The indications for intervention in the aneurysm group are still in evolution but are clearly age and lesiondependant. In 1957 vosschulte introduced the concept of patch aortoplasty, which developed into the onlay dacron patch repair. There was no significant blood pressure difference between the upper and lower extremities. This site is not optimized for internet explorer 8 or older. Thoracic aortography showed significant narrowing of the aortic lumen and some extravasation of contrast material in the patch area. Dacron patch aortoplasty gained increased popularity after its introduction in the midtwentieth century due to its advantages over other surgical treatment methods available at the. We report the case of a patient with severe diffuse peripheral vascular disease, coronary artery disease, congestive heart failure, and gastrointestinal bleeding with a pseudoaneurysm of descending thoracic aorta who underwent successful dacron patch aortoplasty. Widening of the aortic isthmus with a rigid, diamondshaped prosthetic graft has led to many unexpected problems, the great majority related to aneurysm or false aneurysm formation at the repair site even years after primary repair 1, 2, 3. Balloon angioplasty had been performed twice, 3 and 5 years after the aortoplasty, because of recurrent coarctation of the aorta. A 15yearold girl underwent patch aortoplasty for repair of a longsegment coarctation of the aorta 7 years ago. Widening of the aortic isthmus with a rigid, diamondshaped prosthetic graft has led to many unexpected problems, the great majority related to aneurysm or false aneurysm formation at the repair site even years after primary repair. Vascular control and systemic perfusion are performed in similar fashion.
Background the first successful surgical repair of coarctation of the aorta. The guideline stripe on the hemashield knitted double velour fabric and the hemashield platinum. Dacron patch aortoplasty was primarily performed in 9 patients and subclavian flap aortoplasty in 2 patients. We now report one more case of false aneurysm ten years after dacron patch aortoplasty for isthmic coarctation in a 26yearold woman, successfully treated by endovascular repair via the left. Dacron patch aortoplasty for coarctation of aorta springerlink. Aortic coarctation, aneurysm, aortic surgery, magnetic resonance.
Dacron patch aortoplasty of thoracic aortic pseudoaneurysm d. Patch aortoplasty has been shown to be quite effective in reducing the supravalvar gradient, but there have been reports of a persistent gradient across the region of the aortic root. Of particular interest is the occurrence of aneurysms after dacron patch aortoplasty often decades after surgery. Aortopulmonary fistula after coarctation repair with dacron. The first successful surgical repair of coarctation of the. The latter group also tends to be associated with connective tissue disorders and with repaired conotruncal lesions. The reduction of the diameter of the ascending aorta by reduction aortoplasty seems to provide reliable stability that is comparable to the david type repair. Patch angioplasty is commonly performed after carotid endarterectomy. Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation. The role of magnetic resonance angiography as standard imaging technique.
Congenital diseases of the aorta tend to be obstructive when they present early in life, and aneurysmal when they present later in life. Standard carotid endarterectomy with dacron patch angioplasty, risks and outcomes salaheldien altarabsheh md, j. Of particular interest is the occurrence of aneurysms after dacron patch aortoplastyoften decades after surgery. Safe wrapping of the borderline dilated ascending aorta. Longterm complications after this procedure include persisting hypertension, restenosis, aortobronchial fistula, and aneurysm formation 1, 3. Percutaneous stentgraft implantation avoids the need for surgical reintervention. The internet journal of thoracic and cardiovascular surgery. On admission, the patient was hemodynamically stable.
Surgical vs percutaneous treatment of aortic coarctation. Data from several reports 17, 19 demonstrate the postoperative gradient to average 1230 mmhg. Delayed complication rates of up to 50% have been reported. Aneurysms are found following all types of surgical repair of aortic coarctation, but especially after dacron patch aortoplasty, with reported incidences up to 90% during a followup period of more than 20 years. The incidence of aneurysms after patch aortoplasty is reported to be between 5% 2, 9 and 38% 1, 4, 5. At the age of 10, he had undergone aortoplasty at our hospital with a dacron patch, for repair of aortic coarctation. In 1993, aebert et al 29 reported 14 aneurysms in 56 patients who had had dacron patch aortoplasty. External support seems to be an important factor in preventing recurrence but, in some cases, this technique caused erosion of the aorta because of the wrinkles the prosthesis creates in the rear side of the aorta. However, dacron patch aortoplasty was standard therapy 2 decades ago in some surgical units. We now report one more case of false aneurysm ten years after dacron patch aortoplasty for isthmic coarctation in a 26yearold woman, successfully treated by endovascular repair via the left common iliac artery, and a complete exclusion of the aneurysm at two year followup. Longterm results of direct aortoplasty for repair of aortic coarctation in adults leo heikkinen, md, and kari alakulju, md department of thoracic and cardiovascular surgery, helsinki university central hospital, helsinki, finland the longterm results of 14 adult patients who under went a direct aortoplasty for aortic coarctation were. Numerical modeling of hemodynamics in the thoracic aorta and. A unique approach to surgical repair of descending thoracic aortic saccular aneurysm due to penetrating atherosclerotic ulcer is described in a. Augmentation of the lesser curvature with an autologous vascular.
The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous endovascular repair of aneurysm after. Surgery on the thoracic aorta is in some respects similar to other types of openheart surgery. Previous surgical repair consisted of dacron patch aortoplasty, performed at the age of 18.
She was scheduled for balloon angioplasty and stent implantation. Comparison of polytetrafluoroethylene patch aortoplasty and. We describe the finding of an aortic aneurysm in an asymptomatic 43yearold male, who was managed by dacron patch aortoplasty for native coarctation of the aorta 25. This operation had a much lower recoarctation rate than resection and endtoend anastomosis, 512% 10, 11. The computed tomography scan diagnosed an aortic postductal coarctation, which we treated with aortoplasty with dacron patch. Although aneurysm formation and recoarctation after dacron patch aortoplasty have been reported on extensively, less is known about these outcomes after polytetrafluoroethylene patch repair, which was compared with resection and endtoend anastomosis in this study. Using a partial occluding clamp, the pseudoaneurysm was excised and the aorta repaired with a 3. Pseudoaneurysm and aortobronchial fistula after aortic. Aneurysmorrhaphy was performed through a left thoracoabdominal approach with dacron patch aortoplasty. Coarctation of the aorta coa is a major congenital heart disease, characterized by a severe stenosis of the proximal descending thoracic aorta. The technique is very simple, safe and useful for routine repair of coarctation of aorta. Therefore, a chest xray should be a routine component of the followup examination. Brom aoroplasty for supravalvar aortic stenosis ctsnet. Aortic aneurysm formation following coarctation repair by dacron.
Giant aortic aneurysm after patch repair of coarctation. The repair is completed by suturing a dacron patch over the aortotomy. Patch aortoplasty for aortic coarctation orange county surgeons. Thus, in a prospective manner, this study has docu mented that aortic aneurysm occurs commonly after patch aortoplasty for coarctation in childhood, that the chest xray film provides a sensitive screening test and that the. Our experience with dacron patch aortoplasty in 26 unselected patients of coarctation of thoracic aorta has been presented. Longterm results of direct aortoplasty for repair of. The open surgery, in our opinion, is nowadays still preferable due to the timestable and effective outcome. Abdominal aortic pseudoaneurysm after blunt trauma journal. Sudden death from aortic rupture prompted discontinuing this operation and evaluating 39 patients 16 girls. These patients underwent dacron patch graft angioplasty on a selective basis.
Patch aortoplasty is beneficial when a long section of the aorta is narrowed. Please upgrade to a newer version of internet explorer or use an alternate browser such as chrome or. He was asymptomatic and no routine cardiologists followup controls had taken place during the past five years. Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by dacron patch plasty during adulthood. Dacron patch is a kind of implantable consumables in cardiac surgery. A left thoracotomy or thoracoscopy is performed to access the aorta. Comparison of polytetrafluoroethylene patch aortoplasty and endto. Surgical procedures of patch aortoplasty for aortic coarctation on patch aortoplasty for aortic coarctation involves using a synthetic patch to widen the narrowed part of the descending aorta. Wrap without aortoplasty 1, 2, 3 wrapping of the ascending aorta with a fine transparent and stretchable dacron mesh 3 manually preprepared prosthesis which respects the shape of the aorta 8 reduction aortoplasty with wrapping 5, 7, 9, 10, 11 vertical reduction aortoplasty, endarterectomy, and external wrapping 12. Aortic aneurysms remain a significant source of morbidity and mortality after use of dacron patch aortoplasty to repair coarctation of the aorta. Patch aortoplasty with prosthetic material, such as dacron dupont.
The successful end point of clinical trial is determined by echocardiography within 2 days before operation, before discharge, 1 month after discharge and 3 months after discharge. A patch aortoplasty for isthmic aortic coarctation repair was performed 40 years before when she was admitted to our department for dyspnea. Dacron patch aortoplasty for descending thoracic aortic pseudoaneurysm. She was discharged home in 7 days and has successfully undergone stenting of the left subclavian artery and right and left carotid endarterectomy. Fistulous communication between the aorta and the pulmonary parenchyma developed in a 38yearold woman 19 years after repair of a congenital aortic coarctation with dacron patch aortoplasty. Dacron sleeve around ascending aorta without excising the. Incidence of aneurysm formation after dacron patch. Aortic root stability in bicuspid aortic valve disease. Dacron patch aortoplasty for descending thoracic aortic. True aneurysms of dacron grafts are rare but have previously been reported. Haemoptysis from a dacron graft aneurysm 21 years post. Patch aortoplasty patch aortoplasty is an alternative option for patients with limited mobility of aortic tissue.
Late aneurysm formation has also been reported after every type of coao repair endtoend, subclavian flap, and patch aortoplasty, with rupture of such aneurysms being responsible for approximately 7% of all deaths. Abstract we experienced a case in which a 7yearold boy with a characteristic elfin face, heart murmur, and mental retardation, underwent extended patch aortoplasty using diamond shaped dacron patch for congenital supravalvular aortic stenosis. Aortic aneurysm after patch aortoplasty repair of coarctation. Dacron patch angioplasty was introduced in the 1960s and is characterized by successful gradient resolution, avoidance of harm to the intercostal arteries and a low risk for restenosis because of. Is reduction aortoplasty with or without external wrap. The preferred surgical technique for coarctation of the aorta in infants and neonates includes resection of stenotic segments and endtoend anastomosis of aorta.
Patch aortoplasty for aortic coarctation is surgery to widen the narrowed part of the descending aorta with a synthetic patch. A 4yearold male child was admitted with a large 12. The fabrics are also recommended for use in patients requiring systemic heparinization prior to, or during, surgery. He had a history of aortic coarctation repair with the use of dacron patch aortoplasty 19 years before. Dacron patch is utilized may be at increased risk for aneurysm formation. Aortic aneurysm formation following coarctation repair by. In one case, this was noted to be causing compression of the trachea resulting in stridor. Pseudoaneurysm and aortobronchial fistula are very rare complications of aortic coarctation repair by means of patch aortoplasty, and are usually fatal if not treated surgically. A 26yearold man with recentonset massive hemoptysis had undergone aortic coarctation repair by means of dacron patch aortoplasty at the age of 10 in our hospital. Traditionally, surgery has been the treatment of choice for coa. Broms threepatch aortoplasty is indicated for the repair of supravalvar aortic stenosis, which can occur as an isolated defect or as a part of williams syndrom. Incidence of aneurysm formation after dacron patch aortoplasty repair for coarctation of the aorta. Graft dilation after redo surgery for aneurysm formation following.
Advances in surgical technique and perioperative care have allowed. Is reduction aortoplasty with or without external wrap an. Chest xray of a 31yearold male patient, depicting a huge ballooning of the descending aorta arrows suggestive of ao. Aneurysm formation after patch aortoplasty repair the annals of. Techniques of reduction aortoplasty are widely published in the literature with conflicting results. R bard, haverhill, pa patch repair of coarctation of the aorta is true. Endovascular treatment of falseaneurysm ten years after. We describe the clinicalradiologic presentations of 3 late complications of dacron patch angioplasty. This syndrome is characterized by supravalvar aortic stenosis, elfin craniofacial features, peripheral pulmonary artery stenosis, and hypercalcemia.
Hybrid repair of a very late, postaortic coarctation. Surgery for congenital diseases of the aorta the journal of. Randomized prospective trials and metaanalyses have documented improved rates of perioperative and longterm stroke prevention as well as reduced rates of restenosis for patches compared to primary closure of the arteriotomy. In seven patients, patch graft angioplasties were placed for recurrent stenosis of the carotid artery and in 29 patients a dacron patch graft was placed after carotid endarterectomy because of smallcaliber carotid vessels. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. Although surgical repair has proven to be a successful treatment of coarctation of the aorta, immediate and delayed postoperative complications are not rare. A dacron sleeve around the dilated ascending aorta is a simple technique that retains the smoothness of the internal surface of the dacron graft. In the followup of patients after coarctation repair, particularly after patch aortoplasty, one should anticipate aneurysm formation, even decades after the initial successful surgery and in the absence of clinical symptoms. Sudden death from aortic rupture prompted discontinuing this operation and. Aneurysm formation after dacron patch aortoplasty for coarctation of the aorta has. Carotid endarterectomy is the most frequent op eration performed by vascular surgeons today. Patch aortoplasty is an alternative option for patients with limited mobility of aortic tissue.
Endovascular repair of pseudoaneurysms after open surgery for. Surgical wrapping of mild to moderate ascending aortic dilatation at the aortic valve is associated with early, reversed remodeling of the remaining proximal and distal aorta, without any shortterm complications 1. In our series, 6 patients had prior resection with endtoend anastomosis. Aneurysms arising from dacron patch aortoplasty are, however, common. In our patient, a true aneurysm of the graft had eroded into the right upper lobe, resulting in massive. A left thoracotomy or thoracoscopy is needed in order to reach the aorta. Surgical repair of congenital supravalvular aortic. Rapid progression of aortic aneurysms after patch aortoplasty repair of coarctation of the aorta. Both reduction aortoplasty and modified david type repair, paired with patch augmentation of the incompetent bicuspid valve, provide excellent midterm results. Use of patch aortoplasty as a reoperation after resection with endtoend anastomosis may increase the risk of aneurysm formation. Hemashield platinum finesse surgical fabrics, meshes, and.
Computed tomography scan showed a giant and saccular 10cm diameter patch false aneurysm. The aim of this study was to assess the different risk factors and their impact on the final outcome of standard carotid endarterectomy with dacron patch angioplasty. Aortoplasty definition of aortoplasty by medical dictionary. The aorta is incised longitudinally across the segment of coarctation and then augmented with a synthetic patch. Subsequent endovascular repair for postoperative pseudoaneurysm formation was undertaken at a median of 32 years after the coa repair range. Patient age at the time of surgery ranged from 14 to 67 years mean, 28. There was no infectious background or aneurysm at the primary repair site. Among a variety of surgical techniques, we have continued to perform patch. Dacron patch aortoplasty of thoracic aortic pseudoaneurysm.
The fistula, inducing intermittent hemoptysis, arose from the suture line between the prosthetic fabric and the aorta. Efficacy and safety of dacron patch in surgical treatment. Isthmic aortic false aneurysm postpatch coarctation. The aortic segment including the prosthetic patch was resected and replaced with a dacron tubular vascular prosthesis. In response to that problem, the patch aortoplasty was introduced in 1957. Particular details regarding the size and location of the incision, the use of the heartlung machine and specialized techniques used to provide neurologic protection vary depending on the type of aortic surgery being performed. Dacron patch aortoplasty repair of coarctation of the aorta carries an inherent risk of aneurysm development. Open coa repair had been performed by dacron patch aortoplasty in nine and subclavian flap aortoplasty in 2 patients at a median age of 20 years range. A 39yearold male patient presented with complaints of cough and hemoptysis. There were six redilatations in the aortoplasty group, of which five were due to the wrap slipping distally. We describe the finding of an aortic aneurysm in an asymptomatic 43yearold male, who was managed by dacron patch aortoplasty for native coarctation of the aorta 25 years before.
A 73 year old patient with aortic valve stenosis and borderline dilated. Thin, knitted cardiovascular patch are indicated for cardiac and vascular patch grafting. A dacron patch aortoplasty technique was earlier widely accepted as a method of aortic coarctation repair. Aortopulmonary fistula after coarctation repair with.
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