Document Detail


Correction of coarctation of aorta in adult patients--impact of corrective procedure on long-term recoarctation and systolic hypertension.
MedLine Citation:
PMID:  18278682     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Uncorrected coarctation of the aorta in adults predisposes to congestive failure, aortic rupture, stroke and endocarditis. Surgical correction of this condition is fraught with technical difficulties due to the complexity of the lesion, associated anomalies and extensive collaterals. The optimal surgical technique has not yet been well defined in adults. We describe our experience with adult coarctation and the long-term outcome with regard to recoarctation and systolic hypertension. MATERIALS AND METHODS: A consecutive series of 54 patients above the age of 12 years who underwent coarctation correction over a period of 8 years are included in this report. Eight patients underwent balloon angioplasty, one of whom also had stent placement. Forty-eight patients underwent surgical intervention. Twenty-seven patients underwent resection and anastomosis, 6 had patch angioplasty and 13 had a prosthetic graft repair. All patients were followed up at 3 months and then annually to look for recoarctation, regression of hypertension and aneurysm formation. RESULTS: There was no mortality in this series; major morbidities included reoperation for bleeding in 3 patients, pulmonary complications and paraplegia in 1 patient. Hypertension was well controlled in all patients at discharge. Follow-up is 100 % complete and mean follow-up was 4.6 years. There was one case of aortic dissection and one case of aneurysm formation in the balloon angioplasty group. There was a statistical trend towards increased rates of recoarctation in the balloon and resection and anastomosis groups. 32 % of patients were off antihypertensive medications at their last follow-up. CONCLUSIONS: Surgical correction of coarctation of aorta in adults can be achieved with an acceptable morbidity. A variety of options are available for the surgical management of coarctation of the aorta in adults. Prosthetic graft and patch repair are associated with good short and long-term results. Use of balloon angioplasty without stenting as the primary therapy requires further clarification. Hypertension is well controlled in most patients.
Authors:
R Duara; S Theodore; P S Sarma; M Unnikrishnan; K S Neelakandhan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  56     ISSN:  0171-6425     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-18     Completed Date:  2008-06-11     Revised Date:  2008-12-18    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  83-6     Citation Subset:  IM    
Affiliation:
CVTS, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India. rajnishduara@rediffmail.com <rajnishduara@rediffmail.com>
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Angioplasty, Balloon
Aortic Coarctation / complications,  surgery*,  therapy
Cardiac Surgical Procedures*
Female
Humans
Hypertension / etiology
Male
Recurrence
Thoracotomy
Treatment Outcome
Comments/Corrections
Comment In:
Thorac Cardiovasc Surg. 2008 Sep;56(6):378   [PMID:  18704867 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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