Paradoxical hypertension after repair of coarctation of the aorta: A review of its causes

Sealy, Will C.

doi:10.1016/0003-4975(90)90768-2

Cited by 47 publications

(27 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall prognosis after surgery is largely dependent upon the associated cardiac anomalies. Other known complications associated with surgical repair are significant recoarctation (6 to 33% in infants, 0 to 18% in older children) [21,22] formation of aneurysms in all types of coarctation repair [23], particularly well-documented following prosthetic patch angioplasty [23], development of paraplegia [24,25], paradoxical hypertension [26,27] and vascular complications [28][29][30][31][32] related to subclavian flap repair continue to be problems.…”

Section: Surgical Therapymentioning

confidence: 99%

“…Complications such as paraplegia [24,25] and paradoxical hypertension [26,27,85] are seen with significant frequency following surgical repair while such complications are either rare, or if present, very mild and inconsequential following balloon angioplasty. Aneurysms following balloon angioplasty [86,87], through are of concern and need longer follow up, such aneurysms are also seen with surgery [23].…”

Section: Comparison Of Different Treatment Modalitiesmentioning

confidence: 99%

See 1 more Smart Citation

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

View full text Add to dashboard Cite

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...

show abstract

Section: Surgical Therapymentioning

confidence: 99%

Section: Comparison Of Different Treatment Modalitiesmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

View full text Add to dashboard Cite

show abstract

“…Children and young adults undergoing coarctation repair occasionally demonstrated some disturbing postoperative complications. 11 In 1972, Brewer and colleagues 12 reviewed 12,532 coarctectomies and found 66 instances of spinal cord injury, 51 of which were paraplegia, and the commonly cited risk of paraplegia remains today at their described incidence of 0.41%.…”

mentioning

confidence: 99%

Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Ungerleider

Pasquali

Welke

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective The objective of this study was to describe characteristics and early outcomes across a large multicenter cohort undergoing coarctation or hypoplastic aortic arch repair. Methods Patients undergoing coarctation or hypoplastic aortic arch repair (2006–2010) as their first cardiovascular operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database were included. Group 1 patients consisted of those with coarctation or hypoplastic aortic arch without ventricular septal defect (coarctation or hypoplastic aortic arch, isolated); group 2, coarctation or hypoplastic aortic arch with ventricular septal defect (coarctation or hypoplastic aortic arch, ventricular septal defect); and group 3, coarctation or hypoplastic aortic arch with other major cardiac diagnoses (coarctation or hypoplastic aortic arch, other). Results The cohort included 5025 patients (95 centers): group 1, 2705 (54%); group 2, 840 (17%); and group 3, 1480 (29%). Group 1 underwent coarctation or hypoplastic aortic arch repair at an older age than groups 2 and 3 (groups 1, 2, and 3, 75%, 99%, and 88% < 1 year old, respectively; P<.0001). The most common operative techniques for coarctation or hypoplastic aortic arch repair (group 1) were end-to-end (33%) or extended end-to-end (56%) anastomosis. Overall mortality was 2.4%, and was 1%, 2.5%, and 4.8% for groups 1, 2, and 3 respectively (P < .0001). Ventricular septal defect management strategies for group 2 patients included ventricular septal defect closure (n = 211, 25%), pulmonary artery band (n = 89, 11%), or no intervention (n = 540, 64%) without significant difference in mortality (4%, 1%, 2%; P = .15). Postoperative complications occurred in 36% of patients overall and were more common in groups 2 and 3. There were no occurrences of spinal cord injury (0/973). Conclusions In the current era, primary coarctation or hypoplastic aortic arch repair is performed predominantly in neonates and infants. Overall mortality is low, although those with concomitant defects are at risk for higher morbidity and mortality. The risk of spinal cord injury is lower than previously reported.

show abstract

“…A role of the kidney has also been proposed to explain the arterial hypertension of aortic coarctation. 23,28 Although the kidney probably participates in the genesis of the hypertension in patients with aortic coarctation, it is usually assumed not to be involved in its maintenance because plasma renin levels are generally normal. 23 In our patients, too, we did not observe biological anomalies which would obviously incriminate the kidney or the renin-angiotensin system.…”

Section: Discussionmentioning

confidence: 99%

Vascular and neuroendocrine components in altered blood pressure regulation after surgical repair of coarctation of the aorta

et al. 1998

View full text Add to dashboard Cite

Study objective: To investigate potential vascular and neuroendocrine determinants of altered blood pressure (BP) regulation in patients previously operated on for aortic coarctation. Design, setting and patients: We prospectively re-evaluated 45 patients operated on for aortic coarctation at Strasbourg University Hospital over a 13-year period. Four of these patients were less than 2 years old at the time of the operation and four were older than 20 years. Patient age and time since the operation were on average 21 ؎ 13 years and 8 ؎ 3 years, respectively. Surgery consisted of a resection with end-to-end anastomosis for 18 patients, angioplasty (8), prosthesis (4) or sub-clavian flap (15). Results: Despite repair of the coarctation, about 40% of the patients showed an abnormal BP status at rest. The

show abstract

Paradoxical hypertension after repair of coarctation of the aorta: A review of its causes

Cited by 47 publications

References 67 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Vascular and neuroendocrine components in altered blood pressure regulation after surgical repair of coarctation of the aorta

Contact Info

Product

Resources

About