Avoidance of malignant arrhythmia caused by displacement of the right coronary artery ostium in surgical correction of supravalvular aortic stenosis

Peng, Bo; Wang, Qiang

doi:10.1177/0300060518818021

Cited by 4 publications

(6 citation statements)

References 25 publications

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“…For patients with SVAS, reinterventions were mainly caused by recurrent supravalvular stenosis, distal residual stenosis, aortic insufficiency, and PAS ( 14 – 16 , 19 , 20 , 30 , 31 , 33 , 35 , 36 , 43 ). The common shape in two-patch repair is an inverted pantaloon-shaped, which widens the aortic root in the non-coronary sinus and the right sinus.…”

Section: Discussionmentioning

confidence: 99%

“…After reviewing titles and abstracts, 41 citations remained for the full-text screening and 71 records were deleted due to irrelevance to our study. Finally, 27 studies (7, 8,11,14,[16][17][18][19][20][21][22][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were included.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…In the evolution of surgical procedures for SVAS, single-patch repair predominated early on, followed by twopatch repair, and currently, three-patch repair was the mainstay (13). However, authors also found that the dominant treatment modality in Europe and the United States is now two-patch and three-patch repair (14)(15)(16)(17)(18), whereas single-patch and twopatch repairs are predominant in Asian countries (19)(20)(21)(22). Different surgeons have their preferred surgical approaches (13).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Lang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ImportanceThe safety and efficacy of different surgical repairs of supravalvar aortic stenosis (SVAS) are inconsistent.ObjectiveTo compare the prognosis of single-, two- and three-patch repair for patients with SVAS.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science, and clinicaltrials.gov were searched until April 17, 2022.Study selectionStudy reported SVAS patients treated with single-, two- or three-patch repair.Data extraction and synthesisTwo reviewers independently extracted the data of study characteristics and clinical outcomes. Multiple pairwise and frequentist network meta-analyses were conducted. And a fixed-effect model was used when no heterogeneity existed.Main outcomes and measuresOutcomes included the rate of reintervention, aortic insufficiency, early mortality and late mortality, cardiopulmonary bypass (CPB) time, cross-clamping (CCP) time, and postoperative/ follow-up pressure gradient. Binary variables were evaluated by odds ratio (OR) and its 95% confidence interval (CI), while continuous variables were assessed by standardized mean difference (SMD) and its 95% CI.ResultsTwenty-seven retrospective cohort studies were included, comprising 1,162 patients, undergoing single-patch (46.6% of cases), two-patch (33.9%), and three-patch repair (19.4%). Two-patch method had a lower rate of reintervention compared with single-patch (OR = 0.47, 95 % CI 0.28–0.89), and three-patch (OR = 0.31, 95 % CI 0.15–0.64). This finding also applied to juvenile and non-Asian patients. Three-patch method had a lower rate of aortic insufficiency compared with single-patch (OR = 0.11, 95 % CI 0.01–0.63), and two-patch (OR = 0.11, 95 % CI 0.02–0.83). But this repair had the longest CCP time, which was significantly longer than that of single- (SMD = 0.76, 95 % CI 0.36–1.17) or two-patch repair (SMD = 0.61, 95 % CI 0.06–1.16). No significant difference was found in mortality and pressure gradient among three procedures.Conclusion and relevanceTwo-patch repair has the lowest reintervention rate and relatively reasonable operation time. Complex and severe SVAS is suggested to be treated with two-patch repair. Further prospective studies of a reasonable sample size will be required with a special focus on the use of different patch materials and surgeons' unique working experience.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022328146.

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Section: Discussionmentioning

confidence: 99%

Section: Eligible Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Lang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…The blood supply of the RCA decreased after all three operations. Peng and colleagues [30] emphasized that the shape of the patch should be carefully clipped to avoid postoperative myocardium ischemia due to distortion of the RCA after McGoon and Doty repair. We found that the degree of decrease in RCA blood flow after McGoon and Doty repair was greater than that after Brom repair.…”

Section: Discussionmentioning

confidence: 99%

Influence of Surgical Methods on Hemodynamics in Supravalvular Aortic Stenosis: A Computational Hemodynamic Analysis

Liu

Jiang

et al. 2021

Pediatr Cardiol

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We compared differences in the hemodynamic parameters of multiple surgical techniques for supravalvular aortic stenosis (SVAS). A three-dimensional model was reconstructed based on a patient's CT scan. Virtual McGoon, Doty, and Brom repairs were completed using computer-aided design (CAD). Hemodynamic parameters were calculated through computational fluid dynamics (CFD). The velocity profile and wall shear stress (WSS) showed the blood flow pattern. Energy loss (EL) and energy efficiency (EE) were calculated to estimate the cardiac workload. The perioperative blood flow ratio (BFR) of brachiocephalic vessels and coronary arteries was calculated. The preoperative flow velocity was abnormally high (> 5.0 m/s). High WSS was detected at the sinotubular junction (STJ), and its preoperative distribution in the aorta was uneven. High-speed flow disappeared after each of the three operations. The WSS distribution at the aortic root was consistent with the postoperative STJ structure of each operation. EL in the systolic phase decreased postoperatively (Original: 634 mW, McGoon: 218 mW, Doty: 278 mW, Brom: 255 mW). No significant difference in brachiocephalic BFR was detected among the different techniques. A slightly increased coronary BFR (Original: 7.56%, McGoon: 7.99%, Doty: 8.55%, Brom: 8.89%) was detected. McGoon, Doty, and Brom repair each effectively restored stable blood flow and greatly improved EE. The best WSS distribution and coronary blood supply were achieved after Brom repair due to its ability to reconstruct the symmetrical aortic root structure. CFD combined with a virtual operation is a promising method in surgical planning and optimization for SVAS.

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“…As the coronary artery ostia are located at the proximal end of the stenosis, this pressure gradient leads to insufficient blood supply to the coronary arteries, which may cause angina pectoris during childhood. 227 The primary diagnostic method for supravalvular aortic stenosis is echocardiography, which can be used to evaluate the location, form, and severity; mean and maximum gradients; and structure and function of the left ventricle. CMRI and CTA are equally suited for investigating the aorta.…”

Section: Supravalvular Aortic Stenosismentioning

confidence: 99%

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

Meng,

Song,

Zhang

et al. 2024

MedComm

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Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long‐term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.

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Avoidance of malignant arrhythmia caused by displacement of the right coronary artery ostium in surgical correction of supravalvular aortic stenosis

Cited by 4 publications

References 25 publications

Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Assessment of three types of surgical procedures for supravalvar aortic stenosis: A systematic review and meta-analysis

Influence of Surgical Methods on Hemodynamics in Supravalvular Aortic Stenosis: A Computational Hemodynamic Analysis

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

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