Management of Coarctation of The Aorta in Adult Patients: State of The Art

Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.

Management of Coarctation of The Aorta in Adult Patients: State of The Art

Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.

Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly

BACKGROUND AND OBJECTIVES: With the exception of bicuspid aortic valves, atrial septal defects (ASDs) are the most common congenital heart lesions found in adults. A mortality and morbidity benefit has clearly been demonstrated in the treatment of this lesion in younger patients. However, the benefits of ASD closure are less well defined in the elderly. We report our experience with transcatheter ASD closure and detail its impact on functional status and right ventricular remodeling as indicators of right heart failure in patients greater than 60 years of age. SUBJECTS AND METHODS: Fifty-five patients (median age 70 years) underwent ASD closure at a single center during an eight-year period. Data were collected and analyzed retrospectively. RESULTS: Transcatheter closure was successful in all patients. No major complications occurred during the periprocedural or follow-up periods. Complete defect closure was documented in 97% of patients during follow-up. All patients improved by at least one New York Heart Association (NYHA) functional class. Following ASD closure, no patient was in NYHA III or IV. The median right-ventricular end-diastolic diameter decreased from 39 mm to 26.6 mm (p<0.001). CONCLUSION: Atrial septal defect closure is safe and effective in elderly patients. Our data and prior published data consistently demonstrate that even patients greater than 60 years of age experience improvement in functional status and right ventricular remodeling. Therefore, patient age should not influence the decision of whether an ASD should be closed.

Device closure of congenital [perimembranous and muscular] and acquired ventricular septal defects using the amplatzer devices: percutaneous and perventricular techniques

Ventricular septal defect [VSD] accounts for approximately 20% of all forms of congenital heart disease. The conventional treatment has been the surgical closure of these defects. Percutaneous closure of VSD had been attempted in the past but it was not until the development of Amplatzer Muscular VSD occluder device that the higher closure rates and safety of the procedure made it an attractive alternative to the surgical closure. Amplatzer VSD devices have also been designed to close perimembranous and post infarction muscular VSDs and the results have been encouraging. In addition to the percutaneous conventional approach, an intraoperative [perventricular] technique has been developed to allow safe VSD closure with Amplatzer devices in small infants with poor vascular access avoiding the need of cardiopulmonary bypass or in infants with concomitant cardiac defects requiring surgical repair. In this review the transcatheter VSD closure with Amplatzer VSD occluders will be discussed for each type of VSD and the technical aspects will be detailed