Adult ; Aortic Aneurysm ; etiology ; Aortic Coarctation ; complications ; diagnosis ; Female ; Humans

Pseudocoarctation of the aorta is a rare congenital anomaly of the aortic arch, and it has been described as an elongation of the aortic arch with "kinking" at the level of the ligamentum arteriosum without a pressure gradient across the lesion. The treatment for this condition is controversial. We report here on an unusual case of pseudocoarctation of the aorta associated with the anomalous origin of the left vertebral artery and we include a review of the medical literature.
Aortic Coarctation/*complications ; Child ; Humans ; Male ; Vertebral Artery/*abnormalities

Aorta ; Aorta, Thoracic ; Aortic Coarctation ; complications ; Craniofacial Dysostosis ; complications ; Heart Defects, Congenital ; complications ; Humans

Aortic Coarctation ; complications ; Ductus Arteriosus, Patent ; complications ; Humans ; Infant ; Pulmonary Artery ; abnormalities

Chylothorax is a rare but serious and well-recognized complication of thoracic and cardiac procedures. A postoperative chylothorax developed in a 3-month-old male patient after ligation of patent ductus arteriosus and repair of coarctation of aorta. He was treated successfully with conservative management using a combination of parenteral octreotide and medium-chain triglyceride (MCT) -enriched fomula with pleural drainage. We report a case of successful conservative treatment using octreotide for postoperative chylothorax.
Aortic Coarctation ; Chylothorax* ; Drainage ; Ductus Arteriosus, Patent ; Humans ; Infant ; Ligation ; Male ; Octreotide* ; Postoperative Complications ; Triglycerides

OBJECTIVETo review the experience in repair of aortic coarctation with intracardiac anomaly in infants and toddlers.

METHODSFrom January 2000 to December 2006, 84 infants and children diagnosed as aortic coarctation with intracardiac anomaly underwent surgical treatment. Mean age of the patients was 13.5 months, with a range from 1 month to 3 years. Mean body weight was 7.3 kg, with a range from 3.3 to 15 kg. Twelve patients complicated with complex intracardiac anomaly. Seventy-two patients complicated with ventricular septal defect and other simple anomaly. Twenty-one patients had hypoplasia of the aortic arch. Sixty-two patients had one-stage repair. Median sternotomy was used to simultaneously repair coarctation and intracardiac defect in 49 patients. Left thoracotomy and median sternotomy were applied to repair aortic coarctation and intracardiac anomaly respectively in 13 patients. Twenty-two patients had staged repair. Operational techniques for aortic coarctation include 42 patients of patch aortoplasty, 30 patients of resection and end-to-end anastomosis, 6 patients of subclavian flap aortoplasty, 3 patients of vascular bypass, and 1 patient of balloon dilation. In all 49 patients of one-stage operation through median sternotomy, selective cerebral perfusion was used in 43 patients, deep hypothermia low flow was applied in 4 patients, deep hypothermia circulatory arrest was performed in 2 patients.

RESULTSThere were 8 hospital deaths. The mortality is 9.5%. Among 8 deaths, 3 patients were misdiagnosed.

CONCLUSIONSSurgeries for aortic coarctation with intracardiac anomaly have satisfactory short-term results in infants and toddlers. One-stage repair through median sternotomy can be applied to most of the patients. Selective cerebral perfusion with deep hypothermia and circulatory arrest in lower body can protect the brain and other vital organs.

Aortic Coarctation ; complications ; surgery ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To evaluate the safety of surgical repair for neonatal aortic coarctation combined with ventricular septal defect.
 METHODS: Twenty-three aortic coarctation neonates received surgical treatment and their clinical data between April, 2013 and May, 2015 were analyzed retrospectively. All patients underwent coarctation repair + ventricular septal defect repair and mild hyperthermia cardiopulmonary bypass under the condition of general anesthesia. All patients were subjected to delayed sternal closure.
 RESULTS: One patient died at early post-operation, and no one died during 2-27 months' follow-up. Operation time, cardiopulmonary bypass time, aortic cross-clamp time, ICU stay time, mechanical ventilation time, delayed sternal closure time, and post-operative hospital stay time were (192.7±43.4) min, (132.4±26.4) min, (65.3±18.4) min, (185.3±56.4) h, (42.4±24.5) h, (36.3±18.6) h, and (15.3±4.6) d, respectively. Post-operative complications presented in 12 patients, including post-operative hemorrhage in 6 patients, acute renal insufficiency in 4 patients, wound infection in 1 patient, and post-operative coarctation of the aorta in 1 patient. 
 CONCLUSION One-stage complete repair for severe aortic coarctation combined with ventricular septal defect in neonates is safe, and the outcomes are satisfied. Fully free of the aortic arch and individual aorta reconstruction are the keies to successful operation.
Aorta ; Aortic Coarctation ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Safety

Objective: To evaluate the efficacy of surgical treatment of aortic coarctation combined with descending aortic aneurysm in adult patients. Methods: This is a retrospective cohort study. Adult patients with aortic coarctation who were hospitalized in Beijing Anzhen Hospital from January 2015 to April 2019 were enrolled. The aortic coarctation was diagnosed by aortic CT angiography, and the included patients were divided into the combined descending aortic aneurysm group and the uncomplicated descending aortic aneurysm group based on descending aortic diameter. General clinical data and surgery-related data were collected from the included patients, and death and complications were recorded at 30 days after surgery, and upper limb systolic blood pressure was measured in all patients at discharge. Patients were followed up after discharge by outpatient visit or telephone call for their survival and the occurrence of repeat interventions and adverse events, which included death, cerebrovascular events, transient ischemic attack, myocardial infarction, hypertension, postoperative restenosis, and other cardiovascular-related interventions. Results: A total of 107 patients with aortic coarctation aged (34.1±15.2) years were included, and 68 (63.6%) were males. There were 16 cases in the combined descending aortic aneurysm group and 91 cases in the uncomplicated descending aortic aneurysm group. In the combined descending aortic aneurysm group, 6 cases (6/16) underwent artificial vessel bypass, 4 cases (4/16) underwent thoracic aortic artificial vessel replacement, 4 cases (4/16) underwent aortic arch replacement+elephant trunk procedure, and 2 cases (2/16) underwent thoracic endovascular aneurysm repair. There was no statistically significant difference between the two groups in the choice of surgical approach (all P>0.05). In the combined descending aortic aneurysm group at 30 days after surgery, one case underwent re-thoracotomy surgery, one case developed incomplete paraplegia of the lower extremity, and one case died; and the differences in the incidence of endpoint events at 30 days after surgery were similar between the two groups (P>0.05). Systolic blood pressure in the upper extremity at discharge was significantly lower in both groups compared with the preoperative period (in the combined descending aortic aneurysm group: (127.3±16.3) mmHg vs. (140.9±16.3) mmHg, P=0.030, 1 mmHg=0.133 kPa; in the uncomplicated descending aortic aneurysm group: (120.7±13.2) mmHg vs. (151.8±26.3) mmHg, P=0.001). The follow-up time was 3.5 (3.1, 4.4) years. There were no new deaths in the combined descending aortic aneurysm group, no transient ischemic attack, myocardial infarction or re-thoracotomy surgery, and one patient (1/15) suffered cerebral infarction and 10 patients (10/15) were diagnosed with hypertension. The differences in the occurrence of endpoint events during postoperative follow-up were similar between the two groups (P>0.05). Conclusion: In experienced centers, long-term prognosis of patients with aortic coarctation combined with descending aortic aneurysm is satisfactory post surgical intervention.
Male ; Humans ; Adult ; Female ; Aortic Coarctation/surgery* ; Retrospective Studies ; Aortic Aneurysm, Abdominal/surgery* ; Treatment Outcome ; Blood Vessel Prosthesis Implantation/adverse effects* ; Endovascular Procedures/adverse effects* ; Hypertension/complications* ; Myocardial Infarction/complications* ; Aortic Aneurysm, Thoracic/surgery*

OBJECTIVEAlthough NuMED Cheatham-Platinum (CP) stent was specifically designed to treat vascular obstructions associated with congenital heart disease (CHD), its application in pediatric patients is relatively uncommon, especially in the pulmonary artery stenosis. The aim of this study was to evaluate the immediate-, early- and intermediate-term results of CP stent implantation in the treatment of vessel stenosis associated with CHD in children and adolescents.

METHODSFrom August 2005 to May 2007, 5 consecutive patients (3 boys and 2 girls) diagnosed as vascular stenosis associated with CHD underwent CP stent implantation in our institution. One patient had native coarctation of the aorta (CoA) and four patients had pulmonary artery stenosis. The median age and weight of patients were 12 years (range 4 - 15 years) and 24 kg (range 20 - 51 kg), respectively. The CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon inflated successively to expand the stent to desired diameter.

RESULTSTotally 6 stent placement procedures were performed and 8 CP stents (8-zig, 22 - 39 mm in length) were implanted in these 5 patients. All stents but one in a case of right pulmonary artery stenosis were immediately successfully placed in the target lesions without displacement during the procedures. For this case, a repeat procedure was performed and a second CP stent was reimplanted successfully 11 months later. After the procedure, the systolic pressure gradient across the stenosis decreased from (43.43 +/- 25.61) mm Hg (1 mm Hg = 0.133 kPa) to (3.29 +/- 3.09) mm Hg (t = 4.320, P < 0.01) and the narrowest diameter of the stenotic vessels increased from (6.86 +/- 2.04) mm to (13.44 +/- 4.02) mm (t = -4.508, P < 0.01). The percentage of pulmonary artery flow to the ipsilateral lung increased from 11.0% and 13.0% to 47.5% and 52.2% after the procedure in 2 cases of unilateral pulmonary artery branch stenosis, respectively. The ratio of right ventricular to aortic systolic pressure decreased from 62.3% and 72.2% to 27.0% and 33.3% in 2 cases of bilateral branch pulmonary artery stenosis, respectively. Upper limb blood pressure of one case of native CoA dropped greatly from 206/133 mm Hg to 156/95 mm Hg. During a median follow-up of 20 months (range 13 - 34 months), the results have been stable without complications except 2 stents which developed intrastent restenosis 6 months after the procedure.

CONCLUSIONOur experience suggests that the CP stent implantation is safe and feasible for the treatment of vessel stenosis associated with CHD in children and adolescents. The immediate-, early- and interim results are encouraging, but long-term results remain to be further evaluated and demand many more cases to be studied.

Adolescent ; Aortic Coarctation ; therapy ; Cardiac Catheterization ; Child ; Child, Preschool ; Constriction, Pathologic ; Female ; Heart Defects, Congenital ; complications ; therapy ; Humans ; Male ; Platinum ; Pulmonary Valve Stenosis ; complications ; therapy ; Stents ; Treatment Outcome

OBJECTIVEBalloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children. However, its role in the treatment of neonates and infants younger than 3 months old remains controversial. The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.

METHODThis is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012. A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure, with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg. The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg = 0.133 kPa) across aortic coarctation. During one year follow-up, the approach artery injury, recoarctation and aneurysm formation were particularly assessed.

RESULTWe classified these patients into two groups according to their age. Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months. There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05). The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ± 18) to (17 ± 12) mmHg in group B (P = 0.000 for both). Meanwhile, the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P = 0). The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year. Approach arterial complications occurred in 3 patients (9.4%), all of whom were in Group A (P = 0.537). Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery. At follow-up, 8 patients (25.0%) developed recoarctation, with 6 cases in Group A and 2 in Group B. There was no significant difference between groups A and B in the recoarctation rate (P = 1.000). Among them, 7 patients underwent repeat balloon angioplasty, and all showed successful relief of coarctation, and one patient required surgical repair. Two patients (2/37, 5.4%) had small aneurysms of the descending aorta immediately after balloon angioplasty, with one patient in each group (12/25 vs.1/12, P = 0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study.

CONCLUSIONBalloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication, recoarctation and aneurysm formation.

Angioplasty, Balloon ; Aortic Aneurysm ; epidemiology ; Aortic Coarctation ; therapy ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Septal Defects ; surgery ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome