Coarctation of the aorta: Review of 234 patients and clarification of management problems

Liberthson, Richard R.; Pennington, D. Glenn; Jacobs, Marshall L.; Daggett, Willard M.

doi:10.1016/0002-9149(79)90086-9

Cited by 152 publications

(59 citation statements)

References 42 publications

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“…If neither hypertension nor heart failure is present, elective surgical or balloon therapy in children between the ages of one and five years is recommend. Waiting beyond that age is not advisable because of the evidence of residual hypertension if intervention is performed after 5 years of age [12]. More recent studies [13] support the idea that intervention prior to first birth day is likely to avoid hypertension during follow-up.…”

Section: Indications For Surgical or Transcatheter Interventionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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Coarctation of the Aorta (CoA) is a congenital cardiac anomaly consisting of a constricted aortic segment with a prevalence of 5 to 8% of all Congenital Heart Defects (CHD). The classic CoA is located in the thoracic aorta distal to the origin of the left subclavian artery, at about the level of the ductal structure. Significant hypertension and/or congestive heart failure are indications of intervention. If hypertension (rather that heart failure) is the clinical problem, it is better to relieve the aortic obstruction promptly rather that attempting to "treat" hypertension with antihypertensive medications. Surgical relief of the aortic obstruction and catheter interventional techniques (balloon angioplasty and stents) are available alternatives. Since the introduction of surgical correction by Crafoord and Nylin and Gross and Hufnagel in early 1940s, surgical therapy has been the treatment of choice for aortic coarctation. Gruntzig's technique of balloon angioplasty was adopted by Singer and Sperling and their associates to enlarge coarcted aortic segments in post-surgical recoarctation and native coarctation, respectively in early 1980s. This is followed by the application of the technique by other cardiologists to treat native CoA. The procedure consists of inserting a balloon angioplasty catheter across the site of coarctation and inflating the balloon with diluted contrast material. Both immediate and followup results are reasonably good. Residual and recurrent obstructions following surgery and prior balloon angioplasty are also amenable for balloon angioplasty. Despite reasonably good short-term and long-term results of balloon angioplasty, some problems remain and include restenosis, probability of aortic rupture, formation of aneurysms and inability to effectively treat long-segment tubular narrowing. Because of these and other reasons, endovascular stenting of aortic coarctation has gained acceptance over the last decade. The balloon catheter, with the stent mounted on it, is advanced over a stiff guide wire and positioned across the coarctation segment and the balloon inflated, thus implanting the stent. Most cardiologists use stents in adolescents and adults and restrict their use in younger children because of issues related to growth. Stent therapy appears to be an attractive method for treatment of native or recurrent coarctation, aneurysm formation following prior surgical or balloon intervention and for long segment hypoplasia. Role of covered stents to manage aortic coarctation is limited and are used when the assessed risk for development of aneurysm or dissection is high. A comparison of all available treatment modalities was made and while it is difficult to make a definitive statement, the overall data seem to indicate that transcatheter methods may be better than surgery. Selection of the method of therapy is largely based on the age at presentation and anatomy of the coarcted segment and surrounding structures; surgery for infants and long segment coarctations, balloon angioplast...

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Section: Indications For Surgical or Transcatheter Interventionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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“…Results generally indicate that while ambulatory blood pressure is well tolerated and provides reproducible and accurate measurements [5,8] , up to 85% of adolescents diagnosed with diastolic hypertension and up to 70% diagnosed with systolic hypertension on the basis of office blood pressure determination may be found to have daytime ambulatory blood pressure readings below 90 mmHg and 140 mmHg, respectively [9] . Despite apparently successful surgical repair of coarctation of the aorta, 10-40% of patients examined 10 to 20 years after surgery are found to be hypertensive on the basis of 'office' blood pressure measurements [10][11][12] . There exists, however, only limited data on the characterization of daily arterial blood pressure variations using ambulatory blood pressure monitoring in patients operated on for coarctation of the aorta [13,14] and neither of these studies was designed to quantify the extent of blood pressure load in patients after successful repair of coarctation.…”

Section: Introductionmentioning

confidence: 99%

Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta

Johnson

Perrault²,

Vobecky³

et al. 1998

European Heart Journal

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Aims This study quantified hypertension load using 24-h ambulatory blood pressure monitoring after successful repair of coarctation of the aorta less than (1) or more than 10 years previously (2) and examined the influence of the surgical procedure (anastomosis or subclavian flap). Methods and ResultsAmbulatory blood pressure recordings were obtained using an Accutracker II monitor every 30 min during the day and hourly, at night. Day and night systolic and diastolic values were higher in coarctation of the aorta than in controls: (day: systolic blood pressure/ diastolic blood pressure: 133/71 6/4 vs 115/66 3/2 night: systolic blood pressure/diastolic blood pressure: 117/61 4/ 4 vs 107/57 3/2 mmHg, P<0·01) and at all times, were higher in coarctation of the aorta (2) than in coarctation of the aorta (1). Clinical daytime systolic hypertension was observed in 20% of recordings from coarctation of the aorta (1) and 49% from coarctation of the aorta (2) while diastolic hypertension was not observed. However, systolic blood pressure and diastolic blood pressure responses to daily activities were significantly higher in coarctation of the aorta than in controls and this was more marked in coarctation of the aorta (2) than in coarctation of the aorta (1). Type of surgery did not affect either hypertension prevalence or blood pressure reactivity. ConclusionsThese observations indicate exaggerated systolic blood pressure and diastolic blood pressure reactivity after repair of coarctation of the aorta, the prevalence of systolic hypertension doubling 10 years after surgery.

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“…[4][5][6][12][13][14][15][16][17][18] Furthermore, it has been stated that repair during early childhood is associated with less systemic hypertension and improved long-term outcome. [4][5][6][7] Therefore, early identification and repair of this lesion is highly desirable.…”

Section: Discussionmentioning

confidence: 99%

Coarctation of the Aorta: A Call for Early Detection

Ghazal¹,

Samady²,

Howasi³

et al. 1998

Ann Saudi Med

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Background: Early repair of coarctation of the aorta (COA) is associated with few perioperative complications and better long-term outcome. Therefore, early detection and treatment of COA patients is extremely desirable. The aim of this study was to review our referral system, the effectiveness of neonatal screening examination, and orient physicians about this abnormality, the mode and age of presentation, differences in presentation between cases with isolated COA, and cases associated with other cardiac lesions. Patients and Methods: This was a retrospective study of 61 inpatients admitted to our hospital between January 1989 and December 1996, who were found to have COA. Referral data was analyzed and compared to hospital cardiac evaluation findings. Results: All the patients were referred after being symptomatic, but there was no suspicion of COA in any of the cases. One of the patients was referred by a pediatrician from a private clinic, and the rest by hospital pediatricians. Femoral pulse and cardiac murmur were commented upon in only three of the referral letters. Systolic pressure gradient (SPG) between upper and lower limbs and systolic hypertension were not commented on in any of the referral letters. SPG ≥10 mm Hg and systolic hypertension were found in 100% and 58% of the patients, respectively, upon evaluation in our center. SPG in patients with COA associated with other cardiac lesions was significantly lower than in patients with isolated COA (P=0.02). Conclusion: Increased awareness in our primary health physicians of the importance of the neonatal screening examination and of measuring blood pressure in the limbs to detect COA early is needed. Timing of the neonatal screening examination between the third day and the third week is recommended. Systolic pressure gradient is a reliable method to detect COA, and in the lower significant range (≥10 mm Hg) is associated with complex cardiac lesion rather than isolated COA.

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Coarctation of the aorta: Review of 234 patients and clarification of management problems

Cited by 152 publications

References 42 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Influence of the postoperative period and surgical procedure on ambulatory blood pressure-determination of hypertension load after successful surgical repair of coarctation of the aorta

Coarctation of the Aorta: A Call for Early Detection

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