Successful treatment for intraoperatively evolving acute aortic dissection in a neonate

Walther, Thomas; Kiefer, Herbert; Dähnert, Ingo; Kostelka, Martin

doi:10.1016/s0003-4975(03)00563-0

Cited by 10 publications

(4 citation statements)

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“…As reported earlier, one patient required a staged repair owing to an acutely evolving aortic dissection. 12 In conclusion, primary correction of aortic arch obstruction with ventricular septal defect is a challenging operation at any age.…”

Section: Discussionmentioning

confidence: 99%

The association of bicuspid aortic valve on long-term outcome following one-stage repair of aortic arch obstruction associated with ventricular septal defect

et al. 2022

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Objective: The aim of this study was to evaluate the association of bicuspid aortic valve on contemporary outcomes, including reoperation rates, after one-stage correction for interrupted aortic arch with ventricular septal defect or for aortic coarctation with hypoplastic aortic arch and ventricular septal defect. Methods: Seventy-four consecutive patients (35 boys, 47% and 39 girls, 53%) with interrupted aortic arch (n = 41, 55%) or aortic coarctation with hypoplastic aortic arch (n = 33, 45%) with ventricular septal defect underwent early one-stage correction. Twenty (27%) patients had bicuspid aortic valve, and the remaining 54 (73%) had a tricuspid aortic valve. The median aortic valve annulus diameter was 6.0 mm (IQR: 2.0). Patients’ median age was 7 ± 29 days (range, 2–150); median weight was 3.3 ± 0.7 kg (range, 1.5–6.0), with 21 (28%) patients <3.0 kg. Selective brain perfusion through the innominate artery and selective coronary perfusion through the aortic root during aortic arch reconstruction were used in all patients. Statistical analysis was performed using SPSS version 20.0 software (SPSS Inc., Chicago, IL, USA). Results: The early mortality was 1.3%. One premature neonate died in the hospital with extracorporeal membrane oxygenation after aortic coarctation plus ventricular septal defect repair. There was no further mortality. Median follow-up was 5.7 years (IQR: 10.48). Reinterventions occurred in 36 (49%) patients: balloon angioplasty in 18 (24%) patients, reoperations in 4 (5%) patients, and both in 14 (19%) patients. A total of 86 follow-up procedures were required in these 36 (49%) patients: aortic valve valvulopasty (n = 6, 8%), stent implantation (n = 8, 11%), balloon dilatation (n = 39, 53%), and reoperation (n = 33, 45%). The median time to reinterventions was 9.094 years (SE 0.890). A potential risk factor for reintervention after interrupted aortic arch and aortic coarctation with ventricular septal defect repair was bicuspid aortic valve (p = 0.019, Chi2 (1) = 5.457). In addition, a multivariate Cox analysis with backward selection and significance level <0.015 was applied to all variables that showed significant effects in univariable analyzes. This regression confirmed that bicuspid aortic valve (HR = 0.381, p = .016), and interrupted aortic arch (HR = 0.412, p = 0.043) were predictors of late reintervention. All patients had no obvious neurologic impairment in routine examinations at last follow-up. Conclusion: Bicuspid aortic valve was a significant risk factor for valve-related reintervention after one-stage repair for aortic arch obstruction with ventricular septal defect due to later development of stenosis associated with higher late morbidity and mortality. Particularly neonates with bicuspid aortic valve will possibly require reintervention in the future. Regular lifelong cardiac follow-up is recommended.

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Section: Discussionmentioning

confidence: 99%

The association of bicuspid aortic valve on long-term outcome following one-stage repair of aortic arch obstruction associated with ventricular septal defect

et al. 2022

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“…In another reported case, of a 10-year-old child with AD after balloon angioplasty of a recoarctation, distal percutaneous membrane fenestration was performed [36]. There are a few cases describing the effective treatment of children with AD, but they were all treated surgically and not by endovascular approach [37][38]. Moreover, there are cases of AD described in children caused by various factors that were followed by a tragic outcome, independent of the measures taken (conservative treatment or surgical approach) [39,40].…”

Section: Discussionmentioning

confidence: 99%

Successful endovascular treatment of type B aortic dissection in a 15-year-old child

et al. 2017

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Disekce aorty je u dětské populace a u populace mladých dospělých vzácná [1]. V tomto článku popisujeme neobvyklý případ 15letého chlapce s náhlým nástupem bolesti na hrudi, bolesti zad spolu s necitlivostí levé dolní končetiny. Vyšetření výpočetní tomografi í hrudníku a oblasti břicha odhalilo disekci aorty typu B Stanford (typu III klasifi kace DeBakey) s výslednou subokluzivní stenózou horní mezenterické tepny (vyvolávající kritickou dysfunkci střev a ileus) a úplným uzávěrem levé iliacké a renální tepny. Pacient byl přijat v kritickém stavu 48 hodin po nástupu bolesti na hrudi. Po několika následných endovaskulárních výkonech bylo dosaženo revaskularizace a pacient byl propuštěn z nemocnice na základě příznivého klinického výsledku s úplnou obnovou průtoku krve tepnami cílových orgánů. Při první intervenci byly do horní mezenterické tepny a břišní tepny implantovány stenty, a byla provedena balonková dilatace levé iliacké tepny. Pro rezistentní renovaskulární hypertenzi byl o 20 dní později implantován stent do úplně uzavřené levé renální tepny; následně bylo dosaženo optimální úpravy krevního tlaku. O 33 dní později byl implantován stentgraft s cílem uzavřít primární trhlinu v hrudní tepně. Genetické vyšetření odebraných vzorků prokázalo mutaci v genu ACTA2. Tento případ je výjimečný tím, že se jednalo o život ohrožující postižení aorty současně s vaskulopatií, řešené poprvé endovaskulárně u dětského pacienta, a upozorňuje na možnost endovaskulární léčby u dětské populace. V článku popisujeme použití zobrazovacích metod, samotnou léčbu tohoto závažného onemocnění i její úspěšný výsledek.

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“…We report a case of iatrogenic aortic dissection caused by an arterial perfusion cannula, which is also a remarkably uncommon comorbidity in the pediatric population. 1,2 Because it was a type B dissection and the malperfusion of the lower body disappeared after decannulation, we did not perform an aortic corrective procedure immediately, with the expectation that early thrombosis could be obtained in the false lumen. Although the dilatation of the false lumen was observed postoperatively, we fortunately had the chance to perform entry closure concomitantly with a second-stage operation on the Fontan track.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic aortic dissection in an infant with persistent fifth aortic arch and congenital heart defects

Okada¹,

Murayama²,

Hasegawa³

2016

The Journal of Thoracic and Cardiovascular Surgery

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Successful treatment for intraoperatively evolving acute aortic dissection in a neonate

Cited by 10 publications

References 1 publication

The association of bicuspid aortic valve on long-term outcome following one-stage repair of aortic arch obstruction associated with ventricular septal defect

The association of bicuspid aortic valve on long-term outcome following one-stage repair of aortic arch obstruction associated with ventricular septal defect

Successful endovascular treatment of type B aortic dissection in a 15-year-old child

Iatrogenic aortic dissection in an infant with persistent fifth aortic arch and congenital heart defects

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