Recurrence of Aortic Coarctation after Operation in Childhood

Parsons, Clifford G.; Astley, R.

doi:10.1136/bmj.1.5487.573

Cited by 29 publications

(9 citation statements)

References 6 publications

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“…Rathi and Keith (1964) operated for coarctation on 27 infants under the age of 1 year without any restenosis. Parsons and Astley (1966) were less fortunate with 5 coarctations restenosing out of the 10 who survived the operation. D'Abreu and Parsons (1956) and Mulder and Linde (1959) reported cases of restenosis within a few weeks.…”

Section: Discussionmentioning

confidence: 97%

“…D'Abreu and Parsons (1956) and Mulder and Linde (1959) reported cases of restenosis within a few weeks. Parsons (1967) reported a carefully observed case of restenosis ab initio. Restenosis is not confined to infants.…”

Section: Discussionmentioning

confidence: 99%

“…A growth differential has been suggested but is, as Parsons (1967) points out, unable to explain the occurrence of this problem in adults, its random incidence, and the fact that the final restenosed lumen may be narrower than the original. Rodbard (1956Rodbard ( , 1958 has suggested the Bernoulli principle as a cause of narrowing of stenotic lesions, where the pressure in the narrow section of a tube through which fluid is passing is lower than the adjacent lengths of wider tubing.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombus formation, another obvious possibility, has never been successfully demonstrated at re-operation or at necropsy and was certainly absent from our only case. Most restenosed suture lines show merely nonspecific fibrosis and thickening (Cerilli and Lauridsen, 1965;Parsons and Astley, 1966).…”

Section: Discussionmentioning

confidence: 99%

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Management of coarctation of the aorta in the first six weeks of life

Meredith

Sawyer

Braimbridge

1970

Thorax

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Management of coarctation of the aorta in the first six weeks of life

Meredith

Sawyer

Braimbridge

1970

Thorax

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“…These have been related to infection (Martin, Kirklin, and DuShane, 1956;Roesch and Bond, 1960;Oldham et al, 1973), unfavourable anatomy, inadequacies of technique, and, in small children, the problem of growth failure at the suture line (Parsons and Astley, 1966).…”

mentioning

confidence: 99%

Late complications of surgery for coarctation of the aorta.

Ross¹,

Monro²

1975

Thorax

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. (1975). Thorax, 30,[31][32][33][34][35][36][37][38][39]. Late complications of surgery for coarctation of the aorta. The problem of the patient who has had one operation for coarctation of the aorta and who then requires another because of a late complication at or near the coarctation site is a demanding one. The safety of aortic cross-clamping at the second operation depends on the adequacy or otherwise of the collateral circulation, and this in turn depends on the presence or absence of residual or recurrent aortic obstruction. Three illustrative cases are described in which there was complete, incomplete, and no aortic obstruction respectively at the time of reoperation, two of the cases presenting the additional complication of local aneurysm formation. The various aspects of management of such individuals are discussed, and the relevant literature has been reviewed in an attempt to provide a systematic approach to these difficult patients.The methods for assessing collateral circulation are both clinical and radiological with trial clamping of the aorta and pressure measurement as the most reliable ultimate test. A pressure of 50 mmHg in the distal aorta is accepted as indicating an adequate peripheral circulation, but it is recommended that the trial clamping should always include both the left subclavian artery and any particularly large local collaterals. The use of a perfusion technique to sustain the distal tissues is also recommended, although local bypass shunts have a place when their use is dictated in the interests of safety for the patient.From the early days of coarctation surgery late complications have been recognized and recorded (Owens and Swan, 1963). These have been related to infection (Martin, Kirklin, and DuShane, 1956;Roesch and Bond, 1960;Oldham et al., 1973), unfavourable anatomy, inadequacies of technique, and, in small children, the problem of growth failure at the suture line (Parsons and Astley, 1966).The question of late reoperation is often not an easy one and the second operation itself can be difficult and dangerous. Apart from the local hazards in the region of the previous repair, which can include aneurysm formation, dense adhesion to surrounding structures, and abnormal thinning of the aortic wall (Cerilli and Lauridsen, 1965), the most serious risk in reoperation is that of spinal cord damage and consequent paralysis (Brewer et al., 1972). This risk is related to the efficiency of the collateral circulation when the aorta is clamped or to the efficiency of the method 31 chosen to protect the distal tissues when aortic blood flow is interrupted. The state of the collateral circulation itself at the time of the second operation reflects the presence or absence of residual or recurrent aortic obstruction and its duration and degree when present.This communication describes the problem presented by three patients, all requiring late second operation, who had respectively total, partial, and no obstruction to the aortic lumen at the time of their reoperation. The three pa...

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