Share this Article
Ang HL, Lim CW, Hia C, Yip J, Quek SC
Correspondence: Dr Quek Swee Chye, swee _chye _quek@nuhs.edu.sg
ABSTRACT
INTRODUCTION Coarctation of the aorta (CoA) accounts for 5%–8% of all congenital heart defects. If left untreated, most patients with significant CoA will have varying degrees of morbidity (e.g. hypertension, stroke, collateral formation and ventricular hypertrophy), possibly even mortality. Traditionally, treatment for this condition is surgical. Herein, we report stenting during catheterisation as an alternative nonsurgical treatment option for patients with CoA, and present the treatment outcomes of patients who underwent this treatment option.
METHODS We retrospectively reviewed four patients (2 men and 2 women; age range 20–41 years) who underwent CoA stenting under general anaesthesia for the treatment of native CoA or restenosis of CoA at our institution. Three patients had a 40-mm Palmaz stent inserted, while one had a 39-mm Cheatham-Platinum covered stent inserted. Angiography and measurement of pressure gradients were performed before and after stent implantation to ensure good treatment outcomes.
RESULTS The patients’ treatment outcomes were good, with a significant reduction in pressure gradients across the narrowed segments. Angiography showed relief of CoA. The patients were followed up for 1–3 years, during which no complications were noted.
CONCLUSION This is the first reported series in Singapore on the nonsurgical treatment of CoAs in adult patients using stents during interventional cardiac catheterisation. This less invasive procedure may lead to a new paradigm shift with regard to the treatment of CoA.
Keywords: angiogram, aortic coarctation, cardiac catheterisation, pressure gradients, stent
Singapore Med J 2014; 55(6): 302-304; http://dx.doi.org/10.11622/smedj.2014080
REFERENCES
| 1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890-900. http://dx.doi.org/10.1016/S0735-1097(02)01886-7 | ||||
| 2. Campbell M. Natural history of coarctation of the aorta. Br Heart J 1970; 32:633-40.3. | ||||
| 3. Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 1945; 14:347-61. | ||||
| 4. Harrison DA, McLaughlin PR, Lazzam C, Connelly M, Benson LN. Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up. Heart 2001; 85:561-6. http://dx.doi.org/10.1136/heart.85.5.561 | ||||
| 5. Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 2001; 38:1518-23. http://dx.doi.org/10.1016/S0735-1097(01)01572-8 | ||||
| 6. De Lezo JS, Sancho M, Pan M, et al. Angiographic follow-up after balloon angioplasty for coarctation of the aorta. J Am Coll Cardiol 1989; 13:689-95. http://dx.doi.org/10.1016/0735-1097(89)90612-8 | ||||
| 7. Rico J, Sobrino N, Calvo L, et al. [Percutaneous transluminal angioplasty in aortic coarctation in young adults]. Rev Esp Cardiol 1989; 42: 415-7. Spanish. | ||||
| 8. Kulick DL, Kotlewski A, Hurvitz RJ, Jamison M, Rahimtoola SH. Aortic rupture following percutaneous catheter balloon coarctoplasty in an adult. Am Heart J 1990; 119:190-3. http://dx.doi.org/10.1016/S0002-8703(05)80101-2 | ||||
| 9. Fawzy ME, Sivanandam V, Galal O, et al. One- to ten-year follow-up results of balloon angioplasty of native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol 1997; 30:1542-6. http://dx.doi.org/10.1016/S0735-1097(97)00350-1 | ||||
| 10. Phadke K, Dyet JF, Aber CP, Hartley W. Balloon angioplasty of adult aortic coarctation. Br Heart J 1993; 69:36-40. http://dx.doi.org/10.1136/hrt.69.1.36 | ||||
| 11. Fletcher SE, Nihill MR, Grifka RG, O'Laughlin MP, Mullins CE. Balloon angioplasty of native coarctation of the aorta: midterm follow-up and prognostic factors. J Am Coll Cardiol 1995; 25:730-4. http://dx.doi.org/10.1016/0735-1097(94)00437-U | ||||
| 12. Schräder R, Bussmann WD, Jacobi V, Kadel C. Long-term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients. Cathet Cardiovasc Diagn 1995; 36:220-5. http://dx.doi.org/10.1002/ccd.1810360306 | ||||
| 13. Biswas PK, Mitra K, De S, et al. Follow-up results of balloon angioplasty for native coarctation of aorta. Indian Heart J 1996; 48:673-6. | ||||
| 14. Eicken A, Pensl U, Sebening W, et al. The fate of systemic blood pressure in patients after effectively stented coarctation. Eur Heart J 2006; 27:1100-5. http://dx.doi.org/10.1093/eurheartj/ehi748 | ||||
| 15. Musto C, Cifarelli A, Pucci E, et al. Endovascular treatment of aortic coarctation: long-term ef fects on hypertension. Int J Cardiol 2008; 130:420-5. http://dx.doi.org/10.1016/j.ijcard.2007.08.130 | ||||
| 16. Macdonald S, Thomas SM, Cleveland TJ, Gaines PA. Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade. Cardiovasc Intervent Radiol 2003; 26:357-64. http://dx.doi.org/10.1007/s00270-003-2709-7 | ||||
| 17. Forbes TJ, Garekar S, Amin Z, et al. Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter Cardiovasc Interv 2007; 70:276-85. http://dx.doi.org/10.1002/ccd.21164 | ||||
| 18. Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv 2007; 69:289-99. http://dx.doi.org/10.1002/ccd.21009 | ||||
| 19. Moltzer E, Roos-Hesselink JW, Yap SC, et al. Endovascular stenting for aortic (re)coarctation in adults. Neth Heart J 2010; 18:430-6. http://dx.doi.org/10.1007/BF03091810 | ||||
| 20. 20. Mahadevan VS, Vondermuhll IF, Mullen MJ. Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes. Catheter Cardiovasc Interv 2006; 67:268-75. http://dx.doi.org/10.1002/ccd.20585 | ||||
| 21. Tanous D, Collins N, Dehghani P, Horlick EM, Benson LN. Covered stents in the management of coarctation of the aorta in the adult: initial results and 1-year angiographic and hemodynamic follow-up. Int J Cardiol 2010; 140:287-95. http://dx.doi.org/10.1016/j.ijcard.2008.11.085 | ||||
| 22. Chessa M, Carrozza M, Butera G, et al. Results and mid-long-term follow-up of stent implantation for native and recurrent coarctation of the aorta. Eur Heart J 2005; 26:2728-32. http://dx.doi.org/10.1093/eurheartj/ehi491 | ||||
| 23. Egan M, Holzer RJ. Comparing balloon angioplasty, stenting and surgery in the treatment of aortic coarctation. Expert Rev Cardiovasc Ther 2009; 7:1401-12. http://dx.doi.org/10.1586/erc.09.111 | ||||
| 24. Qureshi AM, McElhinney DB, Lock JE, et al. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years' experience of implanting stents to treat aortic coarctation. Cardiol Young 2007; 17:307-18. http://dx.doi.org/10.1017/S1047951107000339 | ||||
| 25. Chen SS, Donald AE, Storry C, et al. Impact of aor tic stenting on peripheral vascular function and daytime systolic blood pressure in adult coarctation. Heart 2008; 94:919-24. http://dx.doi.org/10.1136/hrt.2006.109389 | ||||
| 26. Karl TR. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med (Hagerstown) 2007; 8:50-6. http://dx.doi.org/10.2459/01.JCM.0000247436.05194.c7 | ||||