Role of Computed Tomography Angiography in the Short-Term Follow-up of Aortic Coarctation Repair

ABSTRACT Introduction: Coarctation of the aorta (CoA) is a narrowing of the thoracic aorta that often manifests as discrete stenosis but may be tortuous or in long segment. The study aimed to evaluate pre and post-surgical aspects of pediatric patients submitted to CoA surgical correction and to identify possible predisposing factors for aortic recoarctation. Methods: Twenty-five patients were divided into groups according to presence (N=8) or absence (N=17) of recoarctation after surgical correction of CoA and evaluated according to clinical-demographic profile, vascular characteristics via computed angiotomography (CAT), and other pathological conditions. Results: Majority of males (64%), ≥ 15 days old (76%), ≥ 2.5 kg (80%). There was similarity between groups with and without recoarctation regarding sex (male: 87% vs. 53%; P=0.277), age (≥ 15 days: 62.5 vs. 82%; P=0.505), and weight (≥ 2.5 kg: 87.5 vs. 76.5; P=0,492). Altered values of aortic root/Valsalva diameter, proximal transverse arch, and distal isthmus, and normal values for aorta prevailed in preoperative CAT. Normal values for the aortic root/Valsalva sinus diameter were observed with and without recoarctation, the same for both groups regarding ascending and descending aorta in postoperative CAT. No significant difference for altered values of proximal transverse arch and alteration in distal isthmus was observed. Conclusion: No predictive risk for recoarctation was observed. CTA proved to be important in CoA diagnosis and management, since CoA is mainly related with altered diameter of aortic root/sinus of Valsalva and proximal and distal aortic arch/isthmus, however, it failed to show predictive risk for recoarctation.

Outcomes of arch reintervention for post-repair recoarctation: A retrospectivel analysis in a single center / 中国胸心血管外科临床杂志

@#Objective    To discuss outcomes of arch reintervention for post-repair recoarctation in children. Methods    From 2009 to 2019, 48 patients underwent reintervention for post-repair recoarctation in Shanghai Children’s Medical Center. Of the 48 patients, 22 patients had surgical repair, 25 patients had balloon angioplasty (BA), and 1 patient had a stent implantation. The clinical data were analyzed, and the difference in time-to-event distribution between the surgical group and the BA group was determined by a log-rank test. Results    The median age at reintervention was 15.0 months (range, 3.0 months-15.1 years). The median weight at reintervention was 9.8 kg (range, 3.0-58.0 kg). The time to reintervention after initial repair was 12.5 months (range, 2.0 months-7.8 years). One patient (2.1%) died in hospital and 1 patient (2.1%) experienced arrhythmia after surgical repair. One late mortality (2.1%) occurred after surgical reintervention. One patient (2.1%) experienced aortic dissection after BA. No patient died after BA. Freedom from residual coarctation or new recurrences was 66.7%, 61.3%, and 56.9%, respectively, at 1, 2, and 5 years after reintervention. Freedom from residual coarctation or new recurrences was 90.0%, 81.8%, and 70.1%, respectively, at 1, 2, and 5 years after surgical repair. Freedom from residual coarctation or new recurrences was 52.0%, 48.0%, and 48.0%, respectively, at 1, 2, and 5 years after BA. Compared with BA, surgery-based reintervention had a lower incidence of residual coarctation or recurrences (χ2=4.400, P=0.036). Conclusion    Reintervention for recoarctation has favorable early outcomes. Compared with balloon angioplasty, surgical repair has a more lasting effect in relieving the recoarctation.

Evolución clínica de pacientes pediátricos post-tratamiento de coartación aórtica / Clinical evolution of pediatric patients post-treatment of aortic coarctation

La Coartación Aórtica representa del 5% - 10% de las malformaciones congénitas cardiovasculares. Lamayoría se localizan, en la pared posterior de la aorta (yuxtaductales) Objetivo: Establecer evolución clínicapost tratamiento de coartación aórtica, en el Hospital General de Enfermedad del Instituto Guatemalteco deSeguridad Social. Metodología: Estudio descriptivo, retrospectivo, en pacientes <15 años de edad, condiagnóstico de coartación aórtica que ya hubieran recibido tratamiento. Resultados: Se encontraron 39pacientes. 21 de sexo masculino y 18 de sexo femenino; 18 pacientes (9 masculino / 9 femenino) fuerontratados por intervencionismo; 12 pacientes con tratamiento medico. Las complicaciones fueron 10pacientes con recoartación y 7 pacientes con hipertensión arterial, el 100% en clase funcional NYHA tipo I y0% de mortalidad. Conclusiones: Los pacientes post tratamiento de coartación de aorta, cursaron conevolución clínica adecuada, 43% de ellos tuvo algún tipo de complicación, la mortalidad fue 0%.(

Aortic Coarctation represent 5 % - 10 % of congenital cardiovascular malformations. Most are located in theposterior wall of the aorta (yuxtaductal) Objective: To establish clinical outcome after treatment of aorticcoarctation in the General Hospital of Disease in Guatemalan Institute of Social Security. Methodology: Descriptive, retrospective study, in patients <15 years of age, diagnosed with aortic coarctation who hadalready received treatment. Results: 39 patients were found. 21 male and 18 female, 18 patients (9 male / 9female) were treated for interventional cardiology, 12 patients with medical treatment. Complications werepresent in 10 patients with Re coarctation and 7 patients with hypertension, 100% in NYHA functional class Itype and 0% mortality. Conclusions: The post treatment of aortic coarctation patients, presented with goodclinical course, 43 % of them had some type complication, and mortality was 0 %.