Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: Is low weight a risk factor?

McElhinney, Doff B.; Yang, Song-Gui; Hogarty, Alexa N.; Rychik, Jack; Gleason, Marie M.; Zachary, Christopher; Rome, Jonathan J.; Karl, Tom R.; DeCampli, William M.; Spray, Thomas L.; Gaynor, J. William

doi:10.1067/mtc.2001.116316

Cited by 99 publications

(87 citation statements)

References 16 publications

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“…Serial studies may be indicated at routine intervals for monitoring of valve function, growth of cardiovascular structures, ventricular function, and potential sequelae of medical or surgical intervention. [15][16][17][18] Congenital Heart Disease: History, Symptoms, and Signs…”

Section: Indicationsmentioning

confidence: 99%

Guidelines and Standards for Performance of a Pediatric Echocardiogram: A Report from the Task Force of the Pediatric Council of the American Society of Echocardiography

Lai

Geva²,

Shirali

et al. 2006

Journal of the American Society of Echocardiography

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772

468

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Section: Indicationsmentioning

confidence: 99%

Guidelines and Standards for Performance of a Pediatric Echocardiogram: A Report from the Task Force of the Pediatric Council of the American Society of Echocardiography

Lai

Geva²,

Shirali

et al. 2006

Journal of the American Society of Echocardiography

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772

468

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“…1 With this important caveat, reintervention after surgical repair of CoA appears to vary widely, depending on subject size, anatomy, era, and technique of repair. [12][13][14][15][16][17][18][19] Except in unusual situations, there are no planned surgical reinterventions. In contrast, planned reintervention on endovascular stents, either as a part of a staged approach to severe arch obstruction or as a part of stent therapy in growing patients, is well documented.…”

Section: Clinical and Hemodynamic Outcomes And Reintervention Ratesmentioning

confidence: 99%

Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

et al. 2015

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Background-The Coarctation of the Aorta Stent Trial (COAST) was designed to assess the safety and efficacy of the Cheatham Platinum stent when used in children and adults with native or recurrent coarctation. Acute outcomes have been reported. We report here follow-up to 2 years. Methods and Results-A total of 105 patients underwent attempted implantation, with 104 successes. There were no procedural deaths, serious adverse events, or surgical intervention. All patients experienced immediate reduction in upperto lower-extremity blood pressure difference with sustained improvement to 2 years. Rates of hypertension and medication use decreased from baseline to 12 months and remained largely unchanged at 2 years. Six aortic aneurysms have been identified: 5 were successfully treated with covered stent placement, and 1 resolved without intervention. Stent fractures were noted in 2 patients at 1 year and 11 patients at 2 years, with evidence of fracture progression. To date, only larger stent diameter was associated with stent fracture. Twelve additional fractures have occurred after 2 years. No fracture has resulted in loss of stent integrity, stent embolization, aortic wall injury, or reobstruction. Nine reinterventions occurred in the first 2 years for stent redilation and address of aneurysms, and 10 additional reinterventions occurred after 2 years. Conclusions-The Cheatham Platinum stent is safe and associated with persistent relief of aortic obstruction. Stent fracture and progression of fracture occur but have not resulted in clinically important sequelae. Reintervention is common and related to early and late aortic wall injury and need for re-expansion of small-diameter stents. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00552812.

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“…1,2,4,5 The majority of recoarctation occurs within the first postoperative year 1,5,6 and even in the absence of recoarctation, up to 30% of children develop significant systolic arterial hypertension despite early repair. 18 -20 Arterial physiology studies have shown significant abnormalities in young adults postcoarctation repair.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,4,5 However, recurrent stenosis can occur leading to further invasive procedures. 1,2,5,6 The surgical procedure, itself, may contribute to this complication. It requires resection of all ductal tissue, and in case of arch hypoplasia, greater extension of the anastomosis, thus increasing the distance between the severed aortic ends.…”

mentioning

confidence: 99%

Topical VEGF Enhances Healing of Thoracic Aortic Anastomosis for Coarctation in a Rabbit Model

Seipelt

Backer

Mavroudis³

et al. 2003

Circulation

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Background— Recurrent stenosis after extended end-to-end anastomosis for aortic coarctation is the primary indication for further interventions in children. Tension because of the extended resection and local arterial wall hypoxia are possible pathogenetic mechanisms. We hypothesized that (1) tension interferes with healing and (2) that vascular endothelial growth factor (VEGF), a hypoxia sensitive angiogenic inducer, may enhance healing of the vascular anastomosis. Methods and Results— In a model of coarctation repair, rabbits underwent thoracic aortic end-to-end anastomosis after transection (no-tension; n=15), resection of an aortic ring (tension; n=14) or resection and topical VEGF treatment (0.75 μg VEGF 165 ; tension+VEGF; n=14). Gross and histologic characteristics of the aortic wall were assessed at 1 week, 1 and 2 months. In the tension only group at 1 month, the severity of vascular remodeling was increased with fibrosis and calcification compared with controls. At 2 months, this group also revealed more luminal stenosis (29% versus 19%; P <0.001). Exogenous VEGF resulted in significantly less fibrosis, calcification and chondroid metaplasia at 1 month ( P <0.05) and luminal area was only reduced 3% at 2 months ( P <0.001 versus tension group). Conclusions— In a rabbit model of coarctation repair, the addition of tension on the vascular anastomosis resulted in poor healing and luminal stenosis. Topical VEGF maintained luminal integrity by decreasing fibrosis and calcification. These findings suggest that topical VEGF may be a promising new strategy to enhance healing and improve the outcome of vascular anastomoses for coarctation of the aorta.

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Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: Is low weight a risk factor?

Cited by 99 publications

References 16 publications

Guidelines and Standards for Performance of a Pediatric Echocardiogram: A Report from the Task Force of the Pediatric Council of the American Society of Echocardiography

Guidelines and Standards for Performance of a Pediatric Echocardiogram: A Report from the Task Force of the Pediatric Council of the American Society of Echocardiography

Intermediate Outcomes in the Prospective, Multicenter Coarctation of the Aorta Stent Trial (COAST)

Topical VEGF Enhances Healing of Thoracic Aortic Anastomosis for Coarctation in a Rabbit Model

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