Coarctation of the aorta

Shumacker, Harris B.; Nahrwold, David L.; King, Harold; Waldhausen, John A.

doi:10.1016/s0011-3840(68)80013-9

Cited by 14 publications

(11 citation statements)

References 157 publications

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“…This will cause an obstruction to aortic flow which is considered by Shumacker et al (1968) to prevent blood pressure falling in many cases. We have experienced one case who required re-operation because of such narrowing, and the other two cases have residual proximal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…We have experienced one case who required re-operation because of such narrowing, and the other two cases have residual proximal hypertension. Other bypass techniques using Dacron tubes (Morris, Cooley, De Bakey, and Crawford, 1960), or excised segments of the left subclavian artery (Shumacker et al, 1968), seem needlessly complex and have been used in only a few centres.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothermia was used in two cases when it was considered that the collateral circulation was poor and distal perfusion might be inadequate during the period of aortic occlusion (Owens and Swan, 1963). Left atrial, or femoral vein, to femoral artery bypass techniques (Cooley, DeBakey, and Morris, 1957;Neville, Cox, Leininger, and Pifarr6, 1968;Shumacker, King, Nahrwold, and Waldhausen, 1968) have not been employed. …”

Section: Methodsmentioning

confidence: 99%

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Coarctation of the aorta

Wisheart

1970

Thorax

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In a series of 70 patients who had surgical correotion of coarctation of the aorta between 1952 and 1969, the operative mortality was 7% and the complication rate was 14%. The mortality was particularly high in adult males over 30, with pre-operative evidence of left ventricular ischaemia. Simple surgical procedures had satisfactory results, but the use of prostheses carried a high risk, and turning down the left subclavian artery failed to lower the blood pressure. The blood pressure score fell by 68% after operation, and by a further 8% following discharge from hospital. This result was maintained up to 17 years after operation, and may be expected in all groups of patients.Coarctation of 'the aorta has been surgically treated with success since 1945 (Crafoord and Nylin, 1945; Gross and Hufnagel, 1945). As varying techniques and results are reported from different centres it was considered timely to review the experience at this centre with 70 patients, spanning 17 years. The results have been analysed with regard to the rate of post-operative mortality and complications, the effect of specific operative procedures and the lowering of systolic blood pressure immediately following, and up to 17 years after surgery. CLINICAL MATERIALThese 70 patients include males and females of all age groups (Fig.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Coarctation of the aorta

Wisheart

1970

Thorax

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“…The work described in this manuscript is a contribution to a computational fluid dynamics (CFD) challenge investigating hemodynamics at rest and stress through an aortic coarctation [1]. As was stated on the website for the challenge (http://www.vascularmodel.org/miccai2013/), narrowing of the aorta (coarctation, CoA) accounts for approximately 10 % of congenital heart defects in the western world.…”

Section: Introductionmentioning

confidence: 99%

CFD Challenge: Predicting Patient-Specific Hemodynamics at Rest and Stress through an Aortic Coarctation

Karmonik

Brown

Debus

et al. 2014

Statistical Atlases and Computational Models of the Heart. Imaging and Modelling Challenges

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Abstract. The here presented work is part of a CFD challenge investigating the potential for computational fluid dynamics (CFD) simulations to predicted pressures and flows in an aortic coarctation during stress when conditions for the rest case are known. In our approach, we choose to couple a three element Windkessel model to the outlet boundary conditions. Good reproducibility of flow and pressures for the rest case were achieved. In the stress case, where only the inflow boundary condition was changed, baseline pressure was too high, indicating that the total resistance in the Windkessel models may need to be reduced. This would correspond to dilating the blood vessels as might be the result of a pharmacological stress test. Future work is needed to develop an optimization strategy to tune the Windkessel data for matching the clinical results.

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“…However, it has become less popular because of unsatisfactory operative results. The main cause of failure is attributed to bending or kinking of the subclavian artery at the site of anastomosis (Shumacker et al 1968). This prohibits maintenance of a functionally adequate pathway.…”

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confidence: 99%

Postoperative growth of the left subclavian artery in a case after a modified Blalock-Park procedure.

Ishizawa

Horiuchi

1986

Tohoku J. Exp. Med.

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Various kinds of operations for coarcation of the aorta in infancy are life saving, but they still carry a high operative mortality rate and are followed frequently by residual or recurrent coarctation. Fifteen years ago we performed a modified Blalock-Park procedure on a 12 month old male infant with preductal coarctation, a large VSD and PDA. Recently a follow-up study was performed on this patient. Aortography revealed a normally developed aortic arch without any sign of stenosis. The intraaortic pressure tracings revealed no pressure gradient through the aortic arch and thoracic aorta. These findings suggest that this procedure is recommendable for the treatment of infants with severely hypoplastic aortic isthmus.modified Blalock-Park operation ; side-to-side anastomosis ; growth of subclavian artery ; preductal coarctation Today, the outcome of surgical treatment of coarctation of the aorta in children and young adults is gratifying. However, infants with varying degrees of hypoplastic aortic arch and isthmus can not be treated by resection of the coarctation and direct end-to-end anastomosis of the aorta. In general, the Blalock-Park procedure is used in such cases (Blalock and Park 1944). The coarctation is resected and the subclavian artery is used to restore continuity of the aortic arch. However, it has become less popular because of unsatisfactory operative results. The main cause of failure is attributed to bending or kinking of the subclavian artery at the site of anastomosis (Shumacker et al. 1968). This prohibits maintenance of a functionally adequate pathway.In order to overcome this problem, we modified the conventional technique and carried out a follow-up study for more than 10 years. As a result, no stenosis due to bending or kinking was found at the site of the anastomosis. The left subclavian artery grew as large as the normal portion of the descending aorta to allow normal circulation.This report is concerned with the details of the operative procedure and the clinical course of this case.

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Coarctation of the aorta

Cited by 14 publications

References 157 publications

Coarctation of the aorta

Coarctation of the aorta

CFD Challenge: Predicting Patient-Specific Hemodynamics at Rest and Stress through an Aortic Coarctation

Postoperative growth of the left subclavian artery in a case after a modified Blalock-Park procedure.

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