Repair of Aortic Coarctation in Adults: The Fate of Hypertension

Hashemzadeh, Khosro; Hashemzadeh, Shahryar; Kakaei, Farzad

doi:10.1177/021849230801600104

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…Intracardiac and extracardiac anomalies are commonly presented in patients with CoA and IAA, which influence the treatment planning and postoperative effect 1–4,13 . Thus, it is necessary to identify an appropriate imaging method to achieve a precise preoperative evaluation of these associated intracardiac and extracardiac anomalies in patients with CoA and IAA 1,14–16 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of intracardiac and extracardiac anomalies associated with coarctation of aorta and interrupted aortic arch using dual-source computed tomography

Zhao

Wang

Yang

et al. 2019

Sci Rep

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To evaluate the value of dual-source computed tomography (DSCT) compared with transthoracic echocardiography (TTE) in assessing intracardiac and extracardiac anomalies in patients with coarctation of aorta (CoA) and interrupted aortic arch (IAA). Seventy-five patients (63 with CoA and 12 with IAA) who received preoperative DSCT and TTE were retrospectively studied. Intracardiac and extracardiac anomalies were recorded and compared by DSCT and TTE, in reference to surgical or cardiac catheterization findings. A total of 155 associated anomalies were finally found. Collateral circulation (56, 74.70%), patent ductus arteriosus (PDA; 41, 54.67%) were the most common anomalies. PDA, aortopulmonary window, and collateral circulation were more frequently present in patients with IAA than those with CoA (100% vs. 46.03%, 16.67% vs. 0%, and 100% vs. 69.84%, respectively, all p < 0.05). DSCT was superior to TTE in assessing associated extracardiac-vascular anomalies (sensitivity: 100% vs. 39.81%; specificity: 100% vs. 100%; positive predictive value: 100% vs. 100%; negative predictive value: 100% vs. 76.06%). Extracardiac-vascular anomalies, including collateral circulation and PDA, were the most common anomalies in patients with IAA and CoA. Compared with TTE, DSCT is more reliable in providing an overall preoperative evaluation of morphological features and extracardiac anomalies for surgical planning.

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Section: Discussionmentioning

confidence: 99%

Assessment of intracardiac and extracardiac anomalies associated with coarctation of aorta and interrupted aortic arch using dual-source computed tomography

Zhao

Wang

Yang

et al. 2019

Sci Rep

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“…Persistent systemic hypertension is the major factor contributing to increase in the cardiovascular risk and is found in 17-57% of the patients who have been treated for coarctation. [7,9] The effects of surgical treatment, balloon angioplasty and stent implantation performed for treatment of aortic coarctation on hypertension and in cases of exercise hypertension have been the subject of many studies and investigated with various aspects [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Clinical And Ambulatory Blood Pressure Monitoring In Subjects With Stent Implanted Aortic Coarctation

Erol

2020

Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi

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Bu çalışmada başarılı stent implantasyonu yapılmış aort koarktasyonu olan olgularda klinik ve ambulatuvar kan basıncı monitorizasyonu ile devam eden sistemik hipertansiyonu araştırmak amaçlandı. Gereç ve Yöntemler: Çalışmaya stent implantasyonunun üzerinden en az 6 ay olmak üzere maksimum 3 yıl geçmiş olan aort koarktasyonlu 31 olgu dahil edildi. Olgulara ait demografik, koarktasyonlarına ve stent implantasyonuna ait özellikler, ekokardiyografik bulgular retrospektif olarak incelendi. Çalışma sırasında kan basıncı klasik yöntem ve 24 saatlik ambulatuvar kan basıncı monitorizasyonu ile incelendi. Ekokardiyografileri yapıldı. Bulgular: Olguların 22'si erkek, 9'u kadındı. Yaş ortalaması 14,50 ± 6,56 yıl idi. Ortalama vücut kitle indeksi 18,61 ± 4,02 bulundu. Olguların 16'sı nativ koarktasyon olgusu iken, diğerleri rekoarktasyon olguları idi. Stent implantasyonu işleminin kan basıncı, ekokardiyografik ve anjiyokardiyografik gradiyentler üzerindeki etkinliği istatistiksel olarak anlamlı bulundu. 11 olgu çalışma sırasında antihipertansif ilaç kullanıyordu. 6 normotansif olguda ambulatuvar kan basıncı izleminde hipertansiyon saptandı. Total bu 17 olgu hipertansif grup, diğerleri normotansif olarak kabul edildi. Hipertansif ve normotansif grup arasında; İşlem öncesi ve sonrası demografik parametreler, koarktasyon tipi ve çapı, stent tipi ve boyutu, ekokardiyografik ve kateter gradiyentlerinde istatistiksel olarak anlamlı fark yoktu. Sonuç: Optimal tedaviye rağmen, deneklerin önemli bir bölümünde hipertansiyon devam etmekteydi. Bazı normotansif deneklerde ambulatuvar kan basıncı takibi ile hipertansiyon saptandı. Çalışma, klinik kan basıncı izlemenin sadece hipertansiyonu belirlemek için yeterli olmadığını göstermiştir. Stent implante edilmiş aort koarkatsyonlu olgularda kan basıncı takibinde belirli aralıklarla ambulatuvar kan basıncı ölçümü faydalı olacağı saptanmıştır.

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“…However, most case series have demonstrated better blood pressure control with fewer medications needed in patients. (8) Unfortunately, these studies are limited by small sample size and few of them addressed patients older than 60 years of age.…”

Section: A S E R E P O R Tmentioning

confidence: 99%

Challenges in the management of aortic coarctation in the elderly: native coarctation complicated by severe calcification

Tay¹,

Wijesinghe²,

Leipsic³

et al. 2013

SMedJ

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Singapore Med J 2013; 54(1) : e5 C a s e R e p o r t INTRODUCTIONCompared to the use of balloon angioplasty alone, endovascular treatment of aortic coarctation in adults with the use of stents has shown favourable results and a reduction in complications. CASE REPORTA 65-year-old Caucasian woman with a history of coarctation of the aorta presented in December 2007 with chest and shoulder pain associated with significant elevation of troponin I level, and was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). She had not been previously told that she needed treatment for coarctation and was thus not on regular follow-up. Her left arm blood pressure was 180/90 mmHg and she had a grade 3 ejection systolic murmur heard over the aortic region, which radiated posteriorly. Lower limb pulses were not palpable. Despite treatment with atenolol 100 mg, losartan 100 mg, frusemide 40 mg and methyldopa 500 mg twice daily, her systolic blood pressure remained persistently elevated.Cardiac catheterisation following this acute presentation showed normal coronaries, but a significant peak-to-peak gradient of 60 mmHg across a highly calcified coarctation site was found.The patient had undergone multiple orthopaedic surgeries on both knees as well as repeated surgeries for iritis, one of which was complicated and required enucleation of the left eye. ABSTRACT Although the treatment of aortic coarctation in adults with the use of stents has shown favourable results and reduced complications, there have been few studies involving elderly patients. We highlight the clinical challenges faced in the management of such patients, with attention to severe calcification at the coarctation site. The midterm results were good in our patient, showing an improvement in blood pressure control and maintenance of stent patency.

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Repair of Aortic Coarctation in Adults: The Fate of Hypertension

Cited by 11 publications

References 20 publications

Assessment of intracardiac and extracardiac anomalies associated with coarctation of aorta and interrupted aortic arch using dual-source computed tomography

Assessment of intracardiac and extracardiac anomalies associated with coarctation of aorta and interrupted aortic arch using dual-source computed tomography

Clinical And Ambulatory Blood Pressure Monitoring In Subjects With Stent Implanted Aortic Coarctation

Challenges in the management of aortic coarctation in the elderly: native coarctation complicated by severe calcification

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