Surgical Correction Of Coarctation Research Articles

The level of nitric oxide in children after surgical treatment of coarctation of the aorta

The aim of the study: to determine the level of nitric oxide in children after a successful surgical correction of the coarctation of the aorta as a possible factor in maintaining arterial hypertension.Materials and methods: the main group consisted of 16 patients with arterial hypertension, in 6 patients arterial pressure was characteristic of stable hypertension, in 10 patients – for labile hypertension. The control group consisted of 15 practically healthy children. The age of the patients of both groups was from 12 to 17 years. The postoperative period of children in the main group was 6 to 48 months. The level of nitrite as a final product of nitric oxide, its stable metabolite in plasma was studied.Results. There is a significant reduction in the level of nitric oxide in children after successful surgical correction of the aortic coarctation. The dependence of the level of nitric oxide on the long-term postoperative period was determined.Conclusions. When 24-hour monitoring of arterial pressure was performed, 16 patients were diagnosed with arterial hypertension (66, 67%), hypertension rates were typical for stable hypertension in 6 people, and 10 patients had labile hypertension. The level of nitric oxide is significantly lower in the group of children with arterial hypertension than in the control group. The level of nitric oxide is significantly higher in children with the labile hypertension than in the group with the stable hypertension. The longer arterial hypertension is established (the longer the postoperative period), the lower the level of nitric oxide.

The influence of autonomic nervous system and elastic properties of the aortic wall on arterial hypertension progression in patients after surgical correction of coarctation of the aorta

<p><strong>Aim:</strong> To assess sensitivity of the baroreceptors and elastic properties of the aortic wall in patients who underwent surgical correction of coarctation of the aorta.<br /><strong>Methods:</strong> In this prospective cohort study focus was placed on the evaluation of baroreceptors function and elastic properties of the aorta in 26 young patients who underwent surgical repair of coarctation of the aorta by using end-to-end extended anastomosis (Group I). The evaluation data obtained was then compared with that of the control group consisting of 26 healthy children without any congenital heart defects (Group II).<br /><strong>Results:</strong> Follow-up period was 25 (21;30) months. The spontaneous sensitivity of baroreceptors varied between the groups and was significantly higher in Group I 11.6 (10.5;12.6) versus 8.8 (8.1;9.9) in Group II, p=0.01. The velocity of pulsatile blood flow was higher in Group I 7.7 (5.8;9) (m/s) -1 versus 5.9 (4.8;7.1) (m/s) -1 in Group II, with a statistically significant difference between them (p = 0.003). The elastic properties of the aortic wall in Group I also considerably differed from those in the control group.<br /><strong>Conclusion:</strong> A high baroreceptors sensitivity and aortic wall stiffness in patients after surgical repair of coarctation of the aorta are direct predictors of arterial hypertension progression. However, it is important to assess the influence of the stroke volume on the rate of arterial hypertension incidence in patients who underwent surgical repair of coarctation of the aorta.</p>

Late complication after repair of aortic coarctation.

Coarctation of the aorta is a congenital malformation that has long been considered completely correctable with appropriate surgery in childhood. However, with the aging of these patients, many late complications have been reported, and this notion must be reevaluated. We retrospectively reviewed all patients who underwent reoperation between 1992 and 2012 in our adult cardiac surgery department following surgical correction of coarctation in childhood; 18 patients over 15-years old were included in the study. The median time from coarctation repair to reoperation was 25 years. Patients were reoperated on for several late complications: aortic valve disease secondary to bicuspid aortic valve, ascending aortic aneurysm, recoarctation, aortic arch hypoplasia, pseudoaneurysm, associated recoarctation and pseudoaneurysm, subvalvular aortic obstruction, and descending thoracic aortic aneurysm. One patient died due to an intraoperative complication. In the other cases, the surgical results were satisfactory at the 6-month follow-up. According to literature data, age at coarctation repair and surgical technique appear to be essential factors in late complications: older age and surgical repair with prosthesis interposition are associated with a higher rate of reintervention. Patients who have undergone repair of aortic coarctation frequently remain asymptomatic for a long time. Late complications can be appropriately treated when diagnosed early. Consequently, all coarctation patients need careful lifelong follow-up, especially those with congenital aortic valve disease or surgery in childhood with interposition of prosthetic material.

Application of physical rehabilitation practices following surgical correction of coarctation of the aorta

The paper examines surgical correction of coarctation of the aorta as one of the major problems of pediatric cardiac surgery in relation to the need for physical rehabilitation. The main factors are determined requiring application of physical rehabilitation practices at the early and the late periods following surgical correction of coarctation of the aorta in children. The main factors requiring the use of physical rehabilitation are postsurgical complications, functional and morphometric parameters of heart and blood vessels, and decreased physical performance.

Mid-term results, and therapeutic management, for patients suffering hypertension after surgical repair of aortic coarctation

We designed our study to investigate the efficacy of a new therapeutic approach to late onset hypertension in patients after surgical repair of aortic coarctation. Several studies have shown a higher incidence of hypertension during daily activities, and during exercise, in patients after surgical correction of coarctation. To the best of our knowledge, however, no data exists concerning haemodynamics, the response of arterial pressures, and the effects of medications for lowering blood pressure during exercise or during daily activities.We studied 128 patients, aged 15.6 +/- 4.3 years, to determine the response of blood pressure as we administered treatment in the attempt to achieve a normotensive state. We excluded patient with associated cardiac abnormalities, apart from those with bicuspid aortic valves. We evaluated blood pressure at rest in both the right arm and leg to establish presence of any gradient, as well as the blood pressure in the arm during exercise testing, and by 24-hour ambulatory monitoring.Atenolol was prescribed for those with elevated values of blood pressure but with a normal increment of heart rate during exercise. We prescribed Candesartan for those with elevated levels of blood pressure but with reduced increments of heart rate, specifically maximal heart rates of less than 85% of their predicted value. Both drugs were used when one alone was not effective. We found that, in young patients, candesartan provided better control of blood pressure with no side-effects, especially as demonstrated using 24-hour ambulatory monitoring, while atenolol was less effective, with more side-effects. Our experience suggests that both drugs should be used in patients who are non-responsive to monotherapy.

Intractable tinnitus and sensorineural deafness cured by surgical correction of coarctation of aorta

Tinnitus is a challenging condition to manage with no effective treatment. We report a case of lifelong tinnitus present in a patient who was cured with the surgical repair of his coarctation of aorta. The patient was a fit 37-year-old with coarctation of aorta, senserineural deafness and intractable tinnitus. He underwent a thoracotomy and tube by-pass of his coarctation of aorta. A complete relief of his tinnitus and improvement in his hearing was noted postoperatively and confirmed on audiograms. This is the first reported case of tinnitus due to coarctation of aorta relieved by surgical correction of the coarctation.

Surgical correction of coarctation of the aorta–A retrospective study

Different surgical methods, each having its own advantages and disadvantages have been described in the surgical repair of coarctation of the aorta. A comparison of the surgical methods used in our short series of 26 consecutive coarctation repairs have been retrospectively studied. Resection and grafting or patch aortoplasty were usually done in older subjects; resection with direct anastomoses and subclavian flap repair were done in the young. Associated intracardiac anomaly repair was also done in the same sitting; being corrected first followed by coarctation repair. No major difference was found among the various groups.

Surgical correction of coarctation in early infancy: Does surgical technique influence the result?

Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.9 month. Four different surgical techniques were used: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty (Meier-Mendonca technique). Hospital mortality was 7.5% and was limited to patients with additional complex intracardiac defects. Neither age nor surgical technique had an influence on the operative risk. Follow-up averaged 15 to 43 months for the four different groups. Restenosis developed in 9 (19%) of 47 patients regularly followed up, 5 (11%) of whom have had reoperation. Age at operation was not a predictor for restenosis, which occurred in 17.4% of patients less than 1 month and 20.8% of those greater than 1 month of age at operation. Patch enlargement and the subclavian displacement technique demonstrated the highest restenosis rates (42% and 43%, respectively). However, patients who underwent patch enlargement had less favorable pathological conditions. It is concluded that results of coarctation repair in early infancy do not depend as much on the operative method itself as on the specific pathological aspect, which largely determines the method of treatment. Some reservation must be made in regard to the subclavian displacement technique.

Anaesthetic management for surgical correction of coarctation of aorta

In this paper we have reviewed the anaesthetic management of 57 consecutive patients who underwent surgical correction of coarctation of aorta. The patients were divided into two groups. In group I of ten patients, no volume preloading was done prior to the release of aortic cross-clamp and the declamping hypotension was managed by rapid infusion of fluids along with correction of metabolic acidosis. In group II of 47 patients, volume preloading was done along with administration of sodium bicarbonate 1 mEq/kg just prior to declamping. Statistically significant (p<0.05) decrease in the systolic and diastolic pressures were observed after declamping in group I; whereas in group II, the hypotension observed was statistically insignificant. Declamping hypotension can thus be prevented or minimised by appropriate volume preloading and correction of existing metabolic acidosis just prior to the release of aortic cross-clamp.

Acute aortic occlusion as a late complication of coarctation repair

Late morbidity and mortality following surgical correction of coarctation of the aorta in adults are primarily related to associated cardiovascular disease, especially persistent systemic hypertension and its sequelae. complications related to the site of coarctation repair are relatively uncommon in this age group and include residual and recurrent coarctation and aneurysm formation. An unusual case is presented in which dehiscence of the proximal suture line of a Dacron tube graft resulted in a flap-valve effect, pseudoaneurysm formation, and acute functional occlusion of the aorta. The angiographic findings are described and the relevant literature reviewed.

Effects of aortic cross-clamping on cellular metabolism during surgical correction of coarctation in children: E. Enger, G. Mallgren, and H. Haljamäe. Z Kinderchir 23:356–364 (April), 1978

Effects of aortic cross-clamping on cellular metabolism during surgical correction of coarctation in children: E. Enger, G. Mallgren, and H. Haljamäe. Z Kinderchir 23:356–364 (April), 1978

Surgical correction of coarctation of the aorta in infancy: Special considerations for intraoperative and postoperative management

Surgical correction of coarctation of the aorta in infancy: Special considerations for intraoperative and postoperative management