scholarly journals Extra-Anatomical Bypass: A Surgical Option for Recurrent Aortic Coarctation

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Alban Malaj ◽  
Ombretta Martinelli ◽  
Francesco Giosue' Irace ◽  
Jihad Jabbour ◽  
Bruno Gossetti ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Aortic Coarctation ◽  
Open Surgery ◽  
Median Sternotomy ◽  
Systolic Pressure ◽  
Systemic Hypertension ◽  
Aortic Reconstruction ◽  
Safe Alternative ◽  
Descending Aorta ◽  
Systolic Pressure Gradient

Background. Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. However, in patients with previous small size tube graft, an open surgical correction is mandatory and, in most cases, an anatomical aortic reconstruction is carried out.Methods. We present the case of a 48-year-old woman with recurrent aortic coarctation and systemic hypertension with systolic value around 190–200 mmHg and preoperative systolic pressure gradient 70 mmHg, submitted to an extra-anatomical bypass. Through a median sternotomy, an extra-anatomical bypass from ascending to descending aorta was performed.Results. No intra- or postoperative complications were observed. The postoperative pressure gradient was 10 mmHg and the systolic pressure ranged from 130 to 140 mmHg.Conclusion. The extra-anatomical bypass can be considered an effective and safe alternative to the anatomical aortic reconstruction in the cases with recurrent aortic coarctation unfit for endovascular treatment.

scholarly journals Stenosis of a Reconstructed Aorta Caused a Paradoxical Diastolic Pressure Gradient after Norwood Operation

2012 ◽  
Vol 6 ◽  
pp. CMC.S9789 ◽  
Author(s):  
Satoshi Masutani ◽  
Hirofumi Saiki ◽  
Hirotaka Ishido ◽  
Hideaki Senzaki
Keyword(s):  
Pressure Gradient ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Aortic Pressure ◽  
Ascending Aorta ◽  
Ventricular Ejection ◽  
Norwood Operation ◽  
Descending Aorta ◽  
The Difference ◽  
Systolic Pressure Gradient

An infant with hypoplastic left heart syndrome showed paroxysmal episodes of bradycardia, hypotension, and hypoxemia upon crying after modified Norwood operation. Echocardiography showed decreased right ventricular ejection with grade III tricuspid regurgitation, a markedly enlarged aortic arch, and accelerated blood flow distal to the enlarged aorta. Aortography demonstrated an aneurysmal neo-aorta with an apple-shaped appearance. The pressure measurements revealed intriguing aortic hemodynamics: the diastolic pressure of the ascending aorta was lower than that of the descending aorta (42 mmHg vs. 52 mmHg) despite no systolic pressure gradient. Markedly reduced compliance in the ascending aorta relative to that in the descending aorta, which was suggested by the difference in time constant of aortic pressure decay, may explain this hemodynamics. Impaired coronary circulation caused by lowered diastolic pressure in ascending aorta was indicated by reduced subendocardial viability ratio, and may account for her symptom and lowered ventricular ejection. The patient's condition was indeed significantly improved by surgical correction of the aortic shape. This case highlights the importance of aortic shape and properties after Norwood operation.

scholarly journals Balloon Angioplasty for Native Aortic Coarctation in 3- to 12-Month-Old Infants

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Juan Pablo Sandoval ◽  
Sok-Leng Kang ◽  
Kyong-Jin Lee ◽  
Lee Benson ◽  
Kentaro Asoh ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Balloon Angioplasty ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Aortic Aneurysms ◽  
Older Children ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Systolic Pressure Gradient ◽  
Lost To Follow Up

Background: Balloon angioplasty for native coarctation of the aorta (CoA) is successful in children and adults but in neonates results in frequent restenosis. The efficacy of balloon angioplasty for native CoA during infancy beyond the neonatal period was examined in infants aged 3 to 12 months of age. Methods: A retrospective review of 68 infants who underwent balloon angioplasty for native CoA. 95% CI are in parentheses. Results: Procedural age was (mean±SD) 6±3.4 months and weight was 7±1.8 kg. Balloon angioplasty produced a large decrease in both the noninvasive arm-to-leg blood pressure gradient (41.2±18.7 to 5.6±9.6 mm Hg) and the invasive peak systolic pressure gradient (34±12 to 11±9 mm Hg). Balloon angioplasty increased the CoA diameter from 2.7±1 mm to 4.6±1.2 mm. One patient was lost to follow-up. A catheter reintervention was required in 11.8% and surgery in 10.3%. The hazard of reintervention was highest early. Median freedom from reintervention was 89% (95% CI, 80%–96%) at 1 year, 83% (95% CI, 73%–92%) at 5 years, and 81% (95% CI, 69%–90%) at 10 years. Femoral artery thrombosis was documented in 6 (9%) infants without any long-term consequence. One patient developed a small aortic aneurysm late and has not required treatment. A robust estimate of the frequency of aortic aneurysms remains to be determined as the majority of subjects have not had cross-sectional imaging. Conclusions: Balloon angioplasty of native CoA is effective and safe in infants aged 3 to 12 months with outcomes comparable to those in older children and adults. Catheter reinterventions can avoid the need for surgery in most patients.

Systolic pressure gradients across the aortic valve and in the ascending aorta

1965 ◽  
Vol 209 (3) ◽  
pp. 557-563 ◽  
Author(s):  
Thomas E. Driscol ◽  
Richard W. Eckstein
Keyword(s):  
Aortic Valve ◽  
Pressure Gradient ◽  
Systolic Pressure ◽  
Left Ventricular Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Maximum Pressure ◽  
Early Systole ◽  
Systolic Pressure Gradient

Left ventricular and aortic pressure pulses and the pressure gradient across the aortic valve were recorded in anesthetized and unanesthetized dogs. Aortic pressure recorded immediately above the valve increased 5–15 msec before it was exceeded by left ventricular pressure. The maximum systolic pressure gradient occurred in early systole and remained positive throughout the ejection period. When aortic pressure was recorded 1–3 cm distal to the valve, these pressure pulse relationships were altered so that 1) the rise in aortic pressure was delayed, 2) the early systolic maximum pressure gradient was increased, and 3) aortic pressure exceeded ventricular pressure during the latter half of systole. The changes in early systole are due to a delay in the pulse wave reaching the more distal recording site. The mean systolic pressure gradient between two sites within the ascend-ing aorta was found to be negative, i.e., opposite to the direction of forward flow. The negative pressure gradient probably accounts for the reversal of the transvalvular pressure gradient in late systole when aortic pressure was recorded distal to the valve.

THE BRACHIAL TO DIGITAL BLOOD PRESSURE GRADIENT IN NORMAL SUBJECTS AND IN PATIENTS WITH HIGH BLOOD PRESSURE

1958 ◽  
Vol 36 (9) ◽  
pp. 889-893 ◽  
Author(s):  
P. Gaskell ◽  
A. M. Krisman
Keyword(s):  
Blood Pressure ◽  
Pressure Gradient ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Normal Subjects ◽  
Normal Blood ◽  
Control Group ◽  
Normal Blood Pressure ◽  
Hypertensive Patients ◽  
Systolic Pressure Gradient

The brachial and digital blood pressures were estimated by auscultatory techniques in 10 patients with essential hypertension and in a group of 6 subjects with normal blood pressure who were in a state of regulated peripheral vasoconstriction and again when they were in a state of regulated vasodilatation. The brachial to digital systolic and diastolic pressure gradients in both control subjects and hypertensive patients were greater when the individuals were heated than when they were cooled. The brachial to digital diastolic pressure gradient in the hypertensive patients was not significantly different from that in the subjects with normal blood pressure. However, the systolic pressure gradient was greater in the hypertensive patients than in the control group both when the individuals were heated and when they were cooled.

scholarly journals 4D FLOW Magnetic Resonance Imaging in the Study of Blood Flow in Patients With Aortic Coarctation in the Long-Term After Surgery

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 54-64
Author(s):  
L. A. Yurpolskaya ◽  
M. A. Shlyappo ◽  
V. N. Makarenko ◽  
A. A. Svobodov ◽  
E. G. Levchenko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pressure Gradient ◽  
Blood Vessels ◽  
Thoracic Aorta ◽  
Aortic Coarctation ◽  
Comprehensive Evaluation ◽  
Mr Images ◽  
4D Flow ◽  
Descending Aorta

Aim      Comprehensive evaluation of blood flow in the thoracic aorta using a software for 4D processing of magnetic resonance (MR) images of the heart and blood vessels (4D Flow) in patients with aortic coarctation in the late postoperative period.Materials and methods The MR study of the heart was performed for 10 patients (7 boys and 3 girls) aged 8 to 13 years (median, 9.5 [8.3; 10.8] years) who underwent resection with end-to-end anastomosis for aortic coarctation at age of 2 weeks to 10 months. MR tomography was performed on a 1.5 T MR scanner using a multichannel surface coil for scanning, electrocardiographic synchronization, and a specialized package of pulse sequences for scanning of the heart. Blood flow was evaluated with a 4D data handling software for processing of MR images of heart and blood vessels (4D Flow). The following blood flow parameters were analyzed: blood flow volume per second, peak blood flow velocity, peak and minimum blood flow area at the levels of ascending aorta, arch, isthmus, and descending aorta, and pressure gradient at the level of maximum narrowing of the aorta. 3D-MR images were used for evaluation of aortic geometry. Blood flow formation, distribution, and trajectories were analyzed by maps of vectors, particle trace, and stream lines. Statistical analysis was performed with a Statistica (v. 6.0 StatSoft Inc.) package.Results Accelerated flow in the region of residual aortic stenosis in systole was observed in all patients; 4 patients had an additional vortex flow below the aortic stenosis and a spiral flow in the descending aorta. The pressure gradient on the aortic isthmus was directly correlated with the left ventricular myocardial mass index (r=0.65; р=0.04) and indexes of blood flow in the ascending and descending aorta (р=0.03; р=0.026). No significant correlation was found for blood flow indexes and geometry of the aortic arch (H / L). Delayed contrast enhancement MR imaging did not detect any fibrotic changes in the myocardium in only one patient. The fibrosis severity inversely correlated with the right ventricular ejection fraction (r=0.65; р=0.04) and directly correlated with the pressure gradient at the aortic isthmus (r=0.63; p=0.05).Conclusion      The 4D MR image processing software for the heart and blood vessels allows studying the blood flow in detail under natural conditions, provides potential advantages in comprehensive evaluation of patients with aortic coarctation during a dynamic follow-up. For a definitive conclusion about the relationship between the altered blood flow in the thoracic aorta and markers of residual, post-correction pathology, larger studies are required as well as long-term follow-up of patients with documented pathological patterns of blood flow (changes in blood flow velocity and volume throughout the entire thoracic aorta in combination with disorders in the normal flow geometry during the cardiac cycle).  

Electrocardiographic estimate of peak systolic pressure gradient in children with aortic stenosis

1985 ◽  
Vol 18 (3) ◽  
pp. 203-210
Author(s):  
Michael S. Shaffer ◽  
Rodney S. Fowler ◽  
Paul Corey ◽  
Cathy Steele ◽  
Michael L. Rigby ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Pressure Gradient ◽  
Systolic Pressure ◽  
Systolic Pressure Gradient
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