Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta
Since 1985 balloon angioplasty, followed by surgical repair if angioplasty is unsuccessful, has been used as a treatment strategy for eligible children with discrete native coarctation of the aorta. Although balloon angioplasty has been successful in most patients, this strategy is appropriate only...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1992-02, Vol.19 (2), p.389-393 |
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| creator | Minich, L.Luann Beekman, Robert H. Rocchini, Albert P. Heidelberger, Kathleen Bove, Edward L. |
| description | Since 1985 balloon angioplasty, followed by surgical repair if angioplasty is unsuccessful, has been used as a treatment strategy for eligible children with discrete native coarctation of the aorta. Although balloon angioplasty has been successful in most patients, this strategy is appropriate only if surgery is safe and effective in children in whom angioplasty does not succeed. To address this issue, the surgical procedure and clinical outcome in 11 children who underwent surgery after unsuccessful balloon angioplasty (defined as a residual systolic gradient >20 mm Hg in 10 and a saccular aneurysm in 1) were evaluated. Data for subjects were compared with data for a control group of seven children who had surgical repair of a discrete coarctation without prior angioplasty during the same time period.
In the study group, balloon angioplasty was performed at 4.3 ± 1.2 years of age, resulting in a balloon/isthmus ratio of 0.98 ± 0.05 and decreasing mean peak systolic gradient from 54 ± 3 to 27 ± 2 mm Hg (p < 0.001). Follow-up angiography (n = 7) or nuclear magnetic resonance imaging (n = 4) documented a discrete residual stenosis in 10 patients and a small saccular aneurysm in 1. Collateral circulation decreased in three patients. The subsequent surgical procedure and its outcome were similar in the study and control groups. Chylothorax was the only complication, occurring in one child from each group. No paraplegia or mortality occurred. Pathologic examination revealed irregular intimal surfaces with small flaps of intima in 5 of 10 resected specimens from the study group and in 2 of 6 from the control group.
Follow-up evaluation 1.1 ± 0.2 years after operation for the subjects and 0.6 ± 0.3 year for the control group documented similar mild residual gradients and normal systolic blood pressures in both groups. Thus, surgical repair appears to be safe and effective after unsuccessful balloon angioplasty of native coarctation. |
| doi_str_mv | 10.1016/0735-1097(92)90496-A |
| format | Article |
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In the study group, balloon angioplasty was performed at 4.3 ± 1.2 years of age, resulting in a balloon/isthmus ratio of 0.98 ± 0.05 and decreasing mean peak systolic gradient from 54 ± 3 to 27 ± 2 mm Hg (p < 0.001). Follow-up angiography (n = 7) or nuclear magnetic resonance imaging (n = 4) documented a discrete residual stenosis in 10 patients and a small saccular aneurysm in 1. Collateral circulation decreased in three patients. The subsequent surgical procedure and its outcome were similar in the study and control groups. Chylothorax was the only complication, occurring in one child from each group. No paraplegia or mortality occurred. Pathologic examination revealed irregular intimal surfaces with small flaps of intima in 5 of 10 resected specimens from the study group and in 2 of 6 from the control group.
Follow-up evaluation 1.1 ± 0.2 years after operation for the subjects and 0.6 ± 0.3 year for the control group documented similar mild residual gradients and normal systolic blood pressures in both groups. Thus, surgical repair appears to be safe and effective after unsuccessful balloon angioplasty of native coarctation.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(92)90496-A</identifier><identifier>PMID: 1531059</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Angioplasty, Balloon ; Aorta - pathology ; Aortic Coarctation - pathology ; Aortic Coarctation - surgery ; Aortic Coarctation - therapy ; Biological and medical sciences ; Child, Preschool ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Medical sciences ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart</subject><ispartof>Journal of the American College of Cardiology, 1992-02, Vol.19 (2), p.389-393</ispartof><rights>1992</rights><rights>1992 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-2295930fe69e8081534c92ed28b3f0572e0dff257a9c25f77ec3be8e53eac28b3</citedby><cites>FETCH-LOGICAL-c466t-2295930fe69e8081534c92ed28b3f0572e0dff257a9c25f77ec3be8e53eac28b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/073510979290496A$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5186113$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1531059$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Minich, L.Luann</creatorcontrib><creatorcontrib>Beekman, Robert H.</creatorcontrib><creatorcontrib>Rocchini, Albert P.</creatorcontrib><creatorcontrib>Heidelberger, Kathleen</creatorcontrib><creatorcontrib>Bove, Edward L.</creatorcontrib><title>Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Since 1985 balloon angioplasty, followed by surgical repair if angioplasty is unsuccessful, has been used as a treatment strategy for eligible children with discrete native coarctation of the aorta. Although balloon angioplasty has been successful in most patients, this strategy is appropriate only if surgery is safe and effective in children in whom angioplasty does not succeed. To address this issue, the surgical procedure and clinical outcome in 11 children who underwent surgery after unsuccessful balloon angioplasty (defined as a residual systolic gradient >20 mm Hg in 10 and a saccular aneurysm in 1) were evaluated. Data for subjects were compared with data for a control group of seven children who had surgical repair of a discrete coarctation without prior angioplasty during the same time period.
In the study group, balloon angioplasty was performed at 4.3 ± 1.2 years of age, resulting in a balloon/isthmus ratio of 0.98 ± 0.05 and decreasing mean peak systolic gradient from 54 ± 3 to 27 ± 2 mm Hg (p < 0.001). Follow-up angiography (n = 7) or nuclear magnetic resonance imaging (n = 4) documented a discrete residual stenosis in 10 patients and a small saccular aneurysm in 1. Collateral circulation decreased in three patients. The subsequent surgical procedure and its outcome were similar in the study and control groups. Chylothorax was the only complication, occurring in one child from each group. No paraplegia or mortality occurred. Pathologic examination revealed irregular intimal surfaces with small flaps of intima in 5 of 10 resected specimens from the study group and in 2 of 6 from the control group.
Follow-up evaluation 1.1 ± 0.2 years after operation for the subjects and 0.6 ± 0.3 year for the control group documented similar mild residual gradients and normal systolic blood pressures in both groups. Thus, surgical repair appears to be safe and effective after unsuccessful balloon angioplasty of native coarctation.</description><subject>Angioplasty, Balloon</subject><subject>Aorta - pathology</subject><subject>Aortic Coarctation - pathology</subject><subject>Aortic Coarctation - surgery</subject><subject>Aortic Coarctation - therapy</subject><subject>Biological and medical sciences</subject><subject>Child, Preschool</subject><subject>Evaluation Studies as Topic</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1992</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtKxDAUhoMoOl7eQCELEV1Uk7Rpmo0wiDcQXKjrkElPNNJpxpxW8O3NOIPuXOVyvv_n8BFyyNk5Z7y-YKqUBWdanWpxplml62K6QSZcyqYopVabZPKL7JBdxHfGWN1wvU22uSw5k3pC4tOYXoOzHU2wsCHRgBStB2r7loL34IbwmV9-gETHHkfnANGPHZ3Zrouxz-BriIvO4vBFo6e9_Qm4aJMb8j0T-Xd4yx0xDXafbHnbIRyszz3ycnP9fHVXPDze3l9NHwpX1fVQCKGlLpmHWkPDmrxu5bSAVjSz0jOpBLDWeyGV1U5IrxS4cgYNyBKsW0J75GTVu0jxYwQczDygg66zPcQRjRKqqZmuMlitQJciYgJvFinMbfoynJmlZ7OUaJYSjRbmx7OZ5tjRun-czaH9C63E5vnxem4x2_XJ9i7gLyZ5U3NeZuxyhUF28RkgGXQBegdtSFm9aWP4f49vUjubAg</recordid><startdate>19920201</startdate><enddate>19920201</enddate><creator>Minich, L.Luann</creator><creator>Beekman, Robert H.</creator><creator>Rocchini, Albert P.</creator><creator>Heidelberger, Kathleen</creator><creator>Bove, Edward L.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19920201</creationdate><title>Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta</title><author>Minich, L.Luann ; Beekman, Robert H. ; Rocchini, Albert P. ; Heidelberger, Kathleen ; Bove, Edward L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-2295930fe69e8081534c92ed28b3f0572e0dff257a9c25f77ec3be8e53eac28b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1992</creationdate><topic>Angioplasty, Balloon</topic><topic>Aorta - pathology</topic><topic>Aortic Coarctation - pathology</topic><topic>Aortic Coarctation - surgery</topic><topic>Aortic Coarctation - therapy</topic><topic>Biological and medical sciences</topic><topic>Child, Preschool</topic><topic>Evaluation Studies as Topic</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Minich, L.Luann</creatorcontrib><creatorcontrib>Beekman, Robert H.</creatorcontrib><creatorcontrib>Rocchini, Albert P.</creatorcontrib><creatorcontrib>Heidelberger, Kathleen</creatorcontrib><creatorcontrib>Bove, Edward L.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Minich, L.Luann</au><au>Beekman, Robert H.</au><au>Rocchini, Albert P.</au><au>Heidelberger, Kathleen</au><au>Bove, Edward L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1992-02-01</date><risdate>1992</risdate><volume>19</volume><issue>2</issue><spage>389</spage><epage>393</epage><pages>389-393</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Since 1985 balloon angioplasty, followed by surgical repair if angioplasty is unsuccessful, has been used as a treatment strategy for eligible children with discrete native coarctation of the aorta. Although balloon angioplasty has been successful in most patients, this strategy is appropriate only if surgery is safe and effective in children in whom angioplasty does not succeed. To address this issue, the surgical procedure and clinical outcome in 11 children who underwent surgery after unsuccessful balloon angioplasty (defined as a residual systolic gradient >20 mm Hg in 10 and a saccular aneurysm in 1) were evaluated. Data for subjects were compared with data for a control group of seven children who had surgical repair of a discrete coarctation without prior angioplasty during the same time period.
In the study group, balloon angioplasty was performed at 4.3 ± 1.2 years of age, resulting in a balloon/isthmus ratio of 0.98 ± 0.05 and decreasing mean peak systolic gradient from 54 ± 3 to 27 ± 2 mm Hg (p < 0.001). Follow-up angiography (n = 7) or nuclear magnetic resonance imaging (n = 4) documented a discrete residual stenosis in 10 patients and a small saccular aneurysm in 1. Collateral circulation decreased in three patients. The subsequent surgical procedure and its outcome were similar in the study and control groups. Chylothorax was the only complication, occurring in one child from each group. No paraplegia or mortality occurred. Pathologic examination revealed irregular intimal surfaces with small flaps of intima in 5 of 10 resected specimens from the study group and in 2 of 6 from the control group.
Follow-up evaluation 1.1 ± 0.2 years after operation for the subjects and 0.6 ± 0.3 year for the control group documented similar mild residual gradients and normal systolic blood pressures in both groups. Thus, surgical repair appears to be safe and effective after unsuccessful balloon angioplasty of native coarctation.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>1531059</pmid><doi>10.1016/0735-1097(92)90496-A</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Angioplasty, Balloon Aorta - pathology Aortic Coarctation - pathology Aortic Coarctation - surgery Aortic Coarctation - therapy Biological and medical sciences Child, Preschool Evaluation Studies as Topic Female Humans Male Medical sciences Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart |
| title | Surgical repair is safe and effective after unsuccessful balloon angioplasty of native coarctation of the aorta |
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