Late Repair of Coarctation of the Descending Thoracic Aorta in 190 Patients

Lawrie, Gerald M.; DeBakey, Michael E.; Morris, George C.; Crawford, E. Stanley; Wagner, William F.; Glaeser, Donald H.

doi:10.1001/archsurg.1981.01380240041006

Cited by 49 publications

(24 citation statements)

References 14 publications

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“…Pathological LVH with myocardial fibrosis had an increased risk of mortality and morbidity from heart failure and coronary and cerebrovascular disease [5,6,11,12]. Even after successful CoA repair, the survival time is shorter than expected, and many patients suffer from late postoperative heart failure, hypertension, and cerebrovascular complications [10,13]. Therefore, this study suggests that the suppressive therapy for fibrosis such as anti-reninangiotensin-aldosterone agents is effective in relieving the risk of cardiovascular events after successful repair for coarctation of the aorta.…”

Section: Discussionmentioning

confidence: 99%

Serum Concentration of Procollagen Type III Amino-Terminal Peptide is Increased in Patients with Successfully Repaired Coarctation of the Aorta with Left Ventricular Hypertrophy

et al. 2014

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Pathological left ventricular hypertrophy (LVH) with myocardial fibrosis is an independent risk factor for cardiovascular mortality. Previous studies indicated that patients with coarctation of the aorta (CoA) have increased left ventricular mass (LVM) including LVH, even after successful CoA repair. It is unclear whether the increased LVM is pathological one with cardiac fibrosis. Group A consisted of 17 patients with successfully repaired CoA. Group B consisted of 17 postoperative subjects who matched the age and postoperative periods of group A. Group C comprised 28 subjects for the geometric standard of the left ventricle. The LVM index (LVMI) and the relative wall thickness (RWT) of group A and B were compared with the values of 17 age-matched subjects from group C. The serum concentration of procollagen type III amino-terminal peptide (P-III-P), a biomarker for myocardial fibrosis, in group A was compared with the concentration in group B. The correlations between the serum P-III-P concentration and LVMI and RWT were studied in group A and non-A group. In group A, RWT and LVMI were significantly higher than those in group C (0.37 ± 0.05 vs. 0.31 ± 0.02, p < 0.01; 44.8 ± 11.2 vs. 36.5 ± 7.6, p = 0.04, respectively), and the serum P-III-P concentration was significantly higher than that in group B (1.59 ± 0.74 vs. 1.07 ± 0.33, p = 0.04). Serum P-III-P concentrations were well correlated with RWT and LVMI (r = 0.89, p < 0.01; r = 0.63, p < 0.01, respectively) in group A. LVH in patients with successfully repaired CoA may have an abnormal pathogenesis associated with myocardial fibrosis.

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Section: Discussionmentioning

confidence: 99%

Serum Concentration of Procollagen Type III Amino-Terminal Peptide is Increased in Patients with Successfully Repaired Coarctation of the Aorta with Left Ventricular Hypertrophy

et al. 2014

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“…19 The adult patient with CoA is often hypertensive and at risk of developing coronary artery disease. A careful history should identify at risk patients and coronary angiography is performed at the same time as aortography, if indicated.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

“…CoA repair does reduce the incidence of hypertension but every effort should be made to control the blood pressure 19 and antihypertensive drugs are often needed. ''Re-coarctation'' is a misnomer.…”

Section: Latementioning

confidence: 99%

Role of surgery in the management of the adult patient with coarctation of the aorta

Ramnarine

2005

Postgraduate Medical Journal

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Adult patients with coarctation of the aorta have a range of clinical presentations. These include the presence of additional cardiovascular anomalies (predominantly aortic valve abnormality) and presentation with complications after coarctation repair in childhood (such as recurrent coarctation or aneurysm formation). Developments in endovascular technology over the past decade may potentially reduce the morbidity from open surgical repair. However, some cases are unsuitable for endovascular repair and open surgical techniques continue to play a part in the management of these patients. The number of adult patients with coarctation is very small and a trial comparing surgical and endovascular repair techniques would be difficult to arrange. A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) is best equipped to manage the unique and complex problems that affect these patients. The current surgical options and factors governing the choice of approach are reviewed.

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“…The most common presenting age for surgical repair of aortic coarctation is 3-6 months; however, both adolescents and adults can be diagnosed with primary coarctation of the native aorta as a first-time diagnosis [1][2][3]. Patients who previously underwent surgical repair as an infant receive lifelong surveillance and are at risk for recurrence secondary to re-coarctation at the surgical repair site; however, there is another subset of patients that presents primarily as an adult [4,5]. In this untreated and undiagnosed older age group, primary adult aortic coarctation (PAAC) can be recognised as an incidental finding at the time of an elective cardiac catheterisation or even be diagnosed by a primary care physician who notices a heart murmur or decreased femoral pulses as part of a routine annual physical examination [6].…”

Section: Introductionmentioning

confidence: 99%

“…Traditional treatment for PAAC, like the neonatal presentation, consists of open surgical repair [4]. However, these patients have developed significant collateralisation through intercostal arteries and are at increased surgical risk www secondary to bleeding complications.…”

Section: Introductionmentioning

confidence: 99%