Long-term outcomes in coarctation of the aorta: an evolving story of success and new challenges

Bhatt, Ami B.; Yeh, Doreen DeFaria

doi:10.1136/heartjnl-2015-307641

Cited by 16 publications

(9 citation statements)

References 11 publications

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“…Если добавить к этому обнаруженное падение, а не увеличение скорости и объема кровотока, то, возможно, вклад в повышение системного артериального давления (АД) будут вносить изменения в кровотоке почек, вызывающие увеличение активности ренин-ангиотензин-альдостероновой системы (РААС). Ясно, что в поддержании артериальной гипертонии (АГ) после операции, скорее всего, участвуют те же механизмы, что и до реконструкции: увеличение активности РААС, измененная вазореактивность, нарушение в геометрии дуги аорты, дисфункциональный механизм барорецепторов, ригидность стенок аорты [17,18].…”

Section: Discussionunclassified

4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

et al. 2020

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Aim Comprehensive evaluation of blood flow in the thoracic aorta using a software for 4D processing of magnetic resonance (MR) images of the heart and blood vessels (4D Flow) in patients with aortic coarctation in the late postoperative period.Materials and methods The MR study of the heart was performed for 10 patients (7 boys and 3 girls) aged 8 to 13 years (median, 9.5 [8.3; 10.8] years) who underwent resection with end-to-end anastomosis for aortic coarctation at age of 2 weeks to 10 months. MR tomography was performed on a 1.5 T MR scanner using a multichannel surface coil for scanning, electrocardiographic synchronization, and a specialized package of pulse sequences for scanning of the heart. Blood flow was evaluated with a 4D data handling software for processing of MR images of heart and blood vessels (4D Flow). The following blood flow parameters were analyzed: blood flow volume per second, peak blood flow velocity, peak and minimum blood flow area at the levels of ascending aorta, arch, isthmus, and descending aorta, and pressure gradient at the level of maximum narrowing of the aorta. 3D-MR images were used for evaluation of aortic geometry. Blood flow formation, distribution, and trajectories were analyzed by maps of vectors, particle trace, and stream lines. Statistical analysis was performed with a Statistica (v. 6.0 StatSoft Inc.) package.Results Accelerated flow in the region of residual aortic stenosis in systole was observed in all patients; 4 patients had an additional vortex flow below the aortic stenosis and a spiral flow in the descending aorta. The pressure gradient on the aortic isthmus was directly correlated with the left ventricular myocardial mass index (r=0.65; р=0.04) and indexes of blood flow in the ascending and descending aorta (р=0.03; р=0.026). No significant correlation was found for blood flow indexes and geometry of the aortic arch (H / L). Delayed contrast enhancement MR imaging did not detect any fibrotic changes in the myocardium in only one patient. The fibrosis severity inversely correlated with the right ventricular ejection fraction (r=0.65; р=0.04) and directly correlated with the pressure gradient at the aortic isthmus (r=0.63; p=0.05).Conclusion The 4D MR image processing software for the heart and blood vessels allows studying the blood flow in detail under natural conditions, provides potential advantages in comprehensive evaluation of patients with aortic coarctation during a dynamic follow-up. For a definitive conclusion about the relationship between the altered blood flow in the thoracic aorta and markers of residual, post-correction pathology, larger studies are required as well as long-term follow-up of patients with documented pathological patterns of blood flow (changes in blood flow velocity and volume throughout the entire thoracic aorta in combination with disorders in the normal flow geometry during the cardiac cycle).

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Section: Discussionunclassified

4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

et al. 2020

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“…Вроджені вади серця становлять майже 28 % усіх основних аномалій розвитку [37], коарктація аор-ти досягає 8 % в їх структурі і є п'ятою за частотою [1,33]. У разі природного перебігу цієї вади серця 90 % пацієнтів не доживають до 50 років, а середня тривалість життя сягає близько 30 років [9,34]. За даними різних авторів, причинами смерті стають серцева https://doi.org/10.30702/ujcvs/21.4512/ChD050-7184 УДК 616.132-007.271-089.819 Черпак Б. В., ендоваскулярний хірург відділення рентген-ендоваскулярних методів лікування вроджених і набутих вад серця, https://orcid.org/0000-0002-9956-0432 Дітківський І. О., ендоваскулярний хірург, завідувач відділення рентген-ендоваскулярних методів лікування вроджених і набутих вад серця, https://orcid.org/0000-0001-8768-3307 Ящук Н. С., ендоваскулярний хірург відділення рентген-ендоваскулярних методів лікування вроджених і набутих вад серця, https://orcid.org/0000-0003-1993-5167 Єрмолович Ю. В., лікар-анестезіолог відділення рентген-ендоваскулярних методів лікування вроджених і набутих вад серця, https://orcid.org/0000-0001-9723-1339 Головенко О. С., канд.…”

Section: вступunclassified

“…З метою уточнення анатомоморфологічного варіанта коарктації аорти дітям від 8 до 18 років та вагітним була проведена магнітно-резонансна томографія (МРТ) серця, яку вважають найкращим розширеним методом візуалізації для неінвазивної діагностики коарктації аорти та оцінювання її параметрів, усім іншим обстеженим було виконано комп'ютерну томографію (КТ) -цей метод дослідження коротший за тривалістю, є більш поширеним та доступним, вимагає меншого інституційного досвіду, однак, супроводжується впливом іонізуючої радіації. МРТ проводять переважно пацієнтам молодшого віку, щоб уникнути радіаційного опромінення [9,27,19,30]. Для оцінювання морфологічних і функціональних змін серця, стану його клапанного апарату всім обстеженим (n = 194) була проведена ехокардіографія (ЕхоКГ) за стандартною методикою за допомогою Acuson 128 XP, Vividi, Logic 3 GE.…”

Section: український журнал серцево-судинної хірургії 2021 4 (45)unclassified

Ten-Year Experience in the Treatment of Coarctation of the Aorta through Endovascular Stenting in Patients of Different Age Groups

Cherpak

Ditkivskyy

Yashchuk

et al. 2021

ujcvs

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The aim. To analyze the 10-year experience in aortic coarctation endovascular stenting in patients of different age groups. Materials and methods. Examination and endovascular treatment of 194 patients aged 3 days to 60 years with coarctation of the aorta (CoA) with different anatomical and morphological variants was performed. According to the age criterion, the examined patients were divided into 4 study groups. The first group consisted of 84 patients (43.3%) over 25 years of age, group 2 included 33 patients (17.0%) aged 19 to 25 years, group 3 included 71 patients (36.6%) aged 5 to 18 years, and group 4 included 6 patients (3.1%) under 1 year of age. Results and discussion. We presented the clinical features of different anatomical and morphological variants of CoA. Endovascular treatment of CoA with stenting is considered the best method for adolescents and adults, due to the lower risk of aneurysm formation compared to balloon angioplasty. We were able to successfully reduce the invasive pressure gradient in patients of different ages and to establish the dependence of complication rate on the stent type used. The most common complications were aneurysm formation (2.1%) and stent migration (2.1%). Complications occurred more often in cases of uncovered stents compared to stent grafts (5.3% and 2.1%, respectively, p <0.05). No cases of hospital mortality were recorded in patients older than 5 years. Seven endovascular procedures were performed in 5 patients aged 3 days to 11 months (mean age 3.5 ± 1.6 months) with combined heart defects. Complications were documented in 1 child (20.0%). Endovascular intervention in pregnant women is indicated in refractory hypertension. We performed endovascular CoA stenting in 4 pregnant women at 15–23 weeks of gestation (average, 19.8 ± 3.1 weeks), and in 6 women with well-controlled hypertension stenting was performed within 48 hours to 5 years after delivery. In all the presented cases, successful revascularization was achieved. During follow-up (from 2 months to 10 years), all 10 women are alive, did not develop recoarctation or complications. Conclusions. The results of the analysis of CoA endovascular treatment showed that the chosen method and technique of intervention is appropriate and safe for patients of all ages, including pregnant women. Based on the results obtained, we have developed an algorithm for the management of patients who, according to clinical examination and echocardiography, were diagnosed with CoA during pregnancy.

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“…Preoperative hypertension is a strong predictor of postoperative long-term hypertension [18]. Proposed mechanisms for late hypertension may include upregulation of renin-angiotensin system, altered vasoreactivity, abnormalities in geometry of aortic arch, dysfunctional baroreceptor mechanism, and abnormal aortic compliance [19, 20]. Ambulatory blood pressure monitor (ABPM) study is a valuable tool in detecting chronic hypertension in these patients.…”

Section: Reviewmentioning

confidence: 99%

Coarctation of Aorta in Children

Doshi

Chikkabyrappa

2018

Cureus

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Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6–8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.

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Long-term outcomes in coarctation of the aorta: an evolving story of success and new challenges

Cited by 16 publications

References 11 publications

4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

Ten-Year Experience in the Treatment of Coarctation of the Aorta through Endovascular Stenting in Patients of Different Age Groups

Coarctation of Aorta in Children

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