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Pediatric Cardiology

, Volume 38, Issue 5, pp 1016–1023 | Cite as

Clinical Impact of Stent Implantation for Coarctation of the Aorta with Associated Hypoplasia of the Transverse Aortic Arch

  • W. H. Lu
  • Chun-Po Steve Fan
  • Rajiv Chaturvedi
  • Kyong-Jin Lee
  • Cedric Manlhiot
  • Lee Benson
Original Article

Abstract

The aim of this study was to explore the clinical impact of transverse aortic arch hypoplasia (TAH) after stent implementation for isthmal coarctation of the aorta (CoA). From a retrospective chart review, 51 children (median age 11.1 years) were identified who had TAH and a CoA stent implanted between 10/1995 and 4/2015. Arm–leg cuff blood pressure measurements, echocardiographic arch imaging, and 24-h ambulatory blood pressure monitoring, prior to and after stent implantation, were reviewed. At catheterization, peak systolic gradients across the CoA’s were 25 mmHg before and 4 mmHg after stent implantation. At a median 37-month follow-up, echocardiographic imaging showed no significant catch-up growth in the transverse arch (median z-score; proximal and distal arch −1.54 and −1.99 vs. −1.78 and −1.63, p = 0.13 and 0.90). A trend to increasing systolic blood pressure (SBP) differentials between the right and left arms was noted (11 mmHg [prior to]; 16 mmHg [follow-up], p = 0.09). Age-adjusted percentiles for right arm SBP decreased from 99.7% prior to, and 87.6% in follow-up (p < 0.001). The median time to re-intervention was 5.6 years (95% CI [2.8, 7.8]) and the proportion of children using anti-hypertensive in follow-up was not significantly different before the implantation (38% [prior to]; 45% [follow-up]). Elevated right arm blood pressure persists after successful stent implantation in the setting of associated TAH and there appears to be no catch-up growth of the transverse arch with time. Medical management can be difficult and approaches to surgical arch augmentation or stent implantation should be considered to avoid unilateral arm hypertension.

Keywords

Coarctation of the aorta Stent Transverse arch hypoplasia Systemic hypertension 

Notes

Acknowledgements

This work was supported in part by the Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (VGHKS 105-109), and the Ministry of Science and Technology, Taipei, Taiwan (MOST 105-2314-B-075B-001) to Dr. Wen-Hsien Lu.

Compliance with Ethical Standards

Conflict of interest

There are no conflicts of interest either perceived or real involving any author.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional ethics board, and due to the retrospective nature of the study, individual informed consent was waived.

References

  1. 1.
    Teo LL, Cannell T, Babu-Narayan SV, Hughes M, Mohiaddin RH (2011) Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr Cardiol 32:1120–1127CrossRefPubMedGoogle Scholar
  2. 2.
    Forbes TJ, Kim DW, Du W, Turner DR, Holzer R, Amin Z, Hijazi Z, Ghasemi A, Rome JJ, Nykanen D, Zahn E, Cowley C, Hoyer M, Waight D, Gruenstein D, Javois A, Foerster S, Kreutzer J, Sullivan N, Khan A, Owada C, Hagler D, Lim S, Canter J, Zellers T, CCISC Investigators (2011) Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol 58:2664–2674CrossRefPubMedGoogle Scholar
  3. 3.
    Szopos M, Poussineau N, Maday Y, Canniffe C, Celermajer DS, Bonnet D, Ou P (2014) Computational modeling of blood flow in the aorta–insights into eccentric dilatation of the ascending aorta after surgery for coarctation. J Thorac Cardiovasc Surg 148:1572–1582CrossRefPubMedGoogle Scholar
  4. 4.
    Holzer RJ, Chisolm JL, Hill SL, Cheatham JP (2008) Stenting complex aortic arch obstructions. Catheter Cardiovasc Interv 71:375–382CrossRefPubMedGoogle Scholar
  5. 5.
    Olivieri LJ, de Zelicourt DA, Haggerty CM, Ratnayaka K, Cross RR, Yoganathan AP (2011) Hemodynamic Modeling of Surgically Repaired Coarctation of the Aorta. Cardiovasc Eng Technol 2: 288–295CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Morgan GJ, Lee KJ, Chaturvedi R, Bradley TJ, Mertens L, Benson L (2013) Systemic blood pressure after stent management for arch coarctation implications for clinical care. JACC Cardiovasc Interv 6:192–201CrossRefPubMedGoogle Scholar
  7. 7.
    Ohno N, Chaturvedi R, Lee KJ, Horlick EM, Osten MD, Benson LN (2013) Experience with the Atrium Advanta covered stent for aortic obstruction. J Interv Cardiol 26:411–416CrossRefPubMedGoogle Scholar
  8. 8.
    Trivedi KR, Pinzon JL, McCrindle BW, Burrows PE, Freedom RM, Benson LN (2002) Cineangiographic aortic dimensions in normal children. Cardiol Young 12:339–344CrossRefPubMedGoogle Scholar
  9. 9.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(Suppl ii):555–576Google Scholar
  10. 10.
    Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21:922–934CrossRefPubMedGoogle Scholar
  11. 11.
    Morrow WR, Huhta JC, Murphy DJ Jr, McNamara DG (1986) Quantitative morphology of the aortic arch in neonatal coarctation. J Am Coll Cardiol 8:616–620CrossRefPubMedGoogle Scholar
  12. 12.
    Myers JL, McConnell BA, Waldhausen JA (1992) Coarctation of the aorta in infants: does the aortic arch grow after repair? Ann Thorac Surg 54:869–874CrossRefPubMedGoogle Scholar
  13. 13.
    Weber HS, Cyran SE, Grzeszczak M, Myers JL, Gleason MM, Baylen BG (1993) Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 21:1002–1007CrossRefPubMedGoogle Scholar
  14. 14.
    Ovaert C, Benson LN, Nykanen D, Freedom RM (1998) Transcatheter treatment of coarctation of the aorta: a review. Pediatr Cardiol 19:27–44CrossRefPubMedGoogle Scholar
  15. 15.
    Pushparajah K, Sadiq M, Brzezinska-Rajszys G, Thomson J, Rosenthal E, Qureshi SA (2013) Endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 82:E491–E499PubMedGoogle Scholar
  16. 16.
    Pihkala J, Pedra CA, Nykanen D, Benson LN (2000) Implantation of endovascular stents for hypoplasia of the transverse aortic arch. Cardiol Young 10:3–7CrossRefPubMedGoogle Scholar
  17. 17.
    Boshoff D, Budts W, Mertens L, Eyskens B, Delhaas T, Meyns B, Daenen W, Gewillig M (2006) Stenting of hypoplastic aortic segments with mild pressure gradients and arterial hypertension. Heart 92:1661–1666CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bentham JR, Oswal N, Yates R (2012) Stenting across head and neck vessels using covered stents for persisting aortic arch obstruction. Cardiol Young 22:610–614CrossRefPubMedGoogle Scholar
  19. 19.
    Bogaert J, Gewillig M, Rademakers F, Bosmans H, Verschakelen J, Daenen W, Baert AL (1995) Transverse arch hypoplasia predisposes to aneurysm formation at the repair site after patch angioplasty for coarctation of the aorta. J Am Coll Cardiol 26:521–527CrossRefPubMedGoogle Scholar
  20. 20.
    Valverde I, Gomez G, Coserria JF, Suarez-Mejias C, Uribe S, Sotelo J, Velasco MN, Santos De Soto J, Hosseinpour AR, Gomez-Cia T (2015) 3D printed models for planning endovascular stenting in transverse aortic arch hypoplasia. Catheter Cardiovasc Interv 85:1006–1012CrossRefPubMedGoogle Scholar
  21. 21.
    Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E (2004) Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 25:1853–1859CrossRefPubMedGoogle Scholar
  22. 22.
    Vriend JW, Oosterhof T, Hazekamp MG, Mulder BJ (2005) Aortic arch morphology and hypertension in post-coarctectomy patients. Eur Heart J 26:94Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick ChildrenThe University of Toronto School of MedicineTorontoCanada
  2. 2.Department of PediatricsKaohsiung Veterans General HospitalKaohsiungTaiwan, Republic of China
  3. 3.Department of PediatricsTaiwan National Yang-Ming UniversityTaipeiTaiwan, Republic of China

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