Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Modification of End-to-End Anastomosis for Long-Segment Coarctation of the Aorta / 日本心臓血管外科学会雑誌

<p>Several problems have been reported following coarctectomy, especially in cases involving long-segment coarctation (COA). Although residual COA, proximal arch kinking, and airway compression may occur after coarctectomy, avoiding the use of artificial materials provides a better chance for the subsequent growth of the aorta. We successfully performed a modified end-to-end anastomosis with subclavian flap aortoplasty for a two-month-old boy with COA. A two-month-old boy was admitted to our hospital for nocturnal tachypnea and a feeding disorder. The initial echocardiography showed a preductal long COA beyond the left subclavian artery. A perimembranous VSD, a patent foramen ovale, and a patent ductus arteriosus were also noted. The left ventricular function was mildly depressed with an ejection fraction of 59%. Enhanced CT revealed a long-segment COA with a length of 15 mm. The blood pressure gradient between the upper and lower limbs was 40 mmHg. The operation was performed at the age of 2 months. The 4th intercostal space was opened through a posterolateral left thoracotomy incision. The distal end of the isthmus was so ligated as to maintain blood perfusion to the lower body through the PDA. The arch was clamped between the left carotid and the left subclavian artery (LSCA). The LSCA and the isthmus were divided as distally as possible, and the two distal ends were longitudinally incised and sutured to each other in a side-to-side fashion using a 7-0 polypropylene continuous suture. After complete resection of the ductal tissue, a newly created distal arch was anastomosed to the descending aorta. The left ventricular ejection fraction was increased to 74% at discharge. Catheterizations 3 years after the surgery did not reveal any stenosis or deformity in the aorta at normal PA pressure. The patient has been doing well and is free of complications 7 years after the surgery. At present, end-to-end anastomosis and aortic arch advancement with or without cardiopulmonary bypass are widely used procedures for coarctectomy ; however, a modified end-to-end anastomosis is still a viable option for cases involving long-segment coarctation.</p>

Late complications of aortic coarctation treatment: a mexican cohort study with more than 10-year follow-up / Complicaciones tardías de tratamiento de coartación aórtica: estudio mexicano de cohorte con más de 10 años de seguimiento

Aortic coarctation's (CoA) prevalence is 0.2 in every 1000 live births. Therapeutic options include surgery and, for the last 20 years, interventional cardiology. Objective: To determine the complications of CoA and examine their association with the type of treatment recieved. Methods: Patients that underwent CoA treatment and had follow-up in our center were included. They were included according to treatment in 3 groups: balloon aortoplasty (group 1), stent aortoplasty (group 2) and open surgery (group 3). Patients who suffered from interrupted aortic arch and those who received treatment in other hospitals or presented complications detected in other hospitals were excluded. Data analysis: Descriptive statistics with central mean tendency and dispersion according to distribution, inferential statistics, X-square, ANOVA/Kruskal-Wallis and Kaplan Meier analysis of survival. Results: n =166, age = 18 (range 13-25), 118 male (71%), 48 in group 1, 57 in group 2 and 61 in group 3. The mean follow-up was 15 years. From the analyzed complications, those with statistical significance were: persistent systemic arterial hypertension (group 1, 15%; group 2, 34%; group 3, 41%, p < 0.001) and re-intervention (group 1, 58%; group 2, 11%; group 3, 36%), p = 0.03. Conclusions: The balloon aortoplasty presents greater percentage of reoperation; and aortoplasty stent has fewer complications, but these are manifested in less time.

La prevalencia de Coartación Aórtica (CoA) es de 0.2 por cada 1000 nacidos vivos. Las opciones terapéuticas incluyen cirugía y en los últimos 20 años cardiología intervencionista. Objetivo: determinar las complicaciones de CoA y determinar la asociación con el tipo de tratamiento recibido. Material y métodos: Se incluyeron todos los pacientes con CoA atendidos en nuestra unidad y con seguimiento. Se incluyeron 3 grupos de acuerdo al tratamiento: Grupo 1, aortoplastía con balón, Grupo 2, aortoplastía con Stent y Grupo 3, cirugía. Se excluyeron pacientes con interrupción de arco aórtico o los que habían sido atendidos en otros hospital pero que las complicaciones se registraron en nuestra unidad. Análisis estadístico, se usó estadística descriptiva con medidas de tendencia central y dispersión de acuerdo a la distribución, estadística inferencial con X-cuadrada, ANOVA y Kruskal-Wallis, Kaplan Meier para sobrevida. Resultados: n =166, edad = 18 (rango 13-25), 118 hombres (71%), 48 en grupo 1, 57 en grupo 2, 61 en grupo 3. Seguimiento por 15 años. Al analizar las complicaciones las que tienen significancia estadística fueron: hipertensión arterial persistente (grupo 1, 15%; grupo2, 34%; grupo 3, 41%, p<0.001) y reintervención (grupo 1, 58%; grupo 2, 11%; grupo 3, 36%), p = 0.03. Conclusiones: La aortoplastía con balón tien mayor porcentaje de reintervención y la aortoplastía con stent tiene menor porcentaje de complicaciones, pero estas se manifiestan en un lapso menor de tiempo.

Coartación aórtica crítica: aortoplastía percutánea con balón. Reporte de un caso / Critical aortic coarctation: percutaneous balloon aortoplasty. Case report

La coartación aórtica crítica del recién nacido es una de las cardiopatías congénitas con mayor mortalidad. Se presenta el caso de un paciente diagnosticado de coartación aortica a las dos semanas de vida, operado de coartectomía y anastomosis termino terminal. A los tres meses de edad evoluciona desfavorablemente, con deterioro hemodinámico, confirmándose una recoartación aórtica crítica, por lo que se decide realizar una aortoplastía con balón por vía percutánea, que resulta exitosa y sin complicaciones inmediatas. La aortoplastía con balón constituye una opción terapéutica aceptablemente segura y mínimamente invasiva en pacientes pediátricos con recoartación aórtica.

Aortic coarctation of the newborn is a congenital heart disease with increased mortality. We report the case of an aortic coarctation diagnosed at two weeks old patient, surgery was indicated, the procedure was coarctectomy with end-to-end anastomosis. At three months of age evolves unfavorably, with hemodynamic compromise, confirming critical aortic recoarctation, so it was decided to make a balloon aortoplasty percutaneously, which is successful without immediate complications. The balloon aortoplasty is an acceptably safe and minimally invasive therapeutic option in pediatric patients with aortic coarctation.

Ascending aortic dilatation combined with aortic valve disease: ascending aortic replacement or aortoplasty / 中华胸心血管外科杂志

Objective The results of Aortic valve replacement (AVR). Combined with ascending aortic replacement(group A) or aortoplasty (group B) in patients with aortic valve disease and ascending aortic dilatation were analysed to assess the clinical outcomes and respective indications. Methods Among the two groups, the age, gender, NYHA class, types of aortic valve lesions and left ventricular ejection fraction were not different statically. The ascending aortic diameters in group A[(50.41 ±3.71) mm] and group B [(48.29±2.18) mm] were not statically different. Ascending aortic replacement was performed in Group A. A Dacron tube(diameter 28 ～ 30mm) was routinely wrapped around the ascending aorta after aortoplasty in group B. Results There was 1 postoperative death in group B, blood transfusion volume and postoperative complications were not stasticaly different in the two groups. Cardiopulmonary bypass time [(110.52 ± 27.51) min] and aortic across clumping time [(71.70 ± 17.13)min] in group A were significantly longer than that of group B [(97.31 ± 19.46) min,P=0. 004; (57.13 ±19.46) min, respectively. P=0.025]. Conclusion Aortic valve disease, especially bicuspid valve disease often combines with ascending aortic dilatation or aneurysm. In younger patients, ascending aorta should be actively treated surgically when the diameter is equal or more than 40mm. Aortoplasty with external reinforcement of a Dacron tube is simpler and safer than aortic replacement in patient without aortic atherosclerosis or ulceration, and large aneurysm.

Presentación clínica de coartación de aorta, relato de casos: revisión de manejo actual / Clinical presentation of aortic coarctation: review of current management: a case series report

La coartación de Aorta es una cardiopatía congénita que se presenta con insuficiencia cardiaca congestiva precozmente sobre todo en la edad neonatal y que, de no ser diagnosticada oportunamente evoluciona con elevadísima morbi-mortalidad. Cuando sobrevive a la barrera de la primera infancia, cursa con hipertensión arterial sistémica, pudiendo debutar incluso con un accidente cerebrovascular, con resultado fatal para el paciente, ó dejarlo con incapacidades como secuela. Resaltamos la importancia del correcto y detallado examen clínico cardiovascular, que incluya la palpación adecuada de los pulsos periféricos así como la medición de la presión arterial sistémica, debido a que siempre cursa con hipertensión arterial en los miembros superiores y ausencia de pulsos en los miembros inferiores. Tratado correctamente presenta bajo riesgo de complicaciones y de mortalidad.

Aortic coarctation is a congenital heart defect that presents with early congestive heart failure, especially during the neonatal stage, and which if not opportunely diagnosed progresses with a high degree of morbidity and mortality. When patients survive the barrier of early childhood, they continue having such problems as systemic arterial hypertension, and run risks of outcomes such as fatal or incapacitating cerebrovascular accident. We emphasize the importance of a careful and detailed clinical cardiovascular examination, to include adequate taking of the peripheral pulses and measurement of systemic blood pressure, since this always presents with hypertension in the upper limbs and an absence of pulses in the legs. Treated adequately, it presents little risk of complications or mortality.

Reduction Aortoplasty with Suture Plication Technique for Dilatation of the Ascending Aorta associated with Aortic Valve Disease / 대한흉부외과학회지

BACKGROUND: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. MATERIAL AND METHOD: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7+/-6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7+/-5.4 (7 to 24) months. RESULT: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4+/-3.5 mm preoperatively to 33.2+/-3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. CONCLUSION: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.