Abstract: Objective To summarize onestage repair of coarctation of the aorta(CoA) with intracardiac malformation in infants. Methods From January 2001 to January 2006, 28 patients with CoA and associated intracardiac malformation underwent onestage repair. There were 18 patients with preductal and another 10 patients with juxtaductal CoA. Six patients were accompanied by diffuse hypoplasia of aortic arch and 22 patients were associated with patent ductus arteriosus (PDA). Associated cardiac malformation included ventricular septal defect in 16 patients, ventricular septal defect and atrial septal defect in 5 patients, atrioventricular canal defect in 3 patients, transposition of great artery and ventricular septal defect in 2 patients and double outlet right ventricle in 2 patients. Left posterolateral thoracotomy combined with median sternotomy were used in 12 patients and single median sternotomy was used in 16 patients. End to end anastomosis of aorta with removal of the coarctated segment were performed in 20 patients, Gore-Tex patch graft aortoplasty were performed in 4 patients and aortoplasty with left subclavain flap were performed in 4 patients. Results There was no death.The lasting time of intubation was 7h to 13d, and intensive care unit (ICU) staying time was 3 to 18d. Four patients received delayed sternal closure in 48 to 72h after surgery because of cardiac dilatation. Three patients received peritoneal dialysis for acute renal failure following cardiac surgery. Three patients received inhalation of nitric oxide for treatment of postoperative pulmonary hypertension. The systolic pressure difference between lower limb and upper limb measured after operation was 10 to 20mmHg in 18 patients.There were no obvious systolic pressure difference between arm and leg in 8 patients.The systolic pressure of upper limb was higher than that of lower limb in 2 patients, and the pressure difference was 15mmHg and 20mmHg. All patients were followed up from 3 to 50 months. They were all survival except one died of severe tricuspid regurgitation, pulmonary infection and respiratory failure 3 months after surgery which diagnosis was transposition of great artery and ventricular septal defect. The results of other 27 patients were satisfactory. Recoarctation occurred in 1 patient with end to end anastomosis and 1 patient with Gore-Texpatch graft aortoplasty. The pressure difference through the measurement of echocardiography was 25mmHg and 28mmHg. No reoperation were undergone. Conclusion CoA with intracardiac malformation can be repaired by single median sternotomy or left posterolateral thoracotomy combined with median sternotomy in onestage. This operative approach is beneficial, not only with shorten period of therapy and less operative cost, but also advantageous for the recovery of cardiac and pulmonary function.
Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.
Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.
ObjectiveTo explore the role of increased preoperative ventricular-arterial stiffening in hypertensive infants with coarctation of the aorta (CoA).MethodsA retrospective study was conducted in 314 infants with CoA (CoA group, 193 males and 121 females, aged 5.4±2.2 months), and 314 infants receiving tumor chemotherapy with normal cardiovascular function and without pneumonia (control group, 189 males and 125 females, aged 4.4±3.8 months), who were admitted to our hospital from 2015 to 2017. The clinical data of the two groups were compared.ResultsThere were statistical differences in effective aortic elastance index (Eai), effective left ventricular end-systolic elasticity index (Eesi), ventricle-artery coupling index (VACi), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and ratios of left ventricular hypertrophy, dilation and systolic dysfunction between the two groups (P<0.05). Compared with non-hypertensive CoA infants, CoA infants with hypertension had higher Eai, Eesi, NT-ProBNP level and proportion of left ventricular hypertrophy (P<0.05). Compared with concomitant ventricular septal defect, infants with isolated CoA had higher Eai, Eesi, NT-proBNP level, incidence of hypertension and higher proportion of left ventricular hypertrophy, dilation and systolic dysfunction (P<0.05). Eai and Eesi were positively correlated with NT-proBNP level, left ventricular hypertrophy and fractional shortening of left ventricle (P<0.05), while Eai and Eesi were negatively correlated with left ventricular end diastolic volume index, left ventricular end systolic volume index and concomitant ventricular septal defect (P<0.05). Hypertension was related to preoperative left ventricular hypertrophy, Eai, Eesi and NT-ProBNP. Eai was an independent risk factor for hypertension.ConclusionPreoperative ventricular-arterial stiffening is increased in infants with aortic coarctation, which is related to the occurrence of hypertension. Isolated CoA shows more significant increase in ventricular-arterial stiffening, higher ventricular overload and incidence of hypertension.
ObjectiveTo summarize the clinical experience of the treatment for complex aortic coarctation with extra anatomic bypass and anatomic correction techniques. MethodsThe clinical data of patients with complex aortic coarctation treated in the First Affiliated Hospital of Nanjing Medical University and Friendship Hospital of Ili Kazakh Autonomous Prefecture between April 2012 and November 2020 were retrospectively reviewed. ResultsA total of 12 patients were enrolled, including 5 males and 7 females aged 11-54 (34.3±16.2) years. Extra anatomic bypass grafting was performed in 8 patients and anatomic correction was performed in 4 patients. The operations were successful in all patients. There was no perioperative death. The average cardiopulmonary bypass time was 203.0±46.0 min (7 median incision patients), and the average intraoperative blood loss was 665.0±102.0 mL. The average postoperative ventilator support time was 32.3±7.5 h, and the average postoperative hospital stay time was 10.2±4.3 d. The mean drainage volume of median incision was 1 580.0±360.0 mL, and the mean drainage time was 9.3±2.7 d. The mean drainage volume of left thoracotomy was 890.0±235.0 mL, and the mean drainage time was 4.8±2.5 d. One patient had a transient hoarse after operation and recovered 6 months later. The follow-up period ranged from 2 to 10 years with an average time of 81.0±27.0 months. All patients had a recovery of hypertension, cardiac afterload after 2 years postoperatively. One patient who received an artificial blood vessel replacement in situ was examined stenosis recurrence at the third year after discharge. Others were asymptomatic during the follow-up period. There were no death or other complications. ConclusionThe treatment strategy for complex aortic coarctation should be individualized according to the anatomical features and concomitant heart diseases. Extra anatomic bypass technique is a safe and feasible choice.
Objective To summarize the clinical characteristics of coarctation of the aorta (CoA) associated with intracardiac anomalies in infants. Methods The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies were analyzed. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed retrospectively. There were 56 males and 30 females at age of 1–346 (95.1±78.0)d. All the included patients underwent single-stage repair of CoA associated with intracardiac anomalies. Results Mean operative time was 279.0±56.4 min, mean cardiopulmonary bypass time was 162.3±51.0 min, and mean aorta cross-clamp time was 74.7±25.2 min. Mean length of ICU stay and ventilation time was 7.4±4.7 days and 101.1±75.4 hours, respectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient significantly (42.3±17.7 mm Hg vs. 22.1±9.4 mm Hg, P<0.001), and 7 early deaths were observed after surgery. The mean follow-up time of 79 hospital survivors was 31.0±27.4 months. And no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was 21.2±11.0 mm Hg. Transcoarctation gradient of 29 patients was higher than 20 mm Hg. However, only 4 patients with significant clinical symptom of lower limbs retardation were recommended for ballon angioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69.2%. Conclusions To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies is effective and safe, and the outcomes of early to mid term follow-up are satisfactory.