Surgical Management of Aortic Coarctation from Infant to Adult

Abstract

Objective: In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). Materials and Methods:Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%).Results: A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent resection and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. Conclusions:Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

Coartación aortica, diagnóstico y tratamiento

“…"La coartación causa hipertensión de las extremidades su-periores, que conduce a hipertensión sistémica e hipertrofia ventricular izquierda. Se han propuesto varios mecanismos para la hipertensión en pacientes con coartación, que incluyen distensibilidad arterial reducida, sensibilidad barorreceptora atenuada y disfunción endotelial" (Kaya, 2018) La edad en el momento de la reparación es un determinante importante del desarrollo de hipertensión tardía. Los pacientes que reciben la reparación en la infancia tienen menos del 5% de probabilidades de desarrollar hipertensión en la edad adulta temprana, mientras que los operados después de un año tienen una probabilidad del 25-33% de desarrollar hipertensión.…”

“…En el paciente no reparado, el área transversal aórtica mínima medida y el tiempo de desaceleración corregido por la frecuencia cardíaca en la aorta descendente pueden usarse para predecir un gradiente significativo mediante cateterismo cardíaco y la necesidad futura de intervenciones. "La cMRI proporciona una visualización excepcional del arco aórtico y la detección de complicaciones posteriores a la reparación, incluidos los "retorcimientos" del arco y los pseudoaneurismas" (Kaya, 2018) La angiografía por resonancia magnética de la aorta torácica también permite evaluar la dilatación postestenótica o la formación de aneurismas en el sitio de una reparación previa. "Es importante destacar que la falta de radiación ionizante proporciona una ventaja de la RMc sobre la TC, en la evaluación seriada de las complicaciones tardías después de la reparación" (Eckhauser, 2015).…”

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

“…Найбільш оптимальний спосіб лікування коарктації залишається дещо суперечливим і залежить від віку пацієнта та анатомії самої вади серця [1,21,11]. Деякі центри віддають перевагу ендоваскулярним методам (балонній ангіопластиці або стентуванню місця коарктації аорти), інші -хірургічній корекції та залишають перкутанні методи для рекоарктації у дітей старшого віку або підлітків [4].…”

Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling

“…COA is the 6th most prevalent CHD, occurring in 5–8% of all cases with an approximate incidence of 3/10,000 livebirths 1 – 6 . COA imposes significant afterload on the left ventricle (LV) which results in elevated wall stress, LV hypertrophy, LV dysfunction, the development of arterial collaterals, upper body hypertension, flow disturbance in the thoracic aorta, and decreased perfusion to the lower body 2 , 5 . Further impacts of COA include aortic dissection, aortic rupture, myocardial infarction, and heart failure 5 , 7 .…”

“…COA imposes significant afterload on the left ventricle (LV) which results in elevated wall stress, LV hypertrophy, LV dysfunction, the development of arterial collaterals, upper body hypertension, flow disturbance in the thoracic aorta, and decreased perfusion to the lower body 2 , 5 . Further impacts of COA include aortic dissection, aortic rupture, myocardial infarction, and heart failure 5 , 7 . If left untreated, COA carries dismal prognosis, several studies have shown an average survival age of 30–35 years, with a mortality rate of 75% by age 46 3 , 8 , 9 .…”