fluid dynamics for prediction of efficacy of the surgical interventions for aortic coarctation in adults

Utility of computational fluid dynamics for prediction of efficacy of the surgical interventions for aortic coarctation in adults

Relationship between left atrial myopathy and atrial fibrillation in adults with coarctation of aorta

BackgroundAlthough patients with coarctation of aorta (COA) have clinical risk factors for atrial fibrillation (AF), there are limited data about AF prevalence, and role of left atrial (LA) indices for risk stratification in this population. We hypothesized that LA indices (LA reservoir strain and LA volume index) were associated with AF, and would identify patients at risk for AF progression. MethodsWe analyzed electrocardiograms/Holters, and echocardiograms of adult COA patients at Mayo Clinic (2000–2018). ResultsOf 776 patients, 726(94 %), 46(5.9 %) and 4(0.5 %) had no history of AF, paroxysmal AF, and persistent AF respectively; yielding AF prevalence of 6.4 %. LA reservoir strain (AUC 0.782 [0.751–0.808]) had more robust association with AF as compared to LA volume index (AUC difference −0.115, p < 0.001).Among 726 patients without prior AF, 25(3.4 %) had new-onset AF during follow-up. LA reservoir strain <25 % and LA volume index >34 ml/m2 were independent predictors of new-onset AF (HR 1.81 [1.15–3.85], and HR 1.41 [1.03–4.78], respectively). Of 46 patients with paroxysmal AF, 22(48 %) had recurrent AF, and LA reservoir strain <25 % was an independent predictor of recurrent AF (HR 1.94 [1.41–4.17]). LV pressure overload and stiffness indices were associated with progressive LA dysfunction and new-onset AF. ConclusionsCollectively, these data suggest that LA strain can potentially be used for AF risk stratification. Further studies are required to determine whether LA strain can proactively identify patients that will respond favorably to different antiarrhythmic therapies, and whether interventions to reduce LV pressure overload will improve LA function and reduce AF progression.

Endovascular Treatment for an Adult Isthmic Aortic Coarctation with Complicated Anatomy

The intraluminal stent-graft placement is preferred for alleviation of symptoms as well as prolonging life span of adult aortic coarctation.&#x0D; We presented here the interventional treatment option of a 44 years old aortic coarctation patient with complex isthmic anatomy: long segment stenosis beginning before the left subclavian artery ostia, proximal left subclavian artery aneurysm, multilobulated aneurysm of descending aort, poststenotic dilatation and collateral formation. The patient was treated with endovascular stent-graft implantation successfully. &#x0D; The endovascular interventions of congenital aortic coarctations are complementary and alternative treatment option to surgery for the longterm management of the patients.

Reoperative repair of adult aortic coarctation with explantation of thoracic stent-graft: a case report

Reoperative repair of adult aortic coarctation with explantation of thoracic stent-graft: a case report

A Successful Case of Thoracic Endovascular Aortic Repair for the Treatment of Adult Aortic Coarctation

A Successful Case of Thoracic Endovascular Aortic Repair for the Treatment of Adult Aortic Coarctation

Abstract 12320: Long-Term Outcomes of Open and Endovascular Management of Adult Aortic Coarctation

Objective: To compare outcomes of endovascular vs. surgical management of adult aortic coarctation (CoA). Methods: We performed a retrospective study of patients who underwent surgical vs. endovascular intervention for CoA during adulthood (age&gt;16 years) at a single institution. Results: We identified 137 adult patients with coarctation of the aorta seen between 1975 - 2019. 18/137 (13%) required no intervention for their coarctation. While 23/137 (40%) had surgical procedures and 34/137 (60%) had endovascular procedures. Surgical procedures included extra-anatomic bypass (13/23), resection of coarctation segment with interposition graft (4/23), distal hemi-arch replacement (1/23) and total arch replacement (1/23). Endovascular interventions included balloon angioplasty alone in 2/34 patients and stenting in 32/34 patients. Median age at intervention was 38 years (IQR: 30-47) in the surgical group and 36 (30-47) in the endovascular group. Patient follow up time ranged from 0-45 years with a mean follow-up of 12 years as calculated from the first intervention for CoA during adulthood. Overall survival was 96% in the surgical group and 100% in the endovascular group. There was one post-operative transient ischemic attack in the surgical group and no post-procedural complications in the endovascular group. In a Kaplan Meier analysis of freedom from re-intervention during an overall follow-up period of 45 years, surgical intervention for CoA during adulthood was superior to endovascular treatment (p=0.008). Conclusions: Although long-term survival is similar, surgical intervention for adult CoA offers superior freedom from re-intervention than endovascular treatment (p=0.008).

Immediate and intermediate term results of cheatham platinum stenting for native coarctation of aorta in adults

Immediate and intermediate term results of cheatham platinum stenting for native coarctation of aorta in adults

Persistent hypertension and left ventricular hypertrophy after repair of native coarctation of aorta in adults

Abstract Background There are limited data about outcomes after repair of native coarctation of aorta (COA) in adulthood. The purpose of this study was to describe the procedural outcomes, hemodynamic improvement, regression of LV hypertrophy and cardiovascular events in adults undergoing repair of native COA. Methods The primary outcomes were procedural complications, re-interventions, and hemodynamic improvement (residual COA gradient &amp;lt;20 mmHg) after COA repair. The secondary outcomes were improvement in the severity of hypertension, regression of left ventricular mass index (LVMI), and incidence of cardiovascular events (atrial fibrillation, heart failure hospitalization, and cardiovascular death) after COA repair. Clinical and imaging indices were assessed pre-intervention, and at 1-year (Y1) and 3-years (Y3) post-intervention. Results A total of 172 patients (age 38 [27–48]) underwent COA repair (surgical 161; transcatheter 11). There were no procedural deaths, and all patients had residual COA gradient &amp;lt;20 mmHg. One patients that received transcatheter stent therapy required re-dilation of stent at 12 months post-intervention. There as a reduction in the prevalence of patients requiring anti-hypertensive therapy from 73% (pre-intervention) to 59% and 64% at Y1 and Y3 respectively. However, 72% and 69% of the patients still had systolic blood pressure &amp;gt;130 mmHg (stage 1 and 2 hypertension) at Y1 and Y3 respectively. As compared to patients without hypertension at Y1, patients with stage 1 and stage 2 hypertension had less robust LVMI regression (% change in LVMI 12±5% vs 9±6% vs 5±3%, p&amp;lt;0.001). Hypertension (HR 1.16, 1.05–1.27) and LVMI regression (HR 0.86, 0.81–0.90) were independently associated with cardiovascular events. Conclusions Persistent hypertension was common after repair of native COA in adults. Hypertension (including stage 1 hypertension) was associated with suboptimal regression of LVMI and cardiovascular events. These results are concerning, and highlight the importance of early COA diagnosis and repair, and optimal medical therapy for hypertension after COA repair. Funding Acknowledgement Type of funding sources: None.

Algorithmic Approach to Treatment of Aortic Coarctation in Adults

Aortic coarctation is less commonly encountered in adults and can be treated with open or endovascular intervention with no standardized approach reported. We have described our institutional algorithm for open vs endovascular treatment and detailed the operative and long-term outcomes.

Persistent Hypertension and Left Ventricular Hypertrophy After Repair of Native Coarctation of Aorta in Adults.

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Surgical and endovascular treatment of adult aortic coarctation : tewenty years experience center

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic coarctation accounts for 5 to 8 % of the congenital heart diseases. In adult patients, an expected mortality of 75 % at 43 years old was reported. conventional surgery was the gold standard in the treatment of these patients. Currently with the advancement of endovascular procedures, angioplasty with ou no stenting is increasingly indicated. Methods We report a retrospective, monocentric observational study of 57 patients treated for aortic coarctation surgically or by endovascular approach over a period of 20 years, from 2000 until 2020. Results The median age was 22 years with extremes of 15 and 65 years and the sex ratio was 1.42. All patients were hypertensive. The median of the trans-stenotic gradient was 60 mmHg. Surgical repair consisted mainly of resection-anastomosis using the Crafoord technique in 25 patients (44%) and interposition of a Dacron tube in 22 patients (39%). Endovascular treatment with stenting was done in seven patients. Post treatment gradient was 10 mm Hg ± 5 and no deaths were observed at 30 days. After an average follow-up of 70 months, residual hypertension was found in seven cases without any re-coarctation and in the univariate analysis, the main factors significantly associated with this residual hypertension were: age (p = 0.11), pre and post-operative gradient (p = 0.097), severe hypertension (p = 0,12), developed collateral circulation (p = 0.07), bicuspid aortic valve (p = 0.15) and diaphragm shape (p = 0.07). Conclusion The gold standard treatment remains the surgical correction but in selected patients, the endo-vascular repair is a valid option.we propose a decision-making algorithm based on the results of our study (Fig) Abstract Figure. decision-making algorithm

Coarctation of aorta in adults: a narrative review of surgical and endovascular management

Coarctation of aorta in adults: a narrative review of surgical and endovascular management

Aortic coarctation in adults: the role of multimodality cardiac imaging. Series of case reports and review of literature

Abstract Coarctation of the aorta (CoA) is a relatively frequent congenital defect. Its natural evolution is marked by serious complications including aortic dissection, heart failure, coronary artery disease, infective endocarditis, or cerebral haemorrhages. Correction of CoA before complications arise is associated with a favourable long-term outcome. Timely diagnosis of CoA is therefore of utmost importance in the prognosis of these patients. Non-invasive imaging techniques, ranging from chest radiography to echocardiography, Cardiac Computed Tomography (CCT), and Cardiac Magnetic Resonance (CMR) have evolved to the extent where they can not only suggest but also precisely characterize the lesion and guide further management. We present a series of 3 case reports, highlighting the diagnostic approach and treatment for this pathology.

Endovascular treatment of native aortic coarctation in adults: Two case reports and detailed review of the literature

Coarctation of the aorta (CoA) forms 6-8% of congenital heart diseases (CHD). This narrowing typically occurs in the proximal descending aorta, close to the insertion of the patent ductus arteriosus and can be found with a number of concomitant diseases. CoA is a common cause of secondary arterial hypertension in young adults. Although CoA can be an isolated CHD, it is also commonly found in other congenital syndromes and cardiovascular anomalies. Herein this review paper we reported a brief history of management of aortic coarctation, and current treatment modalities concentrated on stent placement supported with two novel cases.

Left ventricular remodeling after transcatheter versus surgical therapy in adults with coarctation of aorta

Abstract Background Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However, left ventricular (LV) remodeling after transcatheter COA intervention has not been systematically investigated. The purpose of this study was to compare remodeling of LV structure and function after transcatheter stent therapy vs surgical therapy for COA. Methods LV remodeling was assessed at 1, 3 and 5-years post-intervention using: LV mass index (LVMI), LV end-diastolic dimension, LV ejection fraction, LV global longitudinal strain (LVGLS), LV e' and E/e'. Results There were 44 and 128 patients in the transcatheter and surgical groups respectively. Compared to the surgical group, the transcatheter group had less regression of LVMI (−4.6 [95% CI: −5.5 to −3.7] vs −7.3 [95% CI: −8.4 to −6.6] g/m2, p&amp;lt;0.001), less improvement in LVGLS (2.1 [95% CI 1.8–2.4] vs 2.9 [95% CI: 2.6–3.2]%, p=0.024) and e' (1.0 [95% CI: 0.7–1.2] vs 1.5 [95% CI: 1.3–1.7] cm/s, p=0.009) at 5 years post-intervention. Exploratory analysis showed a correlation between change in LVMI and LVGLS, and between change in LVMI and e', and this correlations were independent of the type of intervention received. Conclusions Transcatheter stent therapy was associated with less remodeling of LV structure and function during mid-term follow-up. As transcatheter stent therapy become more widely used in the adult COA population, there is a need for ongoing clinical monitoring to determine if these observed differences in LV remodeling translates to differences in clinical outcomes. Funding Acknowledgement Type of funding source: None

Determinants of left ventricular hypertrophy and dysfunction in adults with coarctation of aorta

Abstract Background Several coarctation of aorta (COA) severity indices are used for timing of COA intervention, and to define severity of residual coarctation post-intervention. However, it is unclear how many of these COA indices are required in order to recommend intervention, and what degree of residual coarctation results in suboptimal recovery of the left ventricle (LV). Our aim was to assess the correlation between different COA indices and effects of chronic LV pressure overload (LV hypertrophy, diastolic and systolic dysfunction), and to determine the effect of residual coarctation on LV reverse remodeling after COA intervention. Methods COA severity indices were defined as Doppler COA gradient, systolic blood pressure, upper-to-lower-extremity systolic blood pressure gradient, aortic isthmus ratio. LV remodeling indices were defined as LV mass index (LVMI), LV global longitudinal strain (LVGLS), e' and E/e'. LV reverse remodeling was defined as the difference between indices obtained pre-intervention and 5-years post-intervention (delta LVMI, e', E/e', LVGLS). Results Of the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β±standard error −28.3±14.1, p&amp;lt;0.001), LVGLS (1.51±0.42, p=0.005), e' (3.11±1.10, p=0.014), and E/e' (−13.4±6.67, p=0.008). Residual aortic isthmus ratio also had the strongest correlation with LV reverse remodeling, and residual aortic isthmus ratio &amp;lt;0.7 was predictive of suboptimal LV reverse remodeling post-intervention. Conclusion Considering the known prognostic implications of LV remodeling and reverse remodeling in response to pressure overload, these results support the use of aortic isthmus ratio for timing of COA intervention, and for prognostication post-intervention. Funding Acknowledgement Type of funding source: None

A rare case of pseudoaneurysm at the site of untreated coarctation of the aorta in an adult patient

Here we report a rare case of pseudoaneurysm at the site of aortic coarctation. Aortic coarctation and a saccular aortic aneurysm protruding from the site of this coarctation were detected in a 50-year-old woman. Owing to the shape of the aneurysm and high risk of rupture, an open surgical repair was performed. The pathological findings of the removed aneurysm revealed a pseudoaneurysm consisting of only a thin adventitial wall. Adult uncorrected aortic coarctation has a poor prognosis. One of its causes may be the formation of such a pseudoaneurysm.