Background: The aims of the study were to analyze the importance of two different surgical procedures, and to determine outcomes for neonates with coarctation of the aorta in two newly established centers. Methods: Ou...Background: The aims of the study were to analyze the importance of two different surgical procedures, and to determine outcomes for neonates with coarctation of the aorta in two newly established centers. Methods: Outcomes of two different surgical repairs for coarctation of the aorta in 43 infants were evaluated retrospectively. The study was designed as a nonrandomized, cross-sectional study. The subclavian flap repair was applied to 22 patients (51%) and resection with extended end-to-end anastomosis technique to 21 patients (49%). After all operative survivors were followed up with a mean follow-up of 1.8 ± 0.8 years, data analyzed with t-test and the p value < 0.05 were considered statistically significant. Results: The overall mortality rate was 4.6%. Forty mmHg gradients were determined in a patient from Resection Group postoperatively in the fifteenth month. After the balloon angioplasty, the gradient decreased to 25 mmHg. The presence of ventricular septal defect (p = 0.094) was the only significant predictor of adverse short-term outcome among the associated cardiac defects analyzed. The first-year survival rate was 100% in both groups in isolated coarctation (p = 0.965), however;such rate was found as 100% and 93.25% in Waldhausen Group and Resection Group, respectively in complex coarctation (p = 0.294). Conclusions: Both the subclavian flap repair and resection with extended end-to-end anastomosis for coarctation of the aorta in infants provide excellent short-term outcomes with lower recurrence rates requiring surgery or angioplasty.展开更多
A 4-month-old previously healthy baby was found to be in congestive heart failure with LV dysfunction and a right aortic arch with severe coarctation,undetectable by blood pressure measurements.A cardiac CT and centra...A 4-month-old previously healthy baby was found to be in congestive heart failure with LV dysfunction and a right aortic arch with severe coarctation,undetectable by blood pressure measurements.A cardiac CT and central blood pressure led to the diagnosis of a unique anatomic variant of aortic coarctation.Once diagnosed the patient underwent surgery with an uncomplicated recovery.展开更多
Aim:To determine the profiles of clinical features including four-limb blood pressure(BP),saturations of peripheral oxygen(SpO2),and echocardiographic features in infants with coarctation of aorta(CoA)to facilitate co...Aim:To determine the profiles of clinical features including four-limb blood pressure(BP),saturations of peripheral oxygen(SpO2),and echocardiographic features in infants with coarctation of aorta(CoA)to facilitate congenital heart diseases screening.Methods:The charts of infants with CoA were retrospectively reviewed.All in-hospital infants suspected of congenital heart diseases by clinical teams were prospectively measured of four limbs BPs and SpO2 in a regional cardiac transferring center during 2013 and 2019.Echocardiography as a gold standard test was followed within 2 days after suspicion.All infants were divided into non-significant CoA group or significant CoA group based on the difference of BPs between right arm and lower limbs.Predictors of nonsignificant CoA were determined with multivariable logistic regression.Results:One hundred thirty-three infants with CoA were identified.The BPs on upper limbs were higher than those on lower limbs(P=0.001).No statistical difference in SpO2 was found between four limbs.Fifty-three(39.8%)infants presented with significant CoA.Thirty-four infants presented with low SpO2 and 26 of 34 presented with non-significant CoA.Small ascending aorta diameter[0.070(95%CI:0.005–0.136),P=0.036]was an independent risk factors for non-significant CoA.Eighteen(13.5%)infants with CoA didn’t present with any of the BP difference,low SpO2,murmur,or weak femoral pulse.Conclusion:Less than half of the infants with CoA presented with a significant BP difference.Another one fifth presented with low SpO2.Small ascending aorta diameter was an independent factor for non-significant CoA.展开更多
Survival to advanced age is exceptional in patients with unrepaired aortic coarctation. We report the case of an 81-year-old man with aortic coarctation and total occlusion who was otherwise asymptomatic. Coarctation ...Survival to advanced age is exceptional in patients with unrepaired aortic coarctation. We report the case of an 81-year-old man with aortic coarctation and total occlusion who was otherwise asymptomatic. Coarctation was suspected when a femoral-radial pulse delay was noted during his routine physical examination. A 70-mmHg systolic blood.展开更多
Background In clinical practice, there are different surgical approaches for postductal coarctation of the aor- ta （CoA）, with their advantages and disadvantages. Limited studies have reported the surgical outcomes ...Background In clinical practice, there are different surgical approaches for postductal coarctation of the aor- ta （CoA）, with their advantages and disadvantages. Limited studies have reported the surgical outcomes of post- ductal CoA in adolescents and adults. Methods From January 2005 to December 2014, a total of 40 patients aged over 14 years underwent surgical corrections of postductal CoA in our institution. The surgical outcomes as reflected by cardiac function and differences in mean blood pressure of upper and lower extremities both preoper- ative and postoperative were recorded and evaluated. Results Among the 40 patients underwent successful sur- gical corrections, 1 patient complicated by acute aortic dissection and died, while the remainings survived to hos- pital discharge. During the 12-36 month follow-up period, postoperative mean blood pressure differences of upper and lower extremities were significantly reduced as compared with the preoperative data. Postoperative evalu- ation of cardiac function was conducted in all patients with New York Heart Association （NYHA） Ⅰ-Ⅱ. Conclusion For adolescent and adult patients with postductal aortic coarctation, surgical correction is highly recom- mended. Surgical approach should be based on the specific anatomy of the coarctation lesion, concomitant mal- formations, and expected grown-up height. Those complicated with other intracardiac malformations should be treated with extra-anatomical bypass technique and simultaneous surgical correction of CoA, which is effective with desirable postoperative prognosis.展开更多
目的本研究旨在综合分析胎儿主动脉缩窄(coarctation of the aorta,CoA)的相关超声心动图指标。方法回顾性分析2018年1月至2023年5月广东省人民医院产前超声心动图检查疑诊CoA存活胎儿204例的临床资料,提取产前超声心动图数据和患者资...目的本研究旨在综合分析胎儿主动脉缩窄(coarctation of the aorta,CoA)的相关超声心动图指标。方法回顾性分析2018年1月至2023年5月广东省人民医院产前超声心动图检查疑诊CoA存活胎儿204例的临床资料,提取产前超声心动图数据和患者资料。根据生后随访结果将研究对象分为真阳性组(A组)和假阳性组(B组)。通过Logistic回归分析筛选预测指标并建立确诊CoA列线图预测模型,按6:4随机将患者分为训练集和测试集,进行模型内部验证及效果评价。结果204例胎儿被纳入研究,其中A组95例(46.5%),B组109例(53.43%)。最终确定4个指标组成列线图模型,包括左心室Z值、主动脉远端横弓Z值、肺动脉主干与升主动脉比值、是否合并室间隔缺损。该模型具有一定预测能力和实用价值[曲线下面积(area under the curve,AUC)=0.888],在验证集中亦取得了良好的诊断效能(AUC=0.825),内部验证显示模型具有良好的预测能力和应用价值。结论本研究建立的列线图模型可作为应用简单且有效的工具,提高CoA的产前诊断准确性,促进围产期及生后的分层管理。展开更多
目的：评价Cheatham-Platinum （CP）支架治疗儿童主动脉缩窄的早中期疗效.方法：对14例主动脉缩窄（coarctation of the aorta,CoA）儿童行CP支架置入术,其中男性8例,女性6例;年龄4～14岁（中位年龄11岁）;体质量19.9～60kg（中位体质...目的：评价Cheatham-Platinum （CP）支架治疗儿童主动脉缩窄的早中期疗效.方法：对14例主动脉缩窄（coarctation of the aorta,CoA）儿童行CP支架置入术,其中男性8例,女性6例;年龄4～14岁（中位年龄11岁）;体质量19.9～60kg（中位体质量38.2kg）.6例（43％）为未经治疗CoA;8例（57％）为再狭窄CoA.收集和分析CP支架置入前后的数据和随访资料.结果：14例患儿均成功置入CP支架,其中6例裸支架,8例覆膜支架.术后即刻CoA最窄处直径由（6.45±1.39）mm增加至（11.79±1.59）mm,P＜0.001;CoA/Dao比由0.41±0.12增加至0.74 ±0.10,P＜0.001;导管测得跨狭窄压差由[（34.86±17.48） mmHg（1 mmHg=0.133kPa）,下降至（1.64±1.64） mmHg,P＜0.001];心脏超声测得跨狭窄压差由[（59.76±15.92） mmHg,下降至（23.89±7.30） mmHg,P＜0.001];上肢收缩压由[（142.07±28.95） mmHg降为（124.79±25.92） mmHg,P＜0.001];下肢收缩压由[（105.21±21.35）mmHg升为（122.29±25.29）mmHg,P＜0.05].未见主动脉瘤和主动脉夹层的发生.1例患儿术中发生髂动脉内膜撕脱导致术后死亡.随访结果未见再狭窄,未见支架的移位断裂.结论：CP支架治疗儿童CoA早中期疗效好,但远期效果尚需进一步的随访和更多病例的研究.展开更多
文摘Background: The aims of the study were to analyze the importance of two different surgical procedures, and to determine outcomes for neonates with coarctation of the aorta in two newly established centers. Methods: Outcomes of two different surgical repairs for coarctation of the aorta in 43 infants were evaluated retrospectively. The study was designed as a nonrandomized, cross-sectional study. The subclavian flap repair was applied to 22 patients (51%) and resection with extended end-to-end anastomosis technique to 21 patients (49%). After all operative survivors were followed up with a mean follow-up of 1.8 ± 0.8 years, data analyzed with t-test and the p value < 0.05 were considered statistically significant. Results: The overall mortality rate was 4.6%. Forty mmHg gradients were determined in a patient from Resection Group postoperatively in the fifteenth month. After the balloon angioplasty, the gradient decreased to 25 mmHg. The presence of ventricular septal defect (p = 0.094) was the only significant predictor of adverse short-term outcome among the associated cardiac defects analyzed. The first-year survival rate was 100% in both groups in isolated coarctation (p = 0.965), however;such rate was found as 100% and 93.25% in Waldhausen Group and Resection Group, respectively in complex coarctation (p = 0.294). Conclusions: Both the subclavian flap repair and resection with extended end-to-end anastomosis for coarctation of the aorta in infants provide excellent short-term outcomes with lower recurrence rates requiring surgery or angioplasty.
文摘A 4-month-old previously healthy baby was found to be in congestive heart failure with LV dysfunction and a right aortic arch with severe coarctation,undetectable by blood pressure measurements.A cardiac CT and central blood pressure led to the diagnosis of a unique anatomic variant of aortic coarctation.Once diagnosed the patient underwent surgery with an uncomplicated recovery.
基金Disclosure of grants or other funding:The Natural Science Foundation of Guangdong Province[2020A1515010904]the Science and Technology Planning Project of Guangdong Province[2019B020230003]。
文摘Aim:To determine the profiles of clinical features including four-limb blood pressure(BP),saturations of peripheral oxygen(SpO2),and echocardiographic features in infants with coarctation of aorta(CoA)to facilitate congenital heart diseases screening.Methods:The charts of infants with CoA were retrospectively reviewed.All in-hospital infants suspected of congenital heart diseases by clinical teams were prospectively measured of four limbs BPs and SpO2 in a regional cardiac transferring center during 2013 and 2019.Echocardiography as a gold standard test was followed within 2 days after suspicion.All infants were divided into non-significant CoA group or significant CoA group based on the difference of BPs between right arm and lower limbs.Predictors of nonsignificant CoA were determined with multivariable logistic regression.Results:One hundred thirty-three infants with CoA were identified.The BPs on upper limbs were higher than those on lower limbs(P=0.001).No statistical difference in SpO2 was found between four limbs.Fifty-three(39.8%)infants presented with significant CoA.Thirty-four infants presented with low SpO2 and 26 of 34 presented with non-significant CoA.Small ascending aorta diameter[0.070(95%CI:0.005–0.136),P=0.036]was an independent risk factors for non-significant CoA.Eighteen(13.5%)infants with CoA didn’t present with any of the BP difference,low SpO2,murmur,or weak femoral pulse.Conclusion:Less than half of the infants with CoA presented with a significant BP difference.Another one fifth presented with low SpO2.Small ascending aorta diameter was an independent factor for non-significant CoA.
文摘Survival to advanced age is exceptional in patients with unrepaired aortic coarctation. We report the case of an 81-year-old man with aortic coarctation and total occlusion who was otherwise asymptomatic. Coarctation was suspected when a femoral-radial pulse delay was noted during his routine physical examination. A 70-mmHg systolic blood.
基金supported by Science and Technology Foundation of Guangzhou(No.2014y2-00052)
文摘Background In clinical practice, there are different surgical approaches for postductal coarctation of the aor- ta （CoA）, with their advantages and disadvantages. Limited studies have reported the surgical outcomes of post- ductal CoA in adolescents and adults. Methods From January 2005 to December 2014, a total of 40 patients aged over 14 years underwent surgical corrections of postductal CoA in our institution. The surgical outcomes as reflected by cardiac function and differences in mean blood pressure of upper and lower extremities both preoper- ative and postoperative were recorded and evaluated. Results Among the 40 patients underwent successful sur- gical corrections, 1 patient complicated by acute aortic dissection and died, while the remainings survived to hos- pital discharge. During the 12-36 month follow-up period, postoperative mean blood pressure differences of upper and lower extremities were significantly reduced as compared with the preoperative data. Postoperative evalu- ation of cardiac function was conducted in all patients with New York Heart Association （NYHA） Ⅰ-Ⅱ. Conclusion For adolescent and adult patients with postductal aortic coarctation, surgical correction is highly recom- mended. Surgical approach should be based on the specific anatomy of the coarctation lesion, concomitant mal- formations, and expected grown-up height. Those complicated with other intracardiac malformations should be treated with extra-anatomical bypass technique and simultaneous surgical correction of CoA, which is effective with desirable postoperative prognosis.
文摘目的本研究旨在综合分析胎儿主动脉缩窄(coarctation of the aorta,CoA)的相关超声心动图指标。方法回顾性分析2018年1月至2023年5月广东省人民医院产前超声心动图检查疑诊CoA存活胎儿204例的临床资料,提取产前超声心动图数据和患者资料。根据生后随访结果将研究对象分为真阳性组(A组)和假阳性组(B组)。通过Logistic回归分析筛选预测指标并建立确诊CoA列线图预测模型,按6:4随机将患者分为训练集和测试集,进行模型内部验证及效果评价。结果204例胎儿被纳入研究,其中A组95例(46.5%),B组109例(53.43%)。最终确定4个指标组成列线图模型,包括左心室Z值、主动脉远端横弓Z值、肺动脉主干与升主动脉比值、是否合并室间隔缺损。该模型具有一定预测能力和实用价值[曲线下面积(area under the curve,AUC)=0.888],在验证集中亦取得了良好的诊断效能(AUC=0.825),内部验证显示模型具有良好的预测能力和应用价值。结论本研究建立的列线图模型可作为应用简单且有效的工具,提高CoA的产前诊断准确性,促进围产期及生后的分层管理。
