Risk of recoarctation in neonates and infants after repair with patch aortoplasty, subclavian flap, and the combined resection-flap procedure

Dietl, Charles A.; Torres, Alberto R.; Favaloro, René G.; Fessier, Cindy L.; Grunkemeier, Gary L.

doi:10.1016/s0022-5223(19)34955-4

Cited by 48 publications

(15 citation statements)

References 41 publications

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“…It is evident that the residual pressure gradient is the most important "mechanical" factor for persistent hypertension after both surgical correction and balloon coarctation angioplasty [4, 211. Recoarctation is of clinical importance only when the initial repair is performed in neonates and infants [22]. Since we have performed balloon dilatation in adolescents and adults only, restenosis was not observed during follow-up.…”

Section: Discussionmentioning

confidence: 95%

Long‐term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients

Schräder

Bussmann

Jacobi

et al. 1995

Cathet. Cardiovasc. Diagn.

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In patients with coarctation of the aorta arterial hypertension frequently persists when surgical repair is performed after age 20 years. There are little data on the long-term effect of angioplasty and the question remains to be determined whether hypertension is sufficiently treated by this procedure. Twenty-nine consecutive patients (9 females and 20 males) 14 to 54 years old (median, 25) underwent angioplasty for native coarctation of the aorta. Twenty-five patients (86%) had pre-existing systolic arterial hypertension (> 140 mm Hg). The mean peak systolic pressure gradient decreased from 62 +/- 18 to 21 +/- 13 mm Hg immediately after angioplasty. At hospital discharge 13 patients still had hypertension. After a mean follow-up interval of 4.0 years (range, 0.3-9.5) the residual peak pressure gradient was 14 +/- 13 mm Hg. Blood pressure was normal without antihypertensive therapy in 23 patients (79%). In the six hypertensive patients the pressure gradients were 7, 13, 30, 30, 35, and 60 mm Hg. One patient died 8 months after angioplasty and another underwent surgery for aortic aneurysm. Although this was an uncontrolled study the data suggest that normalization of blood pressure may occur more frequently after angioplasty than after surgery in adolescents and adults with native coarctation.

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Section: Discussionmentioning

confidence: 95%

Long‐term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients

Schräder

Bussmann

Jacobi

et al. 1995

Cathet. Cardiovasc. Diagn.

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“…1 Furthermore, recoarctation occurs in 3-35%. [2][3][4] The association of a bicuspid aortic valve with coarctation of the aorta is well recognised, but estimates of bicuspid valve in patients with coarctation range from 25-85%. 2 5 The clinical significance of a bicuspid valve in patients with coarctation is not well established.…”

mentioning

confidence: 99%

Aortic valve and aortic arch pathology after coarctation repair

Roos‐Hesselink

Schölzel²,

Heijdra³

et al. 2003

Heart

149

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Objective: To investigate the incidence of clinical problems related to a bicuspid valve (aortic stenosis and regurgitation) and the incidence of ascending aorta and aortic arch pathology in combination with coarctation repair. Patients: 124 adult patients after surgical correction of aortic coarctation were studied. The incidence of aortic valve, ascending aorta, and aortic arch pathology was determined using echocardiography and magnetic resonance imaging. The median age at coarctation repair was 9 years and at last follow up 28 years. Results: Three patients died from aorta pathology. Aortic valve disease was found in 63% of the patients, requiring an intervention in 22%, at a median of 13 years after coarctation repair. Ascending aorta dilatation was observed in 28% and aortic arch abnormalities in 23%, among whom kinking of the aortic arch was found in 12%. Antihypertensive medication was used in 24%. In the patients with hypertension the age at operation and age at follow up were significantly higher (p = 0.0001 and p < 0.0001, respectively). Conclusion: In addition to the well known problems of hypertension and recoarctation, aortic valve and aortic arch pathology are commonly encountered in patients with previous coarctation repair. Aortic abnormalities may predispose to dilatation and dissection, thus necessitating careful lifelong attention in all patients with coarctation. C oarctation of the aorta accounts for 8% of congenital heart disease. In the past, coarctation was considered to be a simple "correctable lesion" and surgery, first performed in 1944, was believed to be curative. In keeping with this belief, normotensive patients were often discharged postoperatively without long term follow up. However, as increasing numbers of patients with surgically corrected coarctation reached maturity, it has become clear that almost a third of patients become or remain hypertensive, despite correction of their lesion, with an increased risk of accelerated atherosclerosis and end organ damage.1 Furthermore, recoarctation occurs in 3-35%. 2-4The association of a bicuspid aortic valve with coarctation of the aorta is well recognised, but estimates of bicuspid valve in patients with coarctation range from 25-85%.2 5 The clinical significance of a bicuspid valve in patients with coarctation is not well established.To address these issues, we retrospectively studied patients after coarctation repair seen in our department for adult congenital heart disease with emphasis on both aortic valve and aortic arch pathology.The specific purpose of this study was, firstly, to assess the prevalence of aortic stenosis or regurgitation in these patients; secondly, to assess how often dilatation of the ascending aorta and pathology of the aortic arch occur in patients with coarctation; and thirdly, to assess a possible correlation of aortic arch pathology with hypertension or recoarctation. METHODSAll patients seen in our department for adult congenital heart disease with surgically corrected coarctation were reviewed. They w...

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“…The incidence of recoarctation reported in the literature varies widely depending on the length of follow-up (3,15). In our study the median follow-up period was 5.5 years, which is insufficient to determine the longterm risk of recoarctation.…”

Section: Discussionmentioning

confidence: 71%

“…Coarctation of the aorta (CoA) presenting with cardiac failure in infancy requires urgent surgical intervention ( I , 2). In recent years several reports have shown improvement in outcome for patients operated on for CoA during infancy (3,4). Different surgical techniques have been used for correction of infantile CoA, such as resection and end-to-end anastomosis, aortoplasty and the subclavian flap technique.…”

Section: S Abdulla Departnwnt Of Paediatricsmentioning

confidence: 99%

A postoperative follow‐up study of infantile coarctation of the aorta

et al. 1995

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Follow‐up investigations were performed in 16 patients operated on for coarctation during infancy The follow‐up period ranged from 4.5 to 11 years (median 5.5 years) Four different surgical techniques were used: resection with end‐to‐end anastomosis (REE) (4 patients), subclavian flap aortoplasty (SFA) (10 patients), patch aortoplasty (1 patient) and resection and SFA (1 patient) One patient developed reforestation (6%) She had been operated on by REE at 7 days of age The other three patients operated on by REE had equal pulses in the arms and legs; none had hypertension and all had normal arm/leg pressure gradients at rest Seven (58%) of the 12 patients operated on by SFA or aortoplasty had weak radial pulses in the left arm but no limitation of left arm function The left arm showed a normal bone age but was smaller and shorter than the right arm in 9 (81%) of the patients None of the patients operated on by SFA had hypertension and the arm/leg gradient at rest was normal.

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Risk of recoarctation in neonates and infants after repair with patch aortoplasty, subclavian flap, and the combined resection-flap procedure

Cited by 48 publications

References 41 publications

Long‐term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients

Long‐term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients

Aortic valve and aortic arch pathology after coarctation repair

A postoperative follow‐up study of infantile coarctation of the aorta

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