Post-Operative Blood Pressures in Coarctation of the Aorta

L, Rathi; Keith, John D.

doi:10.1136/hrt.26.5.671

Cited by 41 publications

(12 citation statements)

References 17 publications

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“…Seven patients underwent percutaneous transluminal balloon angioplasty for treatment of recurrent stenosis in the aorta at the site of previous coarctation repair. The presenting data for these seven patients before the balloon angioplasty are summarized in table 1. The seven patients were divided into four categories based on the type of primary repair performed.…”

Section: Methodsmentioning

confidence: 99%

Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Kan

White

Mitchell³

et al. 1983

Circulation

164

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Percutaneous transluminal angioplasty (PTA) was used successfully to treat coarctation restenosis in seven patients. The patients were 10 months to 17 years old at the time of the angioplasty, and the initial coarctation repair had been performed 10 months to 16½/2 years previously. PTA reduced the systolic pressure gradient across the coarctation from a mean of 58 mm Hg before the procedure to a mean of 13 mm Hg immediately after PTA. Follow-up has been from 1 to 14 months and indicates that the decrease in the systolic pressure gradient is persistent. Circulation 68, No. 5, 1087-1094, 1983 SURGICAL REPAIR of coarctation of the aorta has been performed since 1945. Recent reviews have indicated that there is a high incidence of recurrence of stenosis at the anastomotic site, particularly if the primary repair is performed in infancy. 1-8 If surgical correction is delayed into later childhood, there would be a risk of persistent hypertension, although the risk of recurrent stenosis would be lessened.9' '°T he mechanism of recurrence of stenosis at the coarctation site has been considered to be the result of one or more factors: (1) incomplete relief of the obstruction at the time of the initial repair, (2) incomplete resection of "abnormal" aortic tissue that may have a tendency to proliferate, (2) failure of the anastomotic site to grow, (4) thrombus formation on the suture line, and (5) MethodsClinical material. Seven patients underwent percutaneous transluminal balloon angioplasty for treatment of recurrent stenosis in the aorta at the site of previous coarctation repair. The presenting data for these seven patients before the balloon angioplasty are summarized in table 1. The seven patients were divided into four categories based on the type of primary repair performed.Coarctation restenosis (end-to-end anastomosis, three patients) Patient 1. An 1 1-year-old girl had been in congestive heart failure in infancy. When she was 6 months old, a cardiac catheterization revealed severe coarctation of the aorta with a patent ductus arteriosus (PDA). Intra-aortic pressures indicated a 50 mm Hg pressure gradient across the coarctation. At 9 months of age she had surgical resection of the coarctation with an end-toend anastomosis. Subsequently she was asymptomatic, and when followed up in the outpatient clinic she had normal arm blood pressures and a 20 mm Hg lower pressure in her legs. At 11 years old, she had evidence of upper-extremity hypertension with diminished femoral pulses.Patient 2. An 8-year-old boy had been in congestive heart failure in the neonatal period. When he was 11 days old, cardiac catheterization revealed severe coarctation of the aorta and PDA. When he was 12 days old the coarctation was resected and an end-to-end anastomosis was performed. After the surgical procedure he had persistent upper-extremity hypertension with decreased femoral pulses. When he was 8 years old, cardiac catheterization revealed a discrete recurrent coarctation of the aorta.Patient 3. An 8-year-old boy had congest...

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Section: Methodsmentioning

confidence: 99%

Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Kan

White

Mitchell³

et al. 1983

Circulation

164

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“…On the basis of their own experience and a review of the literature Rathi and Keith (1964) conclude that operation at the age of 3 would produce a satisfactory aortic lumen even if the anastomosis failed to grow significantly. This conclusion depends on two suppositions: (1) that the aortic diameter at diaphragmatic level in the 3-year-old child is about 55% of that of an adult, and (2) that physiological obstruction does not become apparent unless the aortic diameter is less than 55% of the expected normal.…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate increases again in the second decade, and it is therefore unwise to delay operation after puberty (d'Abreu and Parsons, 1956). Rathi and Keith (1964) advise operation between 3 and 6 years of age, but in the large series of cases reported by Schuster and Gross (1962) operative mortality was at its lowest (1.6%) at about the tenth year. In infancy surgical mortality is much higher, Nadas (1963) quoting a range " from 25 to 40%, without guarantee of satisfactory and permanent relief of the hypertension."…”

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confidence: 98%

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Recurrence of Aortic Coarctation after Operation in Childhood

Parsons¹,

Astley²

1966

BMJ

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“…A simple clamp-and-sew technique was employed for coarctation repair which comprised resection and end-to-end anastomosis in 11 patients, patch aortoplasty in 24 with Dacron (in 16) or Gore-Tex (in 8; one of whom had concurrent patent ductus arteriosus closure), and resection with interposition of a Dacron tube graft (size 22) in 3. One patient had undergone a Bentall operation one year earlier.…”

Section: Methodsmentioning

confidence: 99%

Repair of Aortic Coarctation in Adults: The Fate of Hypertension

Hashemzadeh

Kakaei

2008

Asian Cardiovasc Thorac Ann

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The benefit of coarctation repair on the resolution of systolic hypertension in adults has been questioned. In this retrospective study, hypertension was assessed in 38 adults (22 men, 16 women; mean age, 25.6 +/- 6.9 years; range, 16-39 years) who underwent coarctation repair between 1996 and 2006. Thirty patients had preoperative hypertension (mean systolic pressure, 158.3+/-18.6; range 140-200 mm Hg). At preoperative catheterization, the peak mean systolic gradient across the coarctation was 70.6 +/- 21.2 mm Hg (range, 38-120 mm Hg). Operative procedures were resection and end-to-end anastomosis (11 patients), patch aortoplasty (24) and resection with interposition of a Dacron tube graft (3). The patients were followed up for 2-90 months (mean, 37 +/- 23 months). Of the 30 patients with preoperative hypertension, 25 (83%) were normotensive at the last follow-up. The mean postoperative systolic blood pressure was significantly lower than the preoperative level. More than half of the patients (58%) were still taking antihypertensive medication. Surgical repair of coarctation of the aorta in adults can lead to regression of systolic hypertension and a decreased requirement for antihypertensive medication.

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Post-Operative Blood Pressures in Coarctation of the Aorta

Cited by 41 publications

References 17 publications

Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Treatment of restenosis of coarctation by percutaneous transluminal angioplasty.

Recurrence of Aortic Coarctation after Operation in Childhood

Repair of Aortic Coarctation in Adults: The Fate of Hypertension

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