Indications for stenting of coarctation of the aorta in children under 3 months of age

Krasemann, Thomas; Beynum, Ingrid van; Dalinghaus, Michiel; Leuwen, W van; Bogers, Ad J.J.C.; Woestijne, Pieter van de

doi:10.1007/s12471-020-01371-8

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…This allows the patient additional time to recover clinically as well as from LV dysfunction before undergoing surgical repair. Concerns that the stent may complicate surgical therapy could not been confirmed in our case, as it was easy to removed after 1 week (Figures 3A-D) (8,15).…”

Section: Discussionmentioning

confidence: 73%

Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

et al. 2021

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Primary surgical repair remains the traditional treatment for patients with critical duct-dependent coarctation of the aorta (CoA). Initial surgical repair might not be possible or associated with higher risks if additional comorbidities arise in small infants and neonates. Balloon angioplasty (BA) has been described as a rescue strategy for these children. We describe the feasibility of a palliative BA and rescue stent implantation via an alternative antegrade right-axillary artery approach in an initially inoperable infant with pneumonia and respiratory failure and severe CoA, where the stenosis was not passable by traditional retrograde femoral access. This case adds new aspects to the therapy of critical CoA: Stent implantation provides a bridge to surgery in critically ill infants and does not preclude successful surgical repair. Further, if the classic retrograde approach is not possible, the right axillary artery access should be considered as an alternative to pass the stenosis.

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Section: Discussionmentioning

confidence: 73%

Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

et al. 2021

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“…Neonates considered too small or frail for surgical repair, typically those weighing <1.5 kg, may receive intravenous prostaglandin E1 to maintain ductal patency while awaiting somatic growth. Some high-risk patients with isolated CoA may be candidates for temporizing angioplasty and stenting ( 84 ). In such cases, subsequent surgical repair will be necessary because the small size of the initial stent will preclude dilatation to “adult” size.…”

Section: Neonatal Surgical Management Of Isolated Coarctation Of the ...mentioning

confidence: 99%

Isolated Coarctation of the Aorta: Current Concepts and Perspectives

Bhatt

Lantin‐Hermoso

Daniels

et al. 2022

Front. Cardiovasc. Med.

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Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.

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“…The evolution of interventional techniques for management of coarctation of the aorta requires a separate review of this evolving field but we highlight a few recent developments. With increasing experience with interventional techniques, they have been applied to novel patient groups including balloon angioplasty for low-birth-weight premature infants [37 ▪ ], balloon angioplasty using axillary access for critically ill newborns [38 ▪ ], stenting for selected children under 3 months of age [39 ▪ ], and stenting for arch hypoplasia [40 ▪ ,41 ▪ ]. There are promising results of stent implantation being performed in younger children less than 12 kg [42] and less than 20 kg [43].…”

Section: Percutaneous Interventionsmentioning

confidence: 99%

Challenges in diagnosis and management of coarctation of the aorta

Chetan

Mertens

2021

Current Opinion in Cardiology

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Purpose of reviewCoarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. Recent findingsRecent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention. New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention.

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Indications for stenting of coarctation of the aorta in children under 3 months of age

Cited by 5 publications

References 13 publications

Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

Isolated Coarctation of the Aorta: Current Concepts and Perspectives

Challenges in diagnosis and management of coarctation of the aorta

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