Coarctation Of Aorta In Adults Research Articles

Extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation

To review the experience of extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation. From July 1997 to July 2008, 48 consecutive patients (median age 30 years; range 10 to 58 years) with complex aortic coarctation underwent extraanatomic aortic bypass grafting. Indications include: (1) coarctation with intracardiac anomaly (n = 28); (2) coarctation with ascending aortic aneurysm (n = 1); (3) adult coarctation with calcification of local aortic wall (n = 7); (4) coarctation with hypoplasia aortic arch (n = 4); (5) long or multiple coarctation segment (n = 4); (6) coarctation with poststenotic aneurysm (n = 1); and (7) recurrent coarctation (n = 3). Routing of the grafts was:ascending-to-posterior pericardial descending aorta (n = 37); ascending-to-infrarenal abdominal aorta (n = 9); left subclavian artery-to-descending aorta(n = 2). Concomitant cardiac operations were performed in 31 patients (65%) using cardiopulmonary bypass; procedures included: aortic valve replacement in 16; mitral valve repair or replacement in 9; Bentall procedures in 6; patent ductus arteriosus closure in 5; ascending aortic replacement or plasty in 4; ventricular septal defect closure in 3 and coronary artery bypass surgery in 2. There was no operative death. One patient died of septic shock 39 days postoperatively. Two patients received laparotomy because of mechanical ileus shortly after the ascending-to-subrenal abdominal aortic bypass. Mean systolic blood pressure gradient between upper and lower extremities decreased from (65 +/- 27) mm Hg preoperatively to (14 +/- 11) mm Hg postoperatively (P < 0.05). During a mean follow-up of 28.9 months, there were no late deaths or graft-related complications. Residual mild hypertension were observed in five patients. Extraanatomic aortic bypass is an attractive treatment option for complex aortic coarctation in adults and adolescents. It can be performed with low morbidity and mortality. The midterm results is favorable.

Repair of Aortic Coarctation in an Adult by Direct Aortoplasty

Various techniques have been proposed for surgical correction of aortic coarctation in adults. We describe direct aortoplasty repair in a 28-year-old woman with native coarctation. Four-year follow-up with magnetic resonance angiography confirmed a good result. This is a safe and effective technique that provides enlargement of the aortic lumen by avoiding extensive anastomotic suture lines or interposition of prosthetic graft material.

Coarctation repair in adults: beneficial effects on postoperative blood pressure regulation

Objectives: Aim of this study was to determine the results after surgical repair of aortic coarctation in adults, focussing on its effect on arterial blood pressure.

Correction of Coarctation of Aorta in Adult Patients - Impact of Corrective Procedure on Long-Term Recoarctation and Systolic Hypertension

Uncorrected coarctation of the aorta in adults predisposes to congestive failure, aortic rupture, stroke and endocarditis. Surgical correction of this condition is fraught with technical difficulties due to the complexity of the lesion, associated anomalies and extensive collaterals. The optimal surgical technique has not yet been well defined in adults. We describe our experience with adult coarctation and the long-term outcome with regard to recoarctation and systolic hypertension. A consecutive series of 54 patients above the age of 12 years who underwent coarctation correction over a period of 8 years are included in this report. Eight patients underwent balloon angioplasty, one of whom also had stent placement. Forty-eight patients underwent surgical intervention. Twenty-seven patients underwent resection and anastomosis, 6 had patch angioplasty and 13 had a prosthetic graft repair. All patients were followed up at 3 months and then annually to look for recoarctation, regression of hypertension and aneurysm formation. There was no mortality in this series; major morbidities included reoperation for bleeding in 3 patients, pulmonary complications and paraplegia in 1 patient. Hypertension was well controlled in all patients at discharge. Follow-up is 100 % complete and mean follow-up was 4.6 years. There was one case of aortic dissection and one case of aneurysm formation in the balloon angioplasty group. There was a statistical trend towards increased rates of recoarctation in the balloon and resection and anastomosis groups. 32 % of patients were off antihypertensive medications at their last follow-up. Surgical correction of coarctation of aorta in adults can be achieved with an acceptable morbidity. A variety of options are available for the surgical management of coarctation of the aorta in adults. Prosthetic graft and patch repair are associated with good short and long-term results. Use of balloon angioplasty without stenting as the primary therapy requires further clarification. Hypertension is well controlled in most patients.

Repair of Aortic Coarctation in Adults: The Fate of Hypertension

The benefit of coarctation repair on the resolution of systolic hypertension in adults has been questioned. In this retrospective study, hypertension was assessed in 38 adults (22 men, 16 women; mean age, 25.6 +/- 6.9 years; range, 16-39 years) who underwent coarctation repair between 1996 and 2006. Thirty patients had preoperative hypertension (mean systolic pressure, 158.3+/-18.6; range 140-200 mm Hg). At preoperative catheterization, the peak mean systolic gradient across the coarctation was 70.6 +/- 21.2 mm Hg (range, 38-120 mm Hg). Operative procedures were resection and end-to-end anastomosis (11 patients), patch aortoplasty (24) and resection with interposition of a Dacron tube graft (3). The patients were followed up for 2-90 months (mean, 37 +/- 23 months). Of the 30 patients with preoperative hypertension, 25 (83%) were normotensive at the last follow-up. The mean postoperative systolic blood pressure was significantly lower than the preoperative level. More than half of the patients (58%) were still taking antihypertensive medication. Surgical repair of coarctation of the aorta in adults can lead to regression of systolic hypertension and a decreased requirement for antihypertensive medication.

Strategy for Adult Aortic Coarctation Complicated by Coronary Artery Disease

Aortic coarctation in adults is sometimes associated with a fragile aortic wall and may be complicated by coronary artery disease and ascending aortic dilation. Successful management of aortic coarctation in a 45-year-old man with coronary artery disease is described. Tube graft replacement was carried out without cross clamping, under circulatory arrest with axillary artery and graft inflow.

Repair of coarctation of the aorta in adults – mid- and long-term results

The aim of this retrospective study was to determine the mid- and long-term results after surgical repair of aortic coarctation in adults. 25 adults (9 women, 16 men), mean age 43.4 years (range, 19 to 70), underwent aortic coarctation surgical repair. In eleven from 21 patients (52.4%), the diagnose was given as incident finding (in 4 patients could not be retrospectively determined). All patients suffered from preoperative hypertension. Mean blood pressure was 182/97mmHg. 16 (64%) patients demonstrated reduced load capacity. Rhythm disorders in 7 (28%) patients. Operative technique – end-to-end anastomosis for 5 patients (20%), interposition of a Dacron-tube graft for 3 patients (12%), Dacron-patch in 7 (28%) patients, and in 10 (40%) patient an extraanatomical bypass graft. The mean operation time was 194 minutes (range 105–295).

Hypothermic circulatory arrest through a left thoracotomy in a 12-year-old child with aortic coarctation

Surgical correction of adult complex aortic coarctation using hypothermic circulatory arrest often requires central cannulation to secure cerebral perfusion. It is not easy to place the cannula in the ascending aorta, however, especially in children undergoing surgery through a left thoracotomy. In a 12-year-old male with hypoplastic distal aortic arch, we placed an arterial cannula in the ascending aorta using the Seldinger puncture technique through the stenotic segment of the distal aortic arch. Replacement of the stenotic segment with a 20 mm-size Dacron graft was then routine. The ascending aorta was exposed only for the proximal anastomosis. The left subclavian artery was also reconstructed. This central cannulation technique is simple and is useful in repairing complex aortic coarctation.

Concurrent single stage repair of coarctation of aorta and associated cardiac pathology in adult patients

Thoracic aortic coarctation and associated intracradiac pathology including a concomitant valvular lesion or coronary artery disease is an uncommon combination in adult patients. The simultaneous operative management of both lesion is preferred to avoid a second redo surgery and the risks associated with it. We describe a simultaneous operative management of six adult patients with coarctation of aorta and associated cardiac lesion. All six patients had heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) to repair the coarctation and concomitant repair of the cardiac lesion. The associated procedures were aortic valve replacement in 3 patients, coronary artery bypass grafting in 2 patients and mitral valve replacement in 1 patient. There were no operative deaths and all patients are doing well on follow up with patent coarctation of aorta bypass graft at a mean follow up of 18 months. No graft related complications occurred, and there were no instance of stroke or paraplegia. All patients had an uneventful post operative course and are on routine out patient follow up. A median sternotomy for repairing adult coarctation of aorta with concomitant cardiac lesion can be performed safely and readily managed as an excellent single stage approach.

Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach

BackgroundCoarctation of the aorta in the adulthood is sometimes associated with additional cardiovascular pathologies that require intervention. Ideal approach in such patients is uncertain. Anatomic left-sided short aortic bypass from the arcus aorta to descending aorta via median sternotomy allows simultaneuos repair of both complex aortic coarctation and concomitant cardiac operation.MaterialsFour adult patients were underwent Anatomic left-sided short aortic bypass operation for complex aortic coarctation through median sternotomy using deep hypothermic circulatory arrest. Concomitant cardiac operations were Bentall procedure for annuloaortic ectasia in one patient, coronary artery bypass grafting for three vessel disease in two patient, and patch closure of ventricular septal defect in one patient.ResultsAll patients survived the operation and were alive with patent bypass at a mean follow-up of 36 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia.ConclusionWe conclude that single-stage repair of adult aortic coarctation with concomitant cardiovascular lesions can be performed safely using this newest technique.

Percutaneous Interventions on Severe Coarctation of the Aorta: A 21-Year Experience

Different percutaneous interventions can be used to treat coarctation of the aorta. However, a great amount of information is still needed regarding the long-term course. This article reviews our experience spanning 21 years in the percutaneous treatment of aortic coarctation. Four different conditions for treatment were considered. The first condition 1 (group 1) was balloon angioplasty in neonates and infants with untractable heart failure (n = 54; mean age, 1.2 +/- 1.4 months). After balloon angioplasty, most infants sustained significant clinical improvement. However, 9 patients died in the hospital (17%). As a result, we monitored the course of the 45 survivors during a mean period of 10 +/- 6 years (range, 1-19). During this follow-up period, 17 patients needed a single additional intervention on coarctation (8 underwent surgery and 9 were treated percutaneously). After this second treatment, 11 patients needed one or more further interventions. The actuarial survival probability was 83% at 19 years, with 43% of patients remaining surgery free and 23% reintervention free. The second condition (group 2) was balloon angioplasty in children and adults with coarctation of the aorta before the stenting era (n = 28; mean age, 13 +/- 8 years). After treatment, serial hemodynamic and angiographic studies were performed. The long-term relief was higher in patients with a discrete type of coarctation. The rate of late aneurysm formation was 6%. The third condition (group 3) was stent palliation in infants and children younger than the age of 6 years (n = 17; mean age, 2.1 +/- 1.7 years). The stent was implanted for nondilatable stenoses, as a nondefinitive procedure. Stent palliation provides complete initial relief in hypoplastic coarctations or life-threatening conditions. However, further stent expansion is required to ensure adequate stent diameter in the growing aortic wall. In addition, late intrastent proliferation may occur in small stent diameters (18%) and aneurysm formation in hypoplastic coarctations (18%). Both late complications can be managed percutaneously. The fourth condition (group 4) was stent repair of severe aortic coarctation in adults, adolescents, and children older than the age of 6 years (n = 73; mean age, 20 +/- 12 years). Significant relief was observed after treatment, which persisted at follow-up. One patient died at treatment (1.3%). After a mean follow-up of 5 +/- 3 years, all 72 patients remained symptom free and no restenosis or late aneurysm were detected.

Aortic coarctation in adults - a single center 15-years-experience with anatomic and extraanatomic repair

Objectives: Aortic isthmic coarctation in the adult is a surgical challenge. We report on surgical options and long-term follow-ups of 24 adult patients treated between 1990 and 2004.

Our Experiences With Adult Type Aortic Coarctation

Background: Adult patients with coarctation of the aorta may require different treatment modalities and surgical methods from children. A total of five adult aorta coarctation cases who underwent operations in our clinic were reviewed. Methods: In this article, we describe five adult aortic coarctation cases between 22 and 62 years old (33.8±17) who underwent operations between 1998 and 2004. There was preoperative hypertension in all five cases. We performed patch plasty operations with PTFE grafts under aortic cross-clamping in three patients, and bypass operations with 8 mm PTFE grafts under aortic partial clamping in the other two. The mean aortic cross-clamp time of the patch plasty patients was 38,6±8,5 min, and the mean aortic partial clamping time of the bypass patients was 52±12 min. Results: We found paradoxical hypertension 24 h after the operation in two cases (1st and 2nd patients), 48 h after the operation in the third and 72 h after the operation in the remaining two (4th and 5th patients). We observed no perioperative neurogenic complications or mortality. Conclusion: Surgical treatment of coarctation of the aorta in adults usually alleviates hypertension and reduces the need for antihypertensive drugs. A bypass between proximal and distal segments of the aorta that have normal wall structure is a reliable method, with lower morbidity and mortality rates in older patients.

Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults

Background Balloon angioplasty for native coarctation of the aorta (CoA) in adults, though promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few studies available have reported on use of balloon-expandable stents in such a situation. We evaluated the use of self- and balloon-expandable stents in patients with suboptimal response to balloon angioplasty (BA). Methods Twenty-one hypertensive patients (age, 18 to 61 years; mean, 28.6 ± 11.2 years) with native CoA and in whom results of BA were suboptimal (ie, residual peak systolic gradient [PSG] >20 mm Hg) underwent stent implantation. Balloon-expandable Palmaz stents were implanted in 5 patients (group A) and self-expandable nitinol aortic stents in the remaining 16 patients (group B). Results In group A, PSG decreased from 62.8 ± 10.6 (53 to 80) mm Hg to 28.1 ± 6.3 (22 to 39) mm Hg after BA. Systolic gradient further decreased to 8.3 ± 3.9 (2 to 16) mm Hg ( P < .001) after implantation of the balloon-expandable Palmaz stent. In group B, PSG decreased from 70.2 ± 24.6 (40 to 110) mm Hg to 28.4 ± 9.8 (22 to 42) mm Hg after BA and further reduced to 9.0 ± 5.5 (4 to 16) mm Hg ( P < .001). One of these patients had a nitinol self-expandable stent implanted after a Palmaz stent embolized immediately after deployment. Nitinol stents were easier to deploy and conformed better to aortic anatomy compared with balloon-expandable stents. In group A, the diameter of the coarcted segment increased from 3.8 ± 0.8 mm to 13.3 ± 0.8 mm ( P < .001) after stent implantation and in group B it increased from 4.5 ± 1.1 mm to 14.1 ± 2.1 mm ( P < .001). There was no significant difference between the two groups in the PSG and diameter of the coarcted segment before and after stent implantation. With the exception of one case, in which a Palmaz stent embolized, there was no other complication in our series. On follow-up of 12 to 71 months (mean, 40.7 ± 5.8 months) all the implanted stents remained in their original position and none showed evidence of fracture. Improvement in hypertension was seen in 20 of 21(95.2%) of the patients. On recatheterization and angiography 1.2 ± 0.6 years after implantation in 19 patients, one patient showed an increase in PSG to 27 mm Hg across the nitinol stent and underwent successful redilation. No increase in gradient was seen in other patients. Beneficial late remodeling was seen in 10 of 14(71.4%) of patients restudied after implantation of self-expandable stent. None of the patients showed aneurysm formation. Conclusions Stent implantation is safe and effective in improving suboptimal results after BA for CoA. Self-expandable stents were easier to implant, adapted better to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation as balloon-expandable stents.

126 Aortic complications of coarctation of aorta in adults: aneurysm, pseudoaneurysm, infective endarteritis, dissection, fistulae and aortic rupture

126 Aortic complications of coarctation of aorta in adults: aneurysm, pseudoaneurysm, infective endarteritis, dissection, fistulae and aortic rupture

Long-term follow-Up of percutaneous balloon angioplasty in adult aortic coarctation.

To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults. Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements. At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p = 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs required per patient decreased from 0.56 to 0.31 (p = 0.234). No significant residual stenoses or restenoses were seen at MRI. Small but clinically insignificant residual pressure gradients were recorded in all patients using Doppler echocardiography. Complications included one transient ischemic attack at 5 days, one external iliac dissection requiring stent insertion, and a further patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision. PTA of adult coarctation is safe and effective in the long term. Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choice.

A Case Report of Balloon Angioplasty for Coarctation of Aorta in Adult

For the treatment of coarctation of aorta, surgical intervention has been known as a standard therapy. During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient between ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation(2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angio-plasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angio-plasty for coarctation of aorta is the first case reported in Korea.

Percutaneous balloon dilatation of aortic coarctation in adults.

Abstract In conclusion, our experience suggests that PBA of coarctation of the aorta is a feasible and safe procedure for both native and repaired coarctationin adults. However, some patients may have unsuitable morphology and should not be subjected to PBA. The results are effective in the medium term and may obviate the need for surgery in a large number of patients. The procedure should be routinely considered in adults with this condition, but long-term follow-up remains essential.

Repaired aortic coarctation in adults—magnetic resonance imaging with velocity mapping shows distortions of anatomy and flow

AbstractMagnetic resonance velocity mapping of intraaortic flow was performed prospectively in adolescents and adults after coarctation repair. The aims were to assess the feasibility and clinical usefulness of the technique in this patient group, and to study flow velocity distributions in repaired regions. Twenty consecutive patients attending for follow-up after repair of aortic coarctation, aged 15–39, mean 25 years, were studied using a 0.5 tesla Picker magnetic resonance machine. Spin echo and cine imaging with phase velocity mapping, echo time 3.6 ms, were used to study anatomy and flow in the repaired region. Transcutaneous ultrasonic examination, with continuous wave Doppler velocity measurement was performed independently on the same day. Velocity maps, acquired successfully in all patients, showed asymmetry and nonhomogeneity of flow in relation to anatomical distortions of repaired regions. Magnetic resonance and Doppler measurements of peak velocity compared as follows: n=20, range 1.2–3.9 m/sec, mean 2.33 m/sec, mean of differences (Doppler-MR) 0.22 m/sec, standard deviation of differences ±0.27 m/sec. Localized velocity peaks adjacent to wall deformations were identified by magnetic resonance in five patients without significant restenosis. Magnetic resonance imaging with velocity mapping proved reliable and informative in follow-up assessment in adolescents and adults after surgical repair of aortic coarctation. There was satisfactory agreement between magnetic resonance and Doppler measurements of peak velocity. Velocity maps showed that localized velocity peaks may occur in limited parts of the stream adjacent to distorted aortic boundaries without stenosis. This could be a cause of overestimation of pressure gradients from peak velocity data, a possibility which requires further investigation.

Aortic Coarctation with Two Intercostal Aneurysms, Appearing Radiographically as a Subclavian Aneurysm A Case Report

The authors present a case of adult aortic coarctation with two associated intercostal aneurysms and poor left ventricular function. The intercostal aneurysms appear, radiographically, as a subclavian aneurysm. The case illustrates, in aortic coarctation, the potential difficulty in defining the anatomy of the associated vascular aneurysms. The authors also demonstrate that the left ventricular function markedly improves after resection of the aortic coarctation.