Early Diagnosis of Coarctation of the Aorta in Children: A Continuing Dilemma (original) (raw)
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Journal of Biology and Today's World, 2014
To determine short-term (in-hospital) outcome and complications of surgical and interventional procedures performed for patients with coarctation of the aorta (CoA) in the age range of 5 to 25 year. Medical records of 64 patients (48 males and 16 females) with CoA who underwent surgical treatment March 2002 to March 2012 were reviewed. Surgical operation was done for 26 patients and interventional procedures were done for 18 cases. The data gathered included type of CoA, anatomic type, hospitalization duration, and complications occurred during hospitalization such as hypertension, persistent CoA, surgical wound infection, and death. Both surgery and interventional procedures restored pre-operative hypertension significantly. The safest method regarding in-hospital complications was balloon angioplasty (1 patient had systemic hypertension after the procedure, 25%) followed by Dacron patch (3 cases had hypertension and one patient had persistent coarctation). However, no significant difference was observed between different surgical and interventional procedures. Pre-operative systolic blood pressure, age group, peak systolic gradient, simple or complex CoA, discrete or segmental CoA had no significant relationship with in-hospital complications/outcome. In conclusion, we suggest considering all aspects of patients with CoA to choose the best surgical treatment. Based on our experience balloon angioplasty and Dacron patch were the safest method with acceptable rate of restoration in blood pressure during in-hospital follow-up period.
Surgical repair of aortic coarctation in pediatric age: A single center two decades experience
Journal of Cardiac Surgery, 2019
Background: To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in infants and children. Methods: A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. Results: Three hundred forty-one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10-143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end-to-end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty-day mortality was 1.4%. At a median follow-up of 10.2 years (IQR, 6-15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation (P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. Conclusions: Surgical repair of CoAo by EEEA without CPBP is a safe and low-risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long-term, and only a few require antihypertensive therapy. K E Y W O R D S aorta and great vessels, clinical review, congenital heart disease 1 | INTRODUCTION Aortic coarctation (CoAo) accounts for 5% to 8% of all congenital heart disease (CHD), occurring in 0.4% of live births. 1,2 It can occur as an isolated lesion or associated with other major CHD, such as subaortic stenosis, mitral valve abnormalities, ventricular, and atrial septal defects. 3 Severe cases may occur in the neonatal period, presenting with cardiogenic shock when the ductus arteriosus (PDA)
Coarctation of Aorta in Children
Cureus
Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6-8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for twodimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.
[Coarctation of the aorta in infants under one year of age. An analysis of 20 years of experience]
Arquivos brasileiros de cardiologia, 2005
A review of experience with techniques of correction used, in the last 20 years, in children younger than one year old. In the period from 1978 to 1998, 148 patients (pt) with coarctation of the aorta (CoAo), under one year of age, with or without associated intracardiac defects, were submitted to surgery. Median age 50 days, 92 female pt (62.1%). The average weight was 4,367 +/- 1,897 gr. The average follow-up was 1,152 +/- 1,462 days. The population was divided in 3 groups: Group I, isolated CoAo: 74 pt (50%); Group II, CoAo and interventricular communication (IVC): 41 pt (27.7%) and Group III, CoAo with complex intracardiac malformations: 33 pt (22.3%). The total mortality was of 43 patients (29%). In patients younger than 30 days, the mortality was 53%, p=0.009, DR=4.5, between 31 and 90 days, 14.7%, p=0.69, and over 91 days, 15%, p=0.004. The probability of actuarial survival of the whole population was 67% at 5 and 10 years. Thirty-six patients (24.3%) had recoarctation, from ...
Coarctation of the Aorta: Diagnosis and Management
Diagnostics
Coarctation of the aorta (CoA) accounts for approximately 5–8% of all congenital heart defects. Depending on the severity of the CoA and the presence of associated cardiac lesions, the clinical presentation and age vary. Developments in diagnosis and management have improved outcomes in this patient population. Even after timely repair, it is important to regularly screen for hypertension. Patients with CoA require lifelong follow-up with a congenital heart disease specialist as these patients may develop recoarctation and complications at the repair site and remain at enhanced cardiovascular risk throughout their lifetime.
European Journal of Cardio-Thoracic Surgery, 2011
Objective: The aim of the study was to analyze immediate results, rate of complications and re-interventions during medium-term outcome in pediatric patients with native or recurrent aortic coarctation. We focused on an age-related therapeutic approach comparing surgical and trans-catheter treatment. Methods: This is a retrospective, single-centre, clinical observational trial including 91 consecutive patients (age: 1 day-18 years) treated for native coarctation in 67 and recurrent aortic coarctation in 24 patients. Surgical treatment was performed in 56, trans-catheter treatment with balloon dilatation in 17, and by stent implantation in 18 patients. According to the age groups, we treated 48 children in group A (<6 months of age), 16 in group B (6 months-6 years), and 27 in group C (>6 years). A total of 41 patients in group A were operated (85%), patients in group B received either surgical or trans-catheter treatment (50% vs 50%), and 16 patients in group C were treated by stent implantation (62%). Results: Immediate results were excellent with a significant release of pressure gradient in all three age groups (64.7% in group A, 69.1% in group B, and 63.3% in group C). Complication rate and re-intervention rate (surgical and interventional) were both comparable between the three age groups (complications: group A 8.3%, group B 6.3%, and group C 3.7%; re-interventions: group A 16.6%, group B 18.8%, and group C 18.5%). Midterm outcome after a median follow-up period of 17.5 months was satisfactory with a reintervention-free survival after 17.5 months of 83.4%, 81.2%, and 81.5% in group A, group B, and group C, respectively. Conclusions: The current strategy of an age-related therapy for native and recurrent aortic coarctation in our institution is surgery in infants <6 months (group A), either surgery or balloon dilatation in younger patients <6 years (group B), while in older children >6 years of age (group C) the trans-catheter treatment with stent implantation is an excellent alternative to surgery. Balloon dilatations showed limited results with an overall re-intervention rate of 53% and, therefore, should mainly be performed as a rescue procedure or in recurrent aortic coarctation in neonates.
Aortic Coarctation in Infants and Children - Diagnose, Treatment and Prognosis
2015
Coarctation of the aorta is a congenital heart defect involving a narrowing of the descending aorta. Blood pressure is higher before the narrowing and lower past the narrowing, with 20 mmHg difference between upper and lower limbs, clinically expressed by absent femoral pulses. In infants, coarctation of the aorta is severe and represent a cardiological emergency, but in child, aortic coarctation is sometime under-diagnosed, patients presenting at the hospital for high blood pressure of unknown etiology, or complaining of headache, or lower limb pain in effort. We want to highlight aortic coarctation as a cause of high blood pressure in children and to drawn attention that this kind of patients, even after aortic coarctation repair may remain with hypertension that has to be treated and patients followed up. We want to share our experience with some cases of surgical correction of aortic coarctation and complications such as recoarctation in special type of gothic aortic arch and al...
Two decades of aortic coarctation treatment in children; evaluating techniques
Netherlands Heart Journal, 2020
Objective This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity. Methods This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews. Results The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5-year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheterbased interventions compared with surgical interventions
Surgical Management of Aortic Coarctation from Infant to Adult
The Eurasian journal of medicine, 2018
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). 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%). 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...
Follow-up of Adults With Coarctation of the Aorta *
CHEST Journal, 2004
Objectives: To compare images of the aorta obtained with helical CT (HCT) scanning and MRI for the follow-up of adults with coarctation of the aorta (CoA). Design: Longitudinal study. Setting: Department of adult congenital heart disease in a tertiary university hospital. Patients: A total of 37 adults (age range, 16 to 68 years; women, 13) with CoA (after surgery, 34 patients; native, 2 patients; after balloon-angioplasty, 1 patient) Measurements and results: All patients underwent both HCT and MRI of the thoracic aorta within a mean (؎ SD) time interval of 1.86 ؎ 1.11 years. Aortic diameters measured at six intrathoracic levels showed a high correlation (r ؍ 0.79 to 0.94). On average, slightly lower diameters were measured with MRI (1.2 mm). But there was a substantial variation between the two measurements with differences of up to 9 mm. All other pathomorphologic abnormalities were detected and classified similarly with both methods. Conclusions: HCT and MRI are similarly useful for the noninvasive evaluation of the thoracic aorta in patients with CoA. But there can be a substantial variation in two subsequent measurements without an overall substantial bias toward larger diameter in one of the two methods. In repetitive studies, changes of the diameters should be interpreted with care, especially when assessing the progression of aortic diameters.