Results after repair of coarctation of the aorta beyond infancy: A 10 to 28 year follow-up with particular reference to late systemic hypertension

Clarkson, P. M.; Nicholson, M. L.; Barratt‐Boyes, B. G.; Neutze, John M.; Whitlock, R. M. L.

doi:10.1016/0002-9149(83)90661-6

Cited by 216 publications

(133 citation statements)

References 15 publications

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“…Such aspects could not be evaluated in the patients of our series, which makes it difficult to construe the high incidence of control of the HBP in the patients operated by our group; although, besides the relief of stenosis, another factor that could, in our opinion, be related to the HBP control, would be, in our patients, the mean age under 25 years that could be related to less fibrosis and better vascular complacence. Other authors correlated the persistence of hypertension in the postoperative to the existence of a residual gradient higher than 30 mmHg [25]. In our series, the postoperative gradient observed by the echocardiogram was lower than 20 mmHg, which would be an extra factor that could possibly explain the high incidence of HBP control.…”

Section: Discussionsupporting

confidence: 44%

“…The persistence of HBP in the postoperative period may be associated to multiple factors, such as the persistence of endocrine factors and/or the reduction of the vascular bed complacence next to the aortic coarctation [25], factors not changed with the surgery. Such aspects could not be evaluated in the patients of our series, which makes it difficult to construe the high incidence of control of the HBP in the patients operated by our group; although, besides the relief of stenosis, another factor that could, in our opinion, be related to the HBP control, would be, in our patients, the mean age under 25 years that could be related to less fibrosis and better vascular complacence.…”

Section: Discussionmentioning

confidence: 99%

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Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Jatene¹,

Abuchaim²,

Oliveira³

et al. 2009

Rev Bras Cir Cardiovasc

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Objective: The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes.Methods: From January 1997 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients.Results: Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Jatene¹,

Abuchaim²,

Oliveira³

et al. 2009

Rev Bras Cir Cardiovasc

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“…Hypertension has been shown to be more common in patients who were treated after the age of 20 years compared with those who underwent surgical repair in early childhood. [28][29][30][31] In our study, discontinuation or reduction of antihypertensive treatment after stent implantation was possible in about 34% of the patients.…”

mentioning

confidence: 58%

“…Immediate follow -up Immediate complications are summarized in [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44], P = 0.011). However, the gradient after intervention was the same in both groups.…”

Section: Patients and Methods Study Population Frommentioning

confidence: 99%

Immediate and long term outcomes of native aortic coarctation and postsurgical aortic recoarctation treated with stent implantation: one Center experience

Sulik¹,

Fiszer²,

Scalone³

et al. 2017

Polish Archives of Internal Medicine

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INTRODUCTION Stent implantation has become the treatment of choice for native aortic coarctation (CoA) and postsurgical aortic recoarctation (reCoA) in adults and adolescents.OBJECTIVES This study aimed to compare the immediate and long -term outcomes of patients with native CoA and postsurgical reCoA who underwent stent implantation in our center. PATIENTS AND METHODSThe data of 136 patients with native CoA and reCoA who underwent stent implantation between May 1999 and December 2016 were retrospectively analyzed. The study population was divided into 2 groups: 108 patients with native CoA and 28 patients with reCoA. Clinical and procedural characteristics and immediate and long -term outcomes after the intervention were compared between the groups. The use of antihypertensive drugs was analyzed in all patients. RESULTSThere were no significant differences in the clinical characteristics of the study groups. The gradient before the intervention was significantly higher in the native CoA than in the reCoA group (P = 0.011), and the diameter of stenosis before the intervention was smaller in the native CoA group compared with the ReCoA group (P = 0.003). Procedural treatment was successful in 77.8% of the patients with native CoA and 78.5% of those with reCoA. There were no differences in the immediate and long -term outcomes between the groups. The antihypertensive treatment was tapered or discontinued in about 34% of the study population.CONCLUSIONS Stenting is an effective and safe procedure in patients with native CoA and reCoA, with good late outcomes.

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“…The reported prevalence of late hypertension depends on the diagnostic criteria used and on the duration of follow up, ranging from 30% [10] to 75% [11]. Because there are only a few cases of elderly patients with uncorrected aortic coarctation, management strategies in these patients are controversial.…”

Section: Discussionmentioning

confidence: 99%

A severe coarctation of aorta in a 72-year-old female: a case report

et al. 2009

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Aortic coarctation is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 72-year-old female. Our patient was relatively asymptomatic until she presented with exertional dyspnea and fatigue in her seventh decade of life. The patient was managed conservatively with aggressive antihypertensive medication. After the 1-year follow-up visit, the patient was in good clinical condition, without, however, adequate control of blood pressure. Case presentationA 72-year-old obese Caucasian woman was referred to our hospital because of increasing fatigue and exertional dyspnea. She had been well until 10 months previously. The patient had a medical history of diabetes, dyslipidemia and hypertension. Her hypertension was poorly controlled despite a combination of antihypertensive agents (b-blocker, diuretic, calcium channel blocker and angiotensin receptor blocker).Physical examination showed blood pressure 125/75 in both arms and a heart rate of 77 beats/minute. A systolic ejection murmur was heard at the left upper sternal border. Femoral pulses were palpable bilaterally but weak and delayed compared to the brachial pulses. Electrocardiography revealed sinus rhythm and left bundle branch block. A cardiac silhouette at the upper limits of normal and notching of the ribs were observed on the chest radiography. Her echocardiogram showed dilatation of ascending aorta (42 mm), tricuspid sclerotic aortic valve with mild stenosis, moderate systolic dysfunction of the left ventricle (ejection fraction 45-50%) and a turbulent jet at the distal aortic arch. Although it is extremely rare at this age, aortic coarctation was suspected and thoracic computed tomography (CT) angiography was performed. The CT angiogram disclosed severe coarctation of aorta distal to the origin of the left subclavian artery (Figure 1) with post-stenotic dilatation. Compensatory dilatation of the intercostals arteries was noted.The patient underwent cardiac catheterization to evaluate her coronary artery disease and the severity of the coarctation. Coronary angiography performed using a 5Fr pigtail catheter via right radial artery showed coronary arteries of normal distribution without significant atheromatosis. Aortography revealed a significant, tortuous,

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Results after repair of coarctation of the aorta beyond infancy: A 10 to 28 year follow-up with particular reference to late systemic hypertension

Cited by 216 publications

References 15 publications

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Immediate and long term outcomes of native aortic coarctation and postsurgical aortic recoarctation treated with stent implantation: one Center experience

A severe coarctation of aorta in a 72-year-old female: a case report

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