Operative survival and 40 year follow up of surgical repair of aortic coarctation.

Joseph, Bobby; Emami, Javad; Farmer, Richard; Newman, C. G. H.

doi:10.1136/hrt.65.5.271

Cited by 75 publications

(41 citation statements)

References 17 publications

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“…vascular remodeling; contractile protein; hemodynamics; endothelial dysfunction; nonmuscle myosin COARCTATION OF THE AORTA (CoA) is one of the most common congenital cardiovascular anomalies and is associated with reduced life expectancy due to sources of morbidity, including hypertension and early-onset coronary disease, despite improved postoperative outcomes (9,26,30,44). Untreated CoA provides mechanical stimuli for vascular remodeling in the form of elevated blood pressure (BP) proximal to the coarctation and potentially adverse distributions of wall shear stress (WSS) throughout the thoracic aorta.…”

mentioning

confidence: 99%

Altered hemodynamics, endothelial function, and protein expression occur with aortic coarctation and persist after repair

Menon

Eddinger

Wang

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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Coarctation of the aorta (CoA) is associated with substantial morbidity despite treatment. Mechanically induced structural and functional vascular changes are implicated; however, their relationship with smooth muscle (SM) phenotypic expression is not fully understood. Using a clinically representative rabbit model of CoA and correction, we quantified mechanical alterations from a 20-mmHg blood pressure (BP) gradient in the thoracic aorta and related the expression of key SM contractile and focal adhesion proteins with remodeling, relaxation, and stiffness. Systolic and mean BP were elevated for CoA rabbits compared with controls leading to remodeling, stiffening, an altered force response, and endothelial dysfunction both proximally and distally. The proximal changes persisted for corrected rabbits despite >12 wk of normal BP (∼4 human years). Computational fluid dynamic simulations revealed reduced wall shear stress (WSS) proximally in CoA compared with control and corrected rabbits. Distally, WSS was markedly increased in CoA rabbits due to a stenotic velocity jet, which has persistent effects as WSS was significantly reduced in corrected rabbits. Immunohistochemistry revealed significantly increased nonmuscle myosin and reduced SM myosin heavy chain expression in the proximal arteries of CoA and corrected rabbits but no differences in SM α-actin, talin, or fibronectin. These findings indicate that CoA can cause alterations in the SM phenotype contributing to structural and functional changes in the proximal arteries that accompany the mechanical stimuli of elevated BP and altered WSS. Importantly, these changes are not reversed upon BP correction and may serve as markers of disease severity, which explains the persistent morbidity observed in CoA patients.

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mentioning

confidence: 99%

Altered hemodynamics, endothelial function, and protein expression occur with aortic coarctation and persist after repair

Menon

Eddinger

Wang

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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“…This, together with the evidence that residual postoperative hypertension and mortality increases with increasing patient age at the time of surgery [11], makes the aphorism ‘wait and see’ entirely applicable in the setting of tardily discovered CA.…”

Section: Discussionmentioning

confidence: 99%

Highly Effective Compensatory Mechanisms in a 76-Year-Old Man with a Coarctation of the Aorta

Miró

Jiménez²,

González³

et al. 1999

Cardiology

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We present a man who was diagnosed with coarctation of the aorta (CA) at the age of 76. He had developed an extensive collateral circulation for maintaining the circulation below the CA. This compensatory mechanism was highly effective, since the patient had remained asymptomatic and in good health during most of his life. He died from intrahospitalary pneumonia, unrelated to CA. Long-term survival in patients with untreated CA is exceptional, with only 11 patients living into their 70s being previously reported. A review of these cases is included.

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“…Perioperative mortality rates are determined largely by age and concomitant congenital heart disease rather than by the choice of operative technique for correcting CoA [23] and are less than 3% for older children and adults [24]. Several postsurgical complications such as cerebrovascular, cardiac and aortic events may occur.…”

Section: Manifestazioni Cliniche E Trattamentomentioning

confidence: 99%

MR imaging of aortic coarctation

Secchi¹,

Iozzelli²,

Papini³

et al. 2009

Radiol med

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Aortic coarctation accounts for 5%-10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging allows the study of this disease with several advantages in comparison with conventional angiography, transesophageal echocardiography, and computed tomography. The MR protocol applied at our institution for both diagnosis and follow-up after surgical or endovascular treatment consists of four steps: morphologic study, cine MR study, flow analysis, and MR angiography (MRA). The first three sequences are acquired during breath-hold and with electrocardiographic gating. Anatomy is well depicted with dark-blood half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. Cine true-fast imaging with steady-state precession (true-FISP) sequences show not only morphologic features but also blood-flow changes inside the aorta. Gradient-echo sequences for phase-velocity mapping allow flow analysis. Application of Bernoulli's equation--here briefly presented and discussed--allows for calculation of the pressure gradient caused by the coarctation. MRA, acquired with a breath-hold three-dimensional T1-weighted gradient-echo sequence and intravenous administration of paramagnetic contrast material, allows for optimal depiction of the aortic lumen, with a panoramic view of the whole aorta, its main branches and possible collateral circulation.

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Operative survival and 40 year follow up of surgical repair of aortic coarctation.

Abstract: Objective-To study early and late mortality after surgical correction of coarctation of the aorta.Design

Cited by 75 publications

References 17 publications

Altered hemodynamics, endothelial function, and protein expression occur with aortic coarctation and persist after repair

Altered hemodynamics, endothelial function, and protein expression occur with aortic coarctation and persist after repair

Highly Effective Compensatory Mechanisms in a 76-Year-Old Man with a Coarctation of the Aorta

MR imaging of aortic coarctation

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