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EuroIntervention : Journal of EuroPCR... Oct 2015Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually... (Meta-Analysis)
Meta-Analysis Review
AIMS
Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually reported in small retrospective case series. This systematic review provides an overview of clinical experience with stenting for CoA.
METHODS AND RESULTS
A systematic review of the reports published between January 1990 and December 2014 after stenting a CoA was performed with a focus on relief of obstruction and lowering of blood pressure. Study and patient characteristics were extracted, as well as pre- and post-stenting aortic diameter in mm, systolic pressure gradient (SPG) and pre- and post-stenting systolic blood pressure (mmHg), periprocedural and follow-up complications. Forty-five articles met the inclusion criteria. Three outcomes were extracted from the articles - aortic diameter, systolic pressure gradient and blood pressure. Diameter increased from 6.4 mm (5.6, 7.3) to 15.1 mm (14.5, 15.7), pressure gradients decreased from 40 mmHg (35, 42) to 4 mmHg (3, 5) and systolic blood pressure decreased from 153 mmHg (148, 158) to 132 mmHg (127, 136). Stent migration was the most common periprocedural complication (2.4%), and mortality was low (0.4%).
CONCLUSIONS
Stenting is an effective treatment with regard to immediate relief of obstruction and direct lowering effect on blood pressure. However, there is a lack of evidence regarding late effectiveness concerning durable blood pressure lowering, and limited information on periprocedural and late complications. This observation calls for a systematic and longer prospective follow-up of patients after CoA stenting.
Topics: Aortic Coarctation; Arterial Pressure; Endovascular Procedures; Foreign-Body Migration; Humans; Risk Factors; Stents; Time Factors; Treatment Outcome
PubMed: 26499220
DOI: 10.4244/EIJV11I6A133 -
EuroIntervention : Journal of EuroPCR... Feb 2021The aim of this study was to report our experience with the Cook Formula stent in the treatment of (recurrent) coarctation of the aorta in children below 12 kg.
AIMS
The aim of this study was to report our experience with the Cook Formula stent in the treatment of (recurrent) coarctation of the aorta in children below 12 kg.
METHODS AND RESULTS
In vitro study of the Cook Formula 418 (8 mm) and 535 (8 and 10 mm) stents demonstrated successful down-crimping on smaller balloons and predictable fracturing patterns. Between November 2012 and January 2019, one patient with native, one patient with post-interventional and thirteen patients with post-surgical coarctation of the aorta underwent implantation of a Cook Formula stent. Patient and procedural characteristics were obtained as well as procedural success, complications, and follow-up. Median age was 4.3 months and median weight 5.5 kg. Arterial sheath size ranged from 5 to 7 Fr. In-stent diameters of 3.7 to 8.8 mm were obtained with a median residual gradient of 0 mmHg. Major complications consisted of periprocedural haemodynamic instability (n=1), dissection of the iliac artery (n=1) and non-deployment with surgical removal (n=1). Re-dilations were performed after a median interval of 24.3 months. Median follow-up was 31.7 months.
CONCLUSIONS
The bare metal Cook Formula stent provides a durable and effective alternative to reoperation and balloon dilatation for native as well as post-surgical aortic coarctation in children below 12 kg.
Topics: Aorta; Aortic Coarctation; Catheterization; Child; Humans; Infant; Stents; Treatment Outcome
PubMed: 31566574
DOI: 10.4244/EIJ-D-19-00157 -
Journal of Vascular Surgery Jun 2010Surgical treatment of aortic coarctation has increased life expectancy and reduced mortality. Unfortunately, the average lifespan after repair remains only 35 to 50... (Review)
Review
Surgical treatment of aortic coarctation has increased life expectancy and reduced mortality. Unfortunately, the average lifespan after repair remains only 35 to 50 years, and significant morbidity persists as a result of aneurysm formation, hypertension, accelerated coronary disease, and stroke. Follow-up studies have revealed restenosis rates of 30% and persistent hypertension at rest and during exercise, sometimes with compromised cardiac function. The less invasive nature of nonsurgical repair using transcatheter therapies has led to balloon angioplasty and, recently, stent implantation as an emerging concept for the treatment of aortic coarctation. This review focuses on advances in the management, current indication, and techniques of interventional repair in aortic coarctation.
Topics: Adolescent; Adult; Angioplasty, Balloon; Aortic Coarctation; Aortography; Child; Humans; Middle Aged; Patient Selection; Prosthesis Design; Risk Assessment; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Young Adult
PubMed: 20223618
DOI: 10.1016/j.jvs.2009.12.063 -
Diagnostic and Interventional Imaging Sep 2022The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow...
PURPOSE
The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow magnetic resonance imaging (MRI) in patients with bicuspid aortic valve (BAV) and repaired coarctation.
MATERIALS AND METHODS
The study retrospectively included patients with BAV and childhood coarctation repair who had at least two cardiothoracic MRI examinations including 4D flow MRI at baseline and follow-up. Analysis included the calculation of aortic peak velocities, wall shear stress (WSS), pulse wave velocity (PWV), aortic dimensions and annual growth rates. Differences between examinations were assessed using paired t-test or Wilcoxon signed rank test. Relationships between growth rate and 4D flow metrics were assessed using Pearson or Spearman correlation tests.
RESULTS
The cohort included 15 patients (mean age 35 ± 8 [SD] years, 9 men) with a median follow-up time of 3.98 years (Q1: 2.10; Q3: 4.96). There were no significant differences in aortic mean WSS, peak velocities, and PWV between baseline and follow-up values. Greater baseline peak velocities at the site of the coarctation were strongly associated with aortic narrowing (follow-up vs. baseline diameter) at coarctation zone (r = -0.64; P = 0.010) and moderately in descending aorta (r = -0.53; P = 0.042). In addition, increased baseline WSS in the aortic arch was strongly related with narrowing of the coarctation zone at follow-up (r = -0.64, P = 0.011).
CONCLUSION
Measures of aortic hemodynamics and aortic WSS are stable over time in patients with BAV with coarctation repair. Increased peak velocity was associated with a progressive narrowing at the site of the coarctation repair.
Topics: Adult; Aortic Coarctation; Aortic Valve; Bicuspid Aortic Valve Disease; Child; Follow-Up Studies; Hemodynamics; Humans; Magnetic Resonance Imaging; Male; Pulse Wave Analysis; Retrospective Studies
PubMed: 35523699
DOI: 10.1016/j.diii.2022.04.003 -
Clinical Cardiology Nov 1989Since the initial report of balloon coarctation angioplasty in 1982, several workers used this technique in native coarctation and postoperative recoarctation. Immediate... (Review)
Review
Since the initial report of balloon coarctation angioplasty in 1982, several workers used this technique in native coarctation and postoperative recoarctation. Immediate and intermediate-term follow-up results are generally good with a small chance for recoarctation and aneurysmal formation at the site of coarctation. The causes of recoarctation were identified and include age less than 1 year, isthmus hypoplasia, and a small coarcted aortic segment. Despite good immediate and follow-up results, recommendations for use of balloon angioplasty as a treatment procedure of choice are clouded by the reports of development of aneurysms at the site of coarctation. We feel that balloon coarctation angioplasty is the treatment of choice in neonates and small infants, while general use of this technique in both native and postoperative coarctations in older children should await follow-up results in larger numbers of children at selected centers.
Topics: Adolescent; Adult; Angioplasty, Balloon; Aortic Aneurysm; Aortic Coarctation; Cardiac Catheterization; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Postoperative Complications; Recurrence; Ultrasonography
PubMed: 2531050
DOI: 10.1002/clc.4960121103 -
JACC. Cardiovascular Interventions Feb 2022
Topics: Aortic Coarctation; Aortography; Flowers; Humans; Stents; Treatment Outcome
PubMed: 35144788
DOI: 10.1016/j.jcin.2021.12.025 -
Atherosclerosis Oct 2021After aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications. The aim of this study was to measure cardiovascular markers, intima-media...
BACKGROUND AND AIMS
After aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications. The aim of this study was to measure cardiovascular markers, intima-media thickness (IMT) and plaques in controls and patients with CoA.
METHODS
Sixty-four patients with CoA (66% male, mean age 48 ± 15 years) and controls (54% men, mean age 47 ± 16 years) underwent ultrasound of their arteries. A multiplex platform to analyze circulating blood levels biomarkers reflecting inflammation, tissue remodeling and repair was used.
RESULTS
In men following CoA repair, a significantly increased carotid bulb IMT was observed in comparison to the control group (1.05 [0.72-1.24] vs. 0.67 [0.59-0.95] mm; p = 0.003). Median common carotid artery (CCA) IMT was increased in men compared to controls (0.82 [0.61-0.97] mm vs. 0.58 [0.53-0.76] mm, p < 0.003) and in women compared to controls (0.83 [0.70-0.92] vs. 0.60 [0.55-0.69], p < 0.004). CoA demonstrated an independent association with IMT in both men and women. Men with CoA were also more likely to have a plaque in their carotid arteries (p = 0.010). In women with CoA, we observed significantly lower levels of stem cell factor (SCF, p = 0.004) while in men with CoA we observed significantly lower levels of matrix metalloproteinase-3 (MMP-3, p = 0.048), tumor necrosis factor receptor 1 (TNF-R1, p = 0.032), tumor necrosis factor receptor superfamily member 10B (TRAIL-R2, p = 0.019) and monocyte chemotactic protein 1 (MCP-1, p = 0.015).
CONCLUSIONS
This is the first study to show that despite successful CoA repair, patients have more carotid atherosclerosis than can be explained by changes in tissue remodeling and repair.
Topics: Adult; Aortic Coarctation; Carotid Arteries; Carotid Artery Diseases; Carotid Artery, Common; Carotid Intima-Media Thickness; Female; Humans; Male; Middle Aged; Ultrasonography
PubMed: 34564048
DOI: 10.1016/j.atherosclerosis.2021.09.016 -
The Pan African Medical Journal 2022Interrupted aortic arch is a rare congenital abnormality with a high mortality rate in infancy conditioning only a few cases reported in adult patients. The principal...
Interrupted aortic arch is a rare congenital abnormality with a high mortality rate in infancy conditioning only a few cases reported in adult patients. The principal finding is a complete loss of continuity between the ascending and descending portions of aorta, and is usually associated with other cardiac defects. In this case report, we present a 22-year-old male patient with refractory hypertension and diagnosis of interrupted aortic arch associated with aortic coarctation, bicuspid aortic valve and moderate to severe mitral valve regurgitation. We decided to perform a surgical correction and the patient underwent to bypass grafting of the ascending-to-descending aorta, and mitral valve repair. Interrupted aortic arch must be considered in the differential diagnosis of adult patient with refractory hypertension and a careful physical examination is crucial for ensuring the correct diagnosis of rare congenital abnormality non made until adulthood.
Topics: Male; Humans; Adult; Young Adult; Aortic Coarctation; Bicuspid Aortic Valve Disease; Aorta, Thoracic; Mitral Valve Insufficiency; Hypertension; Aortic Valve
PubMed: 36785684
DOI: 10.11604/pamj.2022.43.149.36281 -
Journal of Medicine and Life Feb 2022Management of coarctation of the aorta (CoA) during pregnancy is complicated by increased procedural risks to the pregnant woman and her fetus. The aim of this research...
Management of coarctation of the aorta (CoA) during pregnancy is complicated by increased procedural risks to the pregnant woman and her fetus. The aim of this research was to analyze 10-years of experience of CoA treatment diagnosed during pregnancy. During 2010-2020 we performed percutaneous stents implantations (SI) in 4 women during 15-23 weeks of pregnancy and in 6 women 48 hours - 5 years after delivery. In all presented cases, successful CoA repair was achieved. There was a significant decrease of peak-to-peak invasive systolic pressure gradient across the CoA (60.0±31.2 and 11.8±7.3 mmHg, p=0.001) and mean noninvasive systolic arterial pressure (163.0±46.2 and 120.5±9.2 mmHg, p=0.01) after SI. All percutaneously treated women during pregnancy (n=4) delivered healthy full-term babies. At follow-up (from 2 months to 10 years), all 10 women are alive without significant Doppler gradient across CoA with no signs of aortic aneurysm formation. To the best of our knowledge, we presented the largest published cohort of CoA percutaneous treatment during pregnancy. We categorized our experience in managing aortic coarctation diagnosed during pregnancy in one algorithm. Our experience demonstrates that excellent maternal and neonatal pregnancy outcomes can be obtained in women after CoA percutaneous repair, diagnosed during pregnancy. An aortic stent implantation is effective and safe for both mother and fetus.
Topics: Aortic Coarctation; Female; Humans; Infant, Newborn; Pregnancy; Stents; Systole; Treatment Outcome
PubMed: 35419094
DOI: 10.25122/jml-2021-0363 -
BMC Cardiovascular Disorders Jul 2022One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass...
OBJECTIVE
One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent (hybrid).
METHODS
Between January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results.
RESULTS
All the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5 ± 14.0 years which was older than hybrid group (27.9 ± 8.5 years, P = 0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4 to 119.7 mmHg and 148.4 to 111.6 mmHg, the median peak systolic gradient decreased from 68.0 to 10 mmHg and 46.5 to 10 mmHg respectively (P = 0.09). And the mean upper-lower limbs gradient decreased from 21.7 to 5.9 mmHg and 21.0 to 2.7 mmHg respectively (P = 0.104). The mean follow-up time was 76.92 ± 18.7 in bypass group and 85.4 ± 20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups.
CONCLUSIONS
The bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.
Topics: Adult; Aorta, Abdominal; Aortic Coarctation; Blood Vessel Prosthesis Implantation; Heart Valve Diseases; Humans; Middle Aged; Retrospective Studies
PubMed: 35786318
DOI: 10.1186/s12872-022-02739-x