Spinal cord damage and operations for coarctation of the aorta: aetiology, practice, and prospects.

Keen, G

doi:10.1136/thx.42.1.11

Cited by 46 publications

(22 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The operative approach we presently employ involves extraanatomic bypass through a midline sternotomy, the potential benefits of which include avoiding reentry into the left thorax, incidental pleural injury, infection from a previously or concomitantly implanted prosthesis, and spinal cord injury. 31 This technique is feasible for most patients who are 3 years of age or older.…”

Section: Discussionmentioning

confidence: 99%

Complications following reparative surgery for aortic coarctation or interrupted aortic arch

et al. 1998

View full text Add to dashboard Cite

Repair of aortic coarctation or interrupted aortic arch continues to be associated with major long-term morbidity. Thus, we conducted a review of 87 consecutive patients who underwent aortic arch repairs, focusing particular attention on the complications that developed. A two-stage strategy was employed if cardiac lesions were associated. The median age at surgery was 1.5 months with a range of 12 h to 56 years. The aortic arch was repaired using end-to-end anastomosis, subclavian flap aortoplasty, subclavian arterial turning-down aortoplasty, patch aortoplasty, tube graft interposition, or other methods. There were 10 patients who died soon after repair, and all of whom had complex cardiac anomalies. Of the remaining 77 patients, 8 developed recurrent stenosis. These 8 patients were all similar in age, being under 3 months old, and weighing 4 kg or less. A multivariable analysis of the infants identified interrupted aortic arch as an independent risk factor for the development of this complication with an odds ratio of 6.45. Complications following prosthesis-free techniques were similar in prevalence and timing. All reinterventions were mortality-free, but catheter dilation and patch aortoplasty were not always successful. Three extraanatomic bypasses were successfully performed, and one adult who had undergone a previous graft and pseudoaneurysm operation was successfully treated with an extraanatomic bypass. These findings led us to conclude that the initial repair should be performed without a prosthesis, and that reintervention for stenosis should combine catheter dilation and extraanatomic bypass.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications following reparative surgery for aortic coarctation or interrupted aortic arch

et al. 1998

View full text Add to dashboard Cite

show abstract

“…This concern is usually less for older children because of the development of collateral circulation. Several strategies have been used in the neonate and young infant in efforts to minimize the potential for spinal cord injury [ 43 ]. Inducing mild hypothermia to 34-35 °C before applying the Ao clamp is standard of care at some centers, although the incidence of spinal cord injury in the absence of hyperthermia is exceedingly rare [ 44 ].…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Anesthesia for Cardiac Surgery in Neonates

Miller‐Hance

Gottlieb

Motta

2014

Neonatal Anesthesia

View full text Add to dashboard Cite

“…The incidence of paraplegia in 5492 operations for coarctaction in Great Britain was 0.3%. 62 In this case, intraoperative hypotony represents a problem. Distal to the stenosis, which means in the lumbar spinal cord as well, the blood pressure is up to 30% lower than the proximally registered values.…”

Section: Disturbance Of Vascularisation (Indirect Damage)mentioning

confidence: 99%

“…63 Therefore Wada et al 57 recommended intraoperative measuring of the blood pressure in the distal aorta and obtaining the pressure in the cerebrospinal liquid. In surgery for coarctation as well, intraoperative neuromonitoring is a very useful method, as required by Keen in 1987 62 in combination with electromanometric display of the aortic blood pressure in all patients. 65 called paraplegia an unpredictable complication of multifactorial origin in aortic and cardiac surgery.…”

Section: Disturbance Of Vascularisation (Indirect Damage)mentioning

confidence: 99%

The risk of paraplegia through medical treatment

Bacher¹,

Schiltenwolf

Niethard

et al. 1999

Spinal Cord

View full text Add to dashboard Cite

In the Orthopedic University Hospital of Heidelberg (section Orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. Paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. Knowledge of the consequences and side eects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.

show abstract

Spinal cord damage and operations for coarctation of the aorta: aetiology, practice, and prospects.

Cited by 46 publications

References 13 publications

Complications following reparative surgery for aortic coarctation or interrupted aortic arch

Complications following reparative surgery for aortic coarctation or interrupted aortic arch

Anesthesia for Cardiac Surgery in Neonates

The risk of paraplegia through medical treatment

Contact Info

Product

Resources

About