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Management of coarctation of the aorta in a neonate

Saw HS, Grieve AW, Singham KT, Delilkan AE

Med J Malaysia, 1977 Sep;32(1):63-6.
PMID: 609348
Matched MeSH terms: Aortic Coarctation/diagnosis*; Aortic Coarctation/surgery
Fulltext The cervical aortic arch

Hoe TS, Chan KC, Zambahari R

Med J Malaysia, 1987 Jun;42(2):90-2.
PMID: 3503196

A patient with a cervical aortic arch associated with a coarctation of the aortic arch and a Tetralogy of Fallot presented to the General Hospital, Kuala Lumpur.

Matched MeSH terms: Aortic Coarctation/complications
Fulltext Coarctation of aorta repair at the National Heart Institute (1983-1994)

Adeeb SMSJ, Leman H, Sallehuddin A, Yakub A, Awang Y, Alwi M

Med J Malaysia, 2004 Mar;59(1):11-4.
PMID: 15535329

This retrospective study illustrates our approach to this problem over the years, from performing subclavian flap aortoplasty initially to the more accepted procedure now, which is resection and end-to-end anastomosis. Coarctation of aorta in our population is seen in a varying age groups and are also associated with other cardiac anomalies including both acyanotic and cyanotic congenital cardiac defects. Therefore a wide variety of surgical procedures were performed including resection of the coarcted segment and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty and synthetic tube graft interposition. Subclavian flap aortoplasty is not widely practised anymore in favour of resection with end-to-end anastomosis. Fifty four point four percent of patients had isolated coarctation, 10.5% had associated valvular defects, 28.1% had other simple congenital defects and 7.0% had associated complex cyanotic congenital defects. Perioperative mortality was 5.26% and is correlated with the younger age of patients at time of surgery and severity of cardiac failure at time of presentation. We did not see any difference in mortality for patients with complex congenital disease or between the different surgical procedures. However, we did find that in the early period when resection with end-to-end anastomosis was performed, there was a significantly higher incidence of morbidities.

Matched MeSH terms: Aortic Coarctation/mortality; Aortic Coarctation/surgery*
Fulltext Spiral CT angiography in an infant with a hypoplastic aortic arch

Man Harun S, Faridah Y

Biomed Imaging Interv J, 2006 Apr;2(2):e11.
PMID: 21614223 MyJurnal DOI: 10.2349/biij.2.2.e11

The advent of multislice computed tomography (CT) has revolutionised the performance of body CT and allowed the development of CT angiography (CTA). CTA is a robust and minimally invasive method of visualizing the arterial vascular system. The newer generation of multidetector scans has allowed for shorter scanning times with no respiratory misregistration at peak vascular opacification following peripheral contrast injection. The volume of data obtained from these scans can be further manipulated to generate two-dimensional (2D) and three-dimensional (3D) images with no increase in radiation to the patient. Hence, CTA has gained popularity and importance as the alternative diagnostic tool especially for ill patients in which conventional angiography is inadvisable.We present an infant with coarctation of the aorta and hypoplastic aortic arch, in which CT angiography was used to pinpoint the diagnosis. The CT findings were subsequently confirmed at surgery.

Matched MeSH terms: Aortic Coarctation
Fulltext eComment: Trans-pericardial extra-anatomic aortic bypass for coarctation of the aorta

Sachithanandan A, Badmanaban B

Interact Cardiovasc Thorac Surg, 2011 Jul;13(1):100.
PMID: 21697404 DOI: 10.1510/icvts.2010.265264A
Matched MeSH terms: Aortic Coarctation/therapy*
Feasibility and early outcomes of aortic coarctation treatments with BeGraft Aortic stent

Promphan W, Han Siang K, Prachasilchai P, Jarutach J, Makonkawkeyoon K, Siwaprapakorn W, et al.

Catheter Cardiovasc Interv, 2020 09 01;96(3):E310-E316.
PMID: 32299151 DOI: 10.1002/ccd.28892

OBJECTIVES: To assess feasibility and early outcomes of using BeGraft Aortic stent in the treatment of aortic coarctation (CoA).
BACKGROUND: BeGraft Aortic stent (Bentley InnoMed, Hechingen, Germany) allows large postdilation diameter up to 30 mm. With availability of lengths of 19-59 mm and lower stent profile, they can be used in native and recurrent CoA in adults and in pediatric patients.
MATERIALS AND METHODS: This is a multicentre retrospective analysis of 12 implanted BeGraft Aortic stents in CoA between May 2017 and April 2019.
RESULTS: Twelve patients aged 7.7-38 years (median 18.3 years) with body weight of 19.9-56 kg (median 45.5 kg). Eight patients (66%) had native juxtaductal CoA while four had recurrent CoA after previous surgical or transcatheter treatments. The stents were implanted successfully in all the patients with no serious adverse events. The length of the stents ranged from 27 to 59 mm and the implanted stent diameter varied from 12 to 18 mm. The median intraprocedural CoA pressure gradient decreased from 25 mmHg (range 16-66 mmHg) to 2 mmHg (range 0-13 mmHg). The mean follow-up duration was 10.2 months. Two patient (16.6%) had residual stent narrowing requiring staged redilation. One patient (8%) had pseudoaneurysm formation at 1 year cardiac CT follow-up.
CONCLUSIONS: The BeGraft Aortic stent may be considered to be safe and effective in the short term in treatment of CoA from childhood to adulthood. Long-term follow-up is needed.

Matched MeSH terms: Aortic Coarctation/physiopathology; Aortic Coarctation/surgery*
Fulltext Endovascular therapy versus surgery in adult with coarctation of the aorta

Abdulgani, Hafil Budianto, Oemar, Hamed

Medical Health Reviews, 2009;2009(1):43-58.
MyJurnal

Coarctation of the aorta is a congenital anomaly presented by the combination of upper body hypertension and weak or absent femoral pulses. Increased morbidity and shortened life span of infants born with coarctation suggest that the malformation should be treated early in life. Surgical intervention has been recognized as the gold standard of treatment for children born with this defect. Unfortunately, studies in many institutions have shown that the diagnosis of coarctation of the aorta is often missed. As a consequence, many patients with coarctation of the aorta are not detected until adult life. Long-term follow-up of adult patients following surgical intervention for coarctation of the aorta reveals ongoing risks; hence, less invasive endovascular therapy becomes an alternative approach. Literature’s review was performed to compare the results of endovascular therapy (stenting and angioplasty) with surgical techniques to repair adult with coarctation of the aorta. The immediate improvement in hypertension and the morbidity were similar. Although stenting can be expected to show superiority to balloon angioplasty alone, that was not apparent when comparing these two endovascular approaches. The morbidity, mortality, and repeat intervention rates were just as high for stenting as they were for angioplasty or for a combination of both modalities. The majority of surgical complications were minor (i.e., vasculitis, bleeding), whereas the majority of endovascular complications could be considered more severe (i.e., dissection, traumatic aneurysm, stroke). Surgical therapy was associated with a very low risk of restenosis and recurrence, whereas endovascular therapy had a much higher incidence of restenosis and the need for repeat interventions. In conclusion, surgical therapy is superior compared to other modes of interventional therapy for adult with coarctation of the aorta, and it shall remain as current mode of therapy for adult with coarctation of the aorta.

Matched MeSH terms: Aortic Coarctation
Discovery of coarctation of the aorta following renal doppler sonography

Sidney Ong CL, Ch'ng LS, Aida Bt AA

Med J Malaysia, 2018 10;73(5):330-331.
PMID: 30350816 MyJurnal

Coarctation of the aorta (CoA) is present in 0.4% of live births and in 7% of patients with congenital heart disease. While there may be florid presentations of congestive heart failure in the neonatal period, the diagnosis during adulthood is often delayed. We encountered a 20-year-old woman who was discovered to be hypertensive on routine check-up. Following bilateral abnormal renal doppler sonography, MR angiogram revealed a short-segment stenosis of the descending thoracic aorta. Review of her chest radiograph showed a small aortic knuckle. This case highlights an unconventional algorithm in diagnosing aortic coarctation in adulthood.

Matched MeSH terms: Aortic Coarctation
Fulltext Birth prevalence and late diagnosis of critical congenital heart disease: A population-based study from a middle-income country

Mat Bah MN, Sapian MH, Alias EY

Ann Pediatr Cardiol, 2020 09 17;13(4):320-326.
PMID: 33311920 DOI: 10.4103/apc.APC_35_20

Aims: There are limited data regarding critical congenital heart disease (CCHD) from middle-income countries (MIC). This study aims to determine the birth prevalence, rate of late diagnosis, and influence of timing of diagnosis on the outcome of CCHD.
Setting and Design: Retrospective observational cohort study in the State of Johor, Malaysia.
Subjects and Methods: All infants born between January 2006 and December 2015 with a diagnosis of CCHD, defined as infants with duct-dependent lesions or cyanotic heart disease who may die without early intervention. The late diagnosis was defined as a diagnosis of CCHD after 3 days of age.
Results: Congenital heart disease was diagnosed in 3557 of 531,904 live-born infants and were critical in 668 (18.7%). Of 668, 347 (52%) had duct-dependent pulmonary circulation. The birth prevalence of CCHD was 1.26 (95% confidence interval: 1.16-1.35) per 1000 live births, with no significant increase over time. The median age of diagnosis was 4 days (Q1 1, Q3 26), with 61 (9.1%) detected prenatally, and 342 (51.2%) detected late. The highest rate of late diagnosis was observed in coarctation of the aorta with a rate of 74%. Trend analysis shows a statistically significant reduction of late diagnosis and a significant increase in prenatal detection. However, Cox regression analysis shows the timing of diagnosis does not affect the outcome of CCHD.
Conclusions: Due to limited resources in the MIC, the late diagnosis of CCHD is high but does not affect the outcome. Nevertheless, the timing of diagnosis has improved over time.

Matched MeSH terms: Aortic Coarctation