-
BMJ Case Reports Apr 2019Abandoning a renal transplant operation during a live-related transplant is a rare occurrence. We recently encountered a case of previously undiagnosed coarctation of...
Abandoning a renal transplant operation during a live-related transplant is a rare occurrence. We recently encountered a case of previously undiagnosed coarctation of aorta (CoA) in the recipient during surgery. This was diagnosed by the absence of femoral pulses, a Doppler scan showing monophasic flows bilaterally in the iliac arteries and a difference in the mean arterial pressure between the radial artery and iliac artery of 50 mm Hg. The donor and recipient surgery were abandoned. A CT aortogram was done on the recipient which showed a tight CoA. An angioplasty was performed and a bare metal stent placed for correction of CoA. After a week, transplantation was performed, and the patient made an uneventful recovery. This case highlights the importance of assessment of the peripheral pulses and noting a radiofemoral delay, which was missed in the preoperative assessment.
Topics: Angioplasty; Aortic Coarctation; Delayed Diagnosis; Female; Humans; Hypertension; Iliac Artery; Kidney; Kidney Transplantation; Male; Preoperative Care; Time Factors; Tissue Donors; Transplant Recipients; Ultrasonography, Doppler, Color; Young Adult
PubMed: 31005869
DOI: 10.1136/bcr-2018-228667 -
Medical Archives (Sarajevo, Bosnia and... Jun 2021Coarctation of the aorta (CoA), is a congenital disease in which the aorta is tightening, which occurs most commonly post to the ductus arteriosus. Also, coarctation can...
BACKGROUND
Coarctation of the aorta (CoA), is a congenital disease in which the aorta is tightening, which occurs most commonly post to the ductus arteriosus. Also, coarctation can define as constriction of the aorta of different degrees that may occur at any part from the transverse arch of the aorta to iliac bifurcation but most commonly appear just below the beginning of the subclavian artery.
OBJECTIVE
The aim of the study is to evaluate mortality and morbidity rate among patients use uncover stents in treating adult coarctation of the aorta and short-term outcomes.
METHODS
During the period from February 2018 to February 2020 patients with aortic coarctation who is age above 16 years old have been selected to enter this study. Patients were selected from patients visiting adult cardiology consultation rooms in Najaf cardiac center or from private clinics visiting patient, at the end of two years only 75 patients with Coarctation of the aorta has the eligibility to enter this study.
RESULTS
All patients stent by uncovering stent including for 2 cases with interrupted coarctation, immediately after stent pressure gradient fall to less than 10 mmHg in almost all our patient then follow up 6 months, 1 year by angiography assessment with CT chest shows no stent fracture or aneurysm in the aorta at the stent site.
CONCLUSION
Uncover stent appears to be safe in treating coarctation of the aorta with less morbidity and mortality.
Topics: Adolescent; Adult; Aorta; Aortic Coarctation; Follow-Up Studies; Humans; Stents; Treatment Outcome
PubMed: 34483447
DOI: 10.5455/medarh.2021.75.184-187 -
BMJ Case Reports Apr 2022A man in his mid-30s was admitted with a thunderclap headache. He was conscious and hypertensive. A decade earlier, severe hypertension had been diagnosed and...
A man in his mid-30s was admitted with a thunderclap headache. He was conscious and hypertensive. A decade earlier, severe hypertension had been diagnosed and extensively investigated without revealing an underlying cause. Brain imaging showed subarachnoid haemorrhage caused by a ruptured pericallosal aneurysm. Endovascular occlusion was attempted, but as the sheath could not pass the aortic arch, it was converted to surgical aneurismal clipping. Intraoperative blood pressure measurement revealed a peak-to-peak gradient of 100 mm Hg across the aortic arch and an ankle/brachial index of 0.46 (normal range 0.9-1.2). Aortic coarctation was suspected, and angiographic imaging and echocardiography confirmed the diagnosis. Subacute direct stenting was performed, which normalised the peak-to-peak gradient and ankle/brachial index. To minimise the risk of severe complications, early diagnosis of aortic coarctation is important and can be facilitated by ankle/brachial index and echocardiography in the suprasternal view.
Topics: Aneurysm, Ruptured; Aorta, Thoracic; Aortic Coarctation; Humans; Hypertension; Male; Stents; Subarachnoid Hemorrhage
PubMed: 35387786
DOI: 10.1136/bcr-2021-247364 -
Srpski Arhiv Za Celokupno Lekarstvo 2011Stent implantation, in patients with different forms of aortic coarctation, has significant theoretical advantages over primary balloon dilatation (BD). It can achieve...
INTRODUCTION
Stent implantation, in patients with different forms of aortic coarctation, has significant theoretical advantages over primary balloon dilatation (BD). It can achieve over-dilatation of the coarcted segment with the rigid endoprothesis maintaining the increase in vessel diameter regardless of the intimal injury and, thus, reducing the likelihood of restenosis. Moreover, by preventing vascular recoil, stents can successfully expand long-segment tubular coarctations, hypoplastic isthmus and hypoplastic transverse aortic arch. Finally, by facilitating good apposition of the torn intima to the aortic wall, they can significantly reduce the incidence of aneurysm formation.
OBJECTIVE
Evaluation of the immediate and mid-term results of stent implantation in patients with different forms of aortic coarctation.
METHODS
Between February 2005 and March 2010 eleven stents were implanted in nine patients (two female and seven male) either with post surgical or post primary BD residual coarctation/recoarctation or with native aortic coarcatation. Mean age of our patients was 14 +/- 3 years (9.4-18.1 years) and mean body weight 54 +/- 18 kg (29-76 kg).
RESULTS
Pressure gradient across the coarctation site was reduced from 24.9 +/- 12.4 mm Hg before to 3.9 +/- 5.0 mm Hg after stenting (p = 0.000). There were no complications. Mean followup was 2.0 +/- 1.5 years (range 0.1-5.2 years). In patients with localised aortic arch narrowing no restenosis or aneurysm formation was observed (residual pressure gradient 0-5 mm Hg).
CONCLUSION
In properly selected children (body weight > 25 kg), adolescents and young adults stenting is the method of choice for patients with various forms of aortic arch obstruction.
Topics: Adolescent; Aortic Coarctation; Blood Pressure; Catheterization; Child; Female; Humans; Male; Recurrence; Stents
PubMed: 22338467
DOI: 10.2298/sarh1112728k -
European Journal of Vascular and... Dec 2022
Topics: Humans; Aortic Coarctation; Aortic Aneurysm
PubMed: 36209960
DOI: 10.1016/j.ejvs.2022.10.015 -
The Journal of Thoracic and... Jul 2002Adult patients with aortic coarctation may have complications after childhood repair. Other adult patients have coarctation and aneurysms of the aorta and the left...
OBJECTIVES
Adult patients with aortic coarctation may have complications after childhood repair. Other adult patients have coarctation and aneurysms of the aorta and the left subclavian artery. The optimal management of such cases is not clearly established. We evaluated the role of hypothermic cardiopulmonary bypass and circulatory arrest.
METHODS
Thirteen adult patients (mean age 38 years) with coarctation and coexisting abnormalities of the aorta and left subclavian artery were treated. Five patients had pseudoaneurysms develop after bypass grafting (n = 3) or patch angioplasty (n = 2). These were detected a mean of 21 years (range 13-44 years) after the initial operation. Four pseudoaneurysms were asymptomatic, and 1 had ruptured. One patient had recurrent coarctation from fibrous obliteration of a 10-mm bypass graft inserted 15 years previously. The remaining 7 patients had aneurysms of the left subclavian artery (n = 5), aneurysms of the ascending aorta and arch (n = 1), or stenosis of the left subclavian artery (n = 1) in combination with moderate or severe coarctation. Resection and interposition graft replacement of the aneurysmal or stenotic aortic segments were performed in all cases with an interval of hypothermic circulatory arrest that averaged 44 +/- 5 minutes (range 33-54 minutes). Seven patients had interposition graft replacement of aneurysmal or stenotic left subclavian arteries.
RESULTS
There were no in-hospital or late deaths (maximal follow-up 7 years). No patient had brain injury, paralysis, myocardial, respiratory, or renal failure. No patient has evidence of recurrent coarctation or aneurysm formation.
CONCLUSIONS
Cardiopulmonary bypass with hypothermic circulatory arrest can safely be used in the treatment of complex adult coarctation. It permits accurate delineation of the anatomy with minimal dissection, avoidance of aortic clamping and sacrifice of intercostal arteries, precise interposition graft repair, and adequate protection of vital organs.
Topics: Adult; Aneurysm; Aneurysm, False; Aortic Coarctation; Aortography; Blood Vessel Prosthesis Implantation; Cardiopulmonary Bypass; Female; Heart Arrest, Induced; Humans; Hypothermia, Induced; Male; Postoperative Complications; Subclavian Artery
PubMed: 12091821
DOI: 10.1067/mtc.2002.121494 -
European Heart Journal. Cardiovascular... Sep 2021Several coarctation of aorta (COA) severity indices are used for timing of COA intervention, and to define severity of residual coarctation post-intervention. However,...
AIMS
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 remodelling after COA intervention.
METHODS AND RESULTS
COA severity indices were defined as Doppler COA gradient, systolic blood pressure (SBP, upper-to-lower-extremity SBP gradient, aortic isthmus ratio. LV remodelling indices were defined as LV mass index (LVMI), LV global longitudinal strain (LVGLS), e' and E/e'. LV reverse remodelling was defined as the difference between indices obtained pre-intervention and 5-year post-intervention (delta LVMI, e', E/e', LVGLS).Of the COA indices analysed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β ± standard error -28.3 ± 14.1, P < 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 remodelling, and residual aortic isthmus ratio <0.7 was predictive of suboptimal LV reverse remodelling post-intervention.
CONCLUSION
Considering the known prognostic implications of LV remodelling and reverse remodelling in response to pressure overload, these results support the use of aortic isthmus ratio for timing of COA intervention, and for prognostication post-intervention.
Topics: Adult; Aortic Coarctation; Diastole; Humans; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling
PubMed: 33020809
DOI: 10.1093/ehjci/jeaa199 -
The Journal of Thoracic and... Jul 2021
Topics: Aortic Coarctation; Blood Pressure; Exercise Tolerance; Humans
PubMed: 33277027
DOI: 10.1016/j.jtcvs.2020.11.007 -
BMC Cardiovascular Disorders Jun 2018Coarctation of aorta (CoA) may progressively develop aortic dilation at other site of the aorta and can lead to fatal aortic diseases. We aimed to evaluate the...
BACKGROUND
Coarctation of aorta (CoA) may progressively develop aortic dilation at other site of the aorta and can lead to fatal aortic diseases. We aimed to evaluate the occurrence of aortic dilation and related predictors in patients with CoA using dual-source computed tomography (DSCT).
METHODS
Fifty-three patients with CoA identified by DSCT were retrospectively reviewed. Aortic diameters were measured at six different levels and standardized as z-scores based on the square root of body surface area. Coarctation site-diaphragm ratio (CDR) was used to describe the degree of narrowing. A total of 26 patients were included in mild group (CDR > 50%) and 27 in severe group (CDR < 50%) according to the severity of coarctation. Student's t-test and Spearman correlation coefficients, univariate and multivariable logistic regression analyses were used to assess the risk factors including age, degree of narrowing and other malformations for aortic dilation.
RESULTS
Severe group had significantly larger z-scores of ascending aorta (2.41 ± 0.39 vs. 2.10 ± 0.57, p < 0.05) and post-coarctation aorta (2.17 ± 0.48 vs. 1.68 ± 0.43, p < 0.001) compared with mild group. Degree of coarctation was associated with the z-scores of the ascending aorta (r = - 0.356, p < 0.05) and post-coarctation aorta (r = - 0.414, p < 0.05). Collateral circulation was related to the z-scores of ascending aorta (r = 0.375, p < 0.05). Increased severity of coarctation was independent predictor of ascending (odds ratio 7.46; 95% CI 1.19-46.76; p < 0.05) and post-coarctation aortic dilation(odds ratio 8.42; 95% CI 1.84-38.56; p < 0.05).
CONCLUSIONS
Ascending and post-coarctation aortic diameters or dilations were both associated with the degree of coarctation. By comprehensively evaluating the aortic diameters and associated malformations including collateral circulation, DSCT can aid in stratification of risk for aortic dilation in patients with CoA.
Topics: Adolescent; Adult; Aorta; Aortic Aneurysm; Aortic Coarctation; Aortography; Child; Collateral Circulation; Computed Tomography Angiography; Dilatation, Pathologic; Female; Humans; Male; Predictive Value of Tests; Prognosis; Regional Blood Flow; Retrospective Studies; Risk Factors; Severity of Illness Index; Young Adult
PubMed: 29929466
DOI: 10.1186/s12872-018-0863-8 -
Revista Paulista de Pediatria : Orgao... 2023To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic...
OBJECTIVE
To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation.
CASE DESCRIPTION
Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death.
COMMENTS
We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.
Topics: Humans; Male; Aortic Coarctation; Endarteritis; Aneurysm, False; Hematemesis; Anti-Bacterial Agents; Hypertension
PubMed: 38126604
DOI: 10.1590/1984-0462/2024/42/2023084