scholarly journals Coarctation: A Review

2020 ◽  
Vol 13 (2) ◽  
pp. 99-104
Author(s):  
Marc G Cribbs
Keyword(s):  
Congenital Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Surgical Repair ◽  
Treatment Options ◽  
Coarctation Of The Aorta ◽  
Late Complications ◽  
Transcatheter Therapy ◽  
Complex Defect

Coarctation of the aorta occurs in 0.04% of the population, and accounts for approximately 10% of lesions in adults with congenital heart disease. It can occur as an isolated lesion or as a part of a complex defect, and is most commonly associated with bicuspid aortic valve, ventricular septal defect, and mitral valve abnormalities. Since the first surgical repair in 1944, the available treatment options have expanded greatly. Perhaps one of the most important advances in the management of coarctation of the aorta has been the development of transcatheter therapy for both native and especially recurrent coarctation of the aorta. Late complications, even after apparently successful treatment, are not uncommon. For this reason, lifelong follow-up is vital.

Congenital heart disease in 37,294 births in Tunisia: birth prevalence and mortality rate

2013 ◽  
Vol 24 (5) ◽  
pp. 866-871 ◽  
Author(s):  
Dorra Abid ◽  
Anis Elloumi ◽  
Leila Abid ◽  
Souad Mallek ◽  
Hajer Aloulou ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
Coarctation Of The Aorta ◽  
Ventricular Septal Defects ◽  
Birth Prevalence ◽  
Septal Defects

AbstractAim: To investigate the previously unknown birth incidence, treatment, and mortality of children with congenital heart disease in Tunisia. Methods: We undertook a retrospective review of medical records of all patients who were born in 2010 and 2011, and were diagnosed in Sfax (Tunisia) with congenital heart defect. Results: Among 37,294 births, 255 children were detected to have congenital heart disease, yielding a birth incidence of 6.8 per 1000. The most frequently occurring conditions were ventricular septal defects (31%), ostium secundum atrial septal defects (12.9%), and pulmonary valve abnormalities (12%). Coarctation of the aorta, tetralogy of Fallot, univentricular physiology, pulmonary atresia with ventricular septal defect, and transposition of the great arteries were found in 4.3%, 6.2%, 3.4%, 2.7%, and 2.7%, respectively. During the follow-up of 1 year, 23% of the children died. About three-quarters of those deaths happened before surgery. Conclusion: The present study is in line with the general estimates in the world. It has revealed a high case of mortality among the patients awaiting corrective surgery. These children need more facilities.

Perioperative and Anesthetic Management of Coarctation of the Aorta

2019 ◽  
Vol 23 (2) ◽  
pp. 212-224 ◽  
Author(s):  
Eric B. Fox ◽  
Gregory J. Latham ◽  
Faith J. Ross ◽  
Denise Joffe
Keyword(s):  
Congenital Heart Disease ◽  
Congenital Heart ◽  
Interventional Procedures ◽  
Clinical Presentation ◽  
Surgical Repair ◽  
Anesthetic Management ◽  
Treatment Options ◽  
Balloon Dilation ◽  
Coarctation Of The Aorta ◽  
Interventional Therapy

Isolated coarctation of the aorta is a relatively common form of congenital heart disease that is characterized by variable degrees of obstruction to aortic outflow. The clinical presentation varies from asymptomatic arterial hypertension to cardiogenic shock. The treatment options include surgical repair or interventional therapy with aortic balloon dilation and stent placement. This article will summarize the pathophysiology as well as describe the surgical and interventional procedures. The anesthetic management for those interventions will be reviewed.

scholarly journals Stenting of modified Blalock–Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-4
Author(s):  
Julia Illner ◽  
Holger Reinecke ◽  
Helmut Baumgartner ◽  
Gerrit Kaleschke
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Congenital Heart ◽  
Septal Defect ◽  
Pulmonary Atresia ◽  
Complex Congenital Heart Disease ◽  
Bare Metal

Abstract Background Adults with complex congenital heart disease palliated with systemic-to-pulmonary artery shunts have become rare and represent a particularly challenging patient group for the cardiologist. One of the complications and causes of severe clinical deterioration during long-term follow-up are progressive obstruction or total occlusion of the shunt. The risk for surgical intervention is frequently high and catheter intervention may be complicated by complex anatomy and shunt calcification. Case summary We report the case of a 47-year-old man with uncorrected (palliated) pulmonary atresia and ventricular septal defect who presented with progressive cyanosis (oxygen saturation 69%) and decreasing exercise capacity. Computed tomography revealed a totally occluded modified left Blalock–Taussig (BT) shunt and a severely stenosed central shunt (Waterston–Cooley) in a patient with confluent but hypoplastic pulmonary arteries and multiple major aortic pulmonary collaterals. Due to a high operative risk, an interventional, percutaneous approach was preferred to re-do surgery. From a radial access the calcified BT shunt could be crossed with a hydrophilic guidewire. Then, a rotational thrombectomy, balloon dilatation, and bare-metal stenting at the proximal and distal anastomoses were performed. Post-interventionally, peripheral oxygen saturation increased from 69% to 82%. Clopidogrel was administered for 1 month after bare-metal stenting. At 1-year follow-up, the BT shunt was still patent on echocardiography and exercise tolerance markedly improved. Discussion This case highlights the benefit of percutaneous rotational thrombectomy followed by stenting of chronically occluded systemic-to-pulmonary artery shunts for further palliation in adult patients with complex congenital heart disease not suitable for surgical repair.

scholarly journals Implantable cardioverter defibrillators in adult congenital heart disease: long-term follow up of therapies, complications and clinical events

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Ferreira ◽  
M Cruz Coutinho ◽  
G Portugal ◽  
P Silva Cunha ◽  
B Valente ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Primary Prevention ◽  
Congenital Heart ◽  
Septal Defect ◽  
Long Term Outcomes ◽  
Icd Implantation ◽  
Heart Defect

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Adults with congenital heart disease (ACHD) at increased risk for sudden cardiac death (SCD) often undergo implantable cardioverter defibrillator (ICD) implantation at young ages. Data evaluating the long-term outcomes of ICD in this population remain scarce. We aimed to characterize the population with ACHD and an ICD. Methods Consecutive ACHD submitted to an ICD implantation in a single tertiary center were evaluated. Data on baseline clinical features, heart defect, indication for ICD, type of device, ICD-related complication and therapies and mortality during follow-up were collected. Results A total of 34 patients (P) were evaluated. Median age at implant was 39.3 years (interquartile range [IQR] 29-5-53.6) and median left ventricular ejection fraction (LVEF) was 43.5% (IQR 28.0-53.3). The most common heart defect was tetralogy of Fallot (11P;32,3%), followed by dextro-transposition of the great arteries, ostium secundum atrial septal defect (ASD) and ventricular septal defect (Figure 1). All P were submitted to surgical correction (median age at surgery 12.5 years [IQR 3.0-29.1]). Sixteen P underwent ICD implantation for primary prevention of SCD, owing to complex cardiopathy and ventricular dysfunction, and 18P due to spontaneous ventricular tachyarrhythmias. The implantable devices were a single-chamber ICD in 55.9%, a double-chamber ICD in 17.6%, a subcutaneous ICD in 20.6% and a CRT-D in 5.9%. During a median follow-up of 4.5 years (IQR 2.1-8.8), 52.9% of the P received appropriate ICD therapies, corresponding to 37.5% and 66.7% of primary and secondary prevention P, respectively. Median time to first arrhythmic event was 25.3 months (IQR 13.7-52.9). Six P (17.6%) suffered ICD-related complications and 20.6% received inappropriate therapies due to supraventricular tachyarrhythmias. During follow-up, 8.8% were submitted to heart transplant and 29.4% died (Table 1).  ICD therapies were associated with a composite of death, cardiac transplantation and hospital admission (OR 5.0, 95% CI 1.0-24.3). Conclusion ACHD with ICD experience high rate of appropriate therapies, including those implanted for primary prevention. The long-term burden of ICD-related complications and inappropriate shocks underlines the need for careful risk stratification and close monitoring. The increased survival of this population justifies collecting data on long-term outcomes to improve its care. Abstract Figure.

scholarly journals Surgical repair of perimembranous ventricular septal defect and aortic regurgitation in an adult patient with Laubry-Pezzi syndrome.

2020 ◽  
pp. 15-17
Keyword(s):  
Congenital Heart Disease ◽  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Congenital Heart ◽  
Septal Defect ◽  
Surgical Repair ◽  
Aortic Valve Insufficiency ◽  
Perimembranous Ventricular Septal Defect ◽  
Venturi Effect ◽  
Valve Insufficiency

Laubry-Pezzi syndrome is a congenital heart disease that consist in a prolapse of aortic valve cusping into a subjacent ventricular septal defect due to Venturi effect. It results in progressive aortic valve insufficiency. The perimembranous type is the most common due to the proximity of the aortic annulus to such defects. The aim of this report is to highlight the specificity of the diagnosis and the surgical management of this syndrome in adult patients.

Cardiovascular

2019 ◽  
pp. 1-34
Author(s):  
Tanya M. Monaghan ◽  
James D. Thomas
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Valve Disease ◽  
Prosthetic Valves

This chapter is about cardiovascular medicine, and covers mitral regurgitation, mitral stenosis, aortic regurgitation, aortic stenosis, mixed mitral valve disease, mixed aortic valve disease, tricuspid regurgitation, prosthetic valves, ventricular septal defect, atrial septal defect, hypertrophic cardiomyopathy, coarctation of the aorta, persistent ductus arteriosus, Fallot’s tetralogy, dextrocardia, infective endocarditis, and congenital heart disease diagrams.

Iodinated Contrast Media in Pediatric Cardiac Angiography Nephrotoxic risk evaluation

2018 ◽  
Vol 69 (2) ◽  
pp. 511-514
Author(s):  
Eliza Cinteza ◽  
Mihaela Balgradean ◽  
Cristina Filip ◽  
Gabriela Duica ◽  
Georgiana Nicolae ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Contrast Media ◽  
Contrast Agents ◽  
Congenital Heart ◽  
Septal Defect ◽  
Coarctation Of The Aorta ◽  
Iodinated Contrast ◽  
Asd Closure ◽  
Average Consumption

Contrast agents are among the most frequently used drugs in medical practice. The aim of our study was to evaluate the incidence of complications associated with the use of different contrast agents in an angiography lab dedicated to pediatric patients with congenital heart disease. Between June 2015 and December 2017, 166 patients with congenital heart disease were diagnosed and/or treated in the angiography lab. Of these patients, 38 were excluded because they did not require contrast substance administration. As interventional procedures we performed pulmonary valvular dilatation in 17 cases (10.2%), stent implantation in coarctation of the aorta in 9 cases (5.4%), PDA closure in 62 cases (37.3%), atrial septal defect (ASD) closure in 36 patients (including patients without contrast agent�s administration) (21.7%). In the group of 129 patients who received contrast agents, the median age was 5.8 years (range 0.1-19 years) and median weight 22.8 kg (range 2.8-72 kg). Average consumption of contrast media per procedure was 79 ml/procedure (range 5 - 400 mL) and 4.3 mL/kg (range 0.4 - 22.7). We used iomeprol (24%), iohexol (8.5%), iopromide (67.4%). No contrast related complications are reported in this group. In conclusion, the contrast agents we used seem to be safe and are not associated with renal complications.

The usefulness of brain natriuretic peptide in simple congenital heart disease – a systematic review

2012 ◽  
Vol 23 (3) ◽  
pp. 315-324 ◽  
Author(s):  
Jannet A. Eindhoven ◽  
Annemien E. van den Bosch ◽  
Eric Boersma ◽  
Jolien W. Roos-Hesselink
Keyword(s):  
Systematic Review ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Septal Defect ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Prognostic Value ◽  
Congenital Heart ◽  
Septal Defect

AbstractBrain natriuretic peptide and N-terminal pro-brain natriuretic peptide are two well-established markers for cardiac failure in acquired heart disease. Nevertheless, the clinical utility of these markers in patients with congenital heart disease remains unclear. Therefore, the aim of this study was to evaluate the diagnostic and prognostic value of these markers in patients with congenital heart disease. A PubMed and EMBASE literature search was executed with focus on the most common simple congenital heart defects, atrial septal defect and ventricular septal defect. Data on brain natriuretic peptide measurement, cardiac function parameters, and follow-up were collected. In patients with atrial or ventricular septal defect, brain natriuretic peptide levels were mildly increased when compared with healthy age-matched controls. Shunt severity and pulmonary artery pressure correlated strongly with natriuretic peptide levels. A clear association between brain natriuretic peptide and functional class was demonstrated. After closure of the defect, a rise in brain natriuretic peptide levels in the first hours to days was observed. After longer follow-up, natriuretic peptide levels decreased and became comparable to pre-procedural values. In conclusion, this systematic review shows that brain natriuretic peptide levels are mildly increased in patients with unrepaired and repaired atrial or ventricular septal defect. Brain natriuretic peptide measurement might be a useful additional tool in the diagnostic work-up of patients with atrial or ventricular septal defect. Further investigation in a larger, prospective study with long-term follow-up is warranted to elucidate the true prognostic value of natriuretic peptides in patients with simple congenital heart disease.

scholarly journals Arrhythmias and Conduction Abnormalities after Surgical Repair of Congenital Heart Disease

2021 ◽  
pp. 30-35
Author(s):  
Mohanad Abdulhadi Saleh Lawgali ◽  
Marium Mohamed Mustafa ◽  
Rasmia H. Feituri ◽  
Faiaz Ragab Salem Halies
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Fontan Operation ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Cyanotic Congenital Heart Disease ◽  
Conduction Abnormalities

Aims: To recognize cardiac arrhythmias and conduction abnormalities in children who underwent a surgical repair for congenital heart disease. Patients and Methods: One hundred thirty one (131) patients underwent a surgical repair of congenital heart disease between 2000-2018, and follow-up period after surgery was from two months to eighteen years and our data was collected over 1 year “2018”  by interview both children and parents, sixty-four patients (48.8%) were a cyanotic congenital heart disease (ACCHD),sixty-seven patients(51.1%) were cyanotic congenital heart disease (CCHD), (41.9%) were female, (58.1%) were male. Cyanotic congenital heart disease more common in male. These patients were evaluated by ECG to detect conduction abnormalities and arrhythmias, Holter monitoring in symptomatic patient. Results: Types of abnormal heart rhythm found out by ECG, Holter monitoring, significant premature atrial contraction (PAC) in one patient post fontain, atrial fibrillation in two patients with post-operative (ASD) repaired. RBBB occur in 53 patients and was most common among post-operative (TOF) repaired (37 patients). Frequent ventricular ectopic in one patient with postoperative (TOF) repaired. Atrial tachycardia in one patient with Epstein anomaly, WPW in two patients with Epstein anomaly, complete heart blook in five patients, four of them post operative VSD repaired, one post fontain operation. Symptomatic bradycardia needs pace maker in one patient post fontan operation. Conclusions: The Patient after repair of congenital heart defect needed follow-up for detection of arrhythmias, those with complex defect need more frequent follow-up because they prone more to arrhythmia than those with simple defect with no residual defect. 

Pulmonary Valve Endocarditis in a Corrected Tetralogy of Fallot

2021 ◽  
Author(s):  
Valentina Scheggi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Tetralogy Of Fallot ◽  
Congenital Heart ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Pulmonary Valve Replacement ◽  
Late Complications ◽  
Tract Infections

Tetralogy of Fallot is the most common cyanotic congenital heart disease. In the last decades, the number of adults with surgically corrected defects is increasing and we have to face with late complications. Echocardiography has a central role in the early diagnosis of these conditions. We report the case of a 31-year-old man, treated during childhood with surgical repair of the ventricular septal defect, ventricular right outflow plasty, and pulmonary valve commissurotomy. At the age of 30 years, the patient underwent a second surgical intervention (aortic root replacement and pulmonary bioprosthesis implantation). He was also affected by urethral stenosis and complained of relapsing urinary tract infections. At the admission to our department, he reported remittent fever ensued one month before. We performed a third surgical intervention (aortic and pulmonary valve replacement) after diagnosing Steptococcusagalactiae endocarditis involving the pulmonary prosthesis and the native aortic valve. In conclusion, echocardiographic follow-up and prevention of infection are the mainstays to improve the outcome of corrected congenital heart disease.

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