On admission, the patient was hemodynamically stable. A dacron patch aortoplasty technique was earlier widely accepted as a method of aortic coarctation repair. Vascular control and systemic perfusion are performed in similar fashion. Please upgrade to a newer version of internet explorer or use an alternate browser such as chrome or. Safe wrapping of the borderline dilated ascending aorta. 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. Hybrid repair of a very late, postaortic coarctation. The latter group also tends to be associated with connective tissue disorders and with repaired conotruncal lesions. Patch aortoplasty for aortic coarctation is surgery to widen the narrowed part of the descending aorta with a synthetic patch. 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. Coarctation of the aorta coa is a major congenital heart disease, characterized by a severe stenosis of the proximal descending thoracic aorta. Background the first successful surgical repair of coarctation of the aorta.
Patch aortoplasty is beneficial when a long section of the aorta is narrowed. A 73 year old patient with aortic valve stenosis and borderline dilated. Aneurysmorrhaphy was performed through a left thoracoabdominal approach with dacron patch aortoplasty. A patch aortoplasty for isthmic aortic coarctation repair was performed 40 years before when she was admitted to our department for dyspnea. The technique is very simple, safe and useful for routine repair of coarctation of aorta. At the age of 10, he had undergone aortoplasty at our hospital with a dacron patch, for repair of aortic coarctation. Brom aoroplasty for supravalvar aortic stenosis ctsnet. Percutaneous stentgraft implantation avoids the need for surgical reintervention. This operation had a much lower recoarctation rate than resection and endtoend anastomosis, 512% 10, 11.
Aortic aneurysms remain a significant source of morbidity and mortality after use of dacron patch aortoplasty to repair coarctation of the aorta. Surgical repair of congenital supravalvular aortic. Dacron patch aortoplasty for descending thoracic aortic. A 4yearold male child was admitted with a large 12. Haemoptysis from a dacron graft aneurysm 21 years post. There was no significant blood pressure difference between the upper and lower extremities. In our patient, a true aneurysm of the graft had eroded into the right upper lobe, resulting in massive. Dacron sleeve around ascending aorta without excising the. Abdominal aortic pseudoaneurysm after blunt trauma journal. Standard carotid endarterectomy with dacron patch angioplasty, risks and outcomes salaheldien altarabsheh md, j. Giant aortic aneurysm after patch repair of coarctation. Although surgical repair has proven to be a successful treatment of coarctation of the aorta, immediate and delayed postoperative complications are not rare. These patients underwent dacron patch graft angioplasty on a selective basis. Numerical modeling of hemodynamics in the thoracic aorta and.
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. There was no infectious background or aneurysm at the primary repair site. However, dacron patch aortoplasty was standard therapy 2 decades ago in some surgical units. 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. Thoracic aortography showed significant narrowing of the aortic lumen and some extravasation of contrast material in the patch area. Of particular interest is the occurrence of aneurysms after dacron patch aortoplastyoften decades after surgery. 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. 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. 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. Longterm complications after this procedure include persisting hypertension, restenosis, aortobronchial fistula, and aneurysm formation 1, 3. Patch angioplasty is commonly performed after carotid endarterectomy. Patient age at the time of surgery ranged from 14 to 67 years mean, 28. A 15yearold girl underwent patch aortoplasty for repair of a longsegment coarctation of the aorta 7 years ago.
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. Endovascular treatment of falseaneurysm ten years after. Sudden death from aortic rupture prompted discontinuing this operation and evaluating 39 patients 16 girls. Sudden death from aortic rupture prompted discontinuing this operation and. 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. 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. Endovascular repair of pseudoaneurysms after open surgery for. Aortic aneurysm formation following coarctation repair by. Advances in surgical technique and perioperative care have allowed.
True aneurysms of dacron grafts are rare but have previously been reported. In one case, this was noted to be causing compression of the trachea resulting in stridor. 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. Is reduction aortoplasty with or without external wrap an. Hemashield platinum finesse surgical fabrics, meshes, and. Aortic coarctation, aneurysm, aortic surgery, magnetic resonance. We describe the clinicalradiologic presentations of 3 late complications of dacron patch angioplasty. Efficacy and safety of dacron patch in surgical treatment. Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by dacron patch plasty during adulthood. 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. She was scheduled for balloon angioplasty and stent implantation. Augmentation of the lesser curvature with an autologous vascular. 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. 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. Incidence of aneurysm formation after dacron patch. Data from several reports 17, 19 demonstrate the postoperative gradient to average 1230 mmhg. Surgery for congenital diseases of the aorta the journal of. Dacron patch aortoplasty for coarctation of aorta springerlink. 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. 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. Dacron patch aortoplasty of thoracic aortic pseudoaneurysm d. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. Dacron patch aortoplasty for descending thoracic aortic pseudoaneurysm.
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 open surgery, in our opinion, is nowadays still preferable due to the timestable and effective outcome. This syndrome is characterized by supravalvar aortic stenosis, elfin craniofacial features, peripheral pulmonary artery stenosis, and hypercalcemia. Of particular interest is the occurrence of aneurysms after dacron patch aortoplasty often decades after surgery. Delayed complication rates of up to 50% have been reported. A left thoracotomy or thoracoscopy is performed to access the aorta.
Dacron patch is utilized may be at increased risk for aneurysm formation. In 1993, aebert et al 29 reported 14 aneurysms in 56 patients who had had dacron patch aortoplasty. Balloon angioplasty had been performed twice, 3 and 5 years after the aortoplasty, because of recurrent coarctation of the aorta. Dacron patch aortoplasty of thoracic aortic pseudoaneurysm. 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. R bard, haverhill, pa patch repair of coarctation of the aorta is true. Graft dilation after redo surgery for aneurysm formation following. Aortic aneurysm formation following coarctation repair by dacron. Aneurysm formation after dacron patch aortoplasty for coarctation of the aorta has.
Previous surgical repair consisted of dacron patch aortoplasty, performed at the age of 18. Therefore, a chest xray should be a routine component of the followup examination. Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation. Longterm results of direct aortoplasty for repair of. The internet journal of thoracic and cardiovascular surgery. A left thoracotomy or thoracoscopy is needed in order to reach the aorta. Subsequent endovascular repair for postoperative pseudoaneurysm formation was undertaken at a median of 32 years after the coa repair range. 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 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. In our series, 6 patients had prior resection with endtoend anastomosis. The role of magnetic resonance angiography as standard imaging technique. 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. Pseudoaneurysm and aortobronchial fistula after aortic. Dacron patch is a kind of implantable consumables in cardiac surgery.
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. Incidence of aneurysm formation after dacron patch aortoplasty repair for coarctation of the aorta. Percutaneous endovascular repair of aneurysm after. The preferred surgical technique for coarctation of the aorta in infants and neonates includes resection of stenotic segments and endtoend anastomosis of aorta. He was asymptomatic and no routine cardiologists followup controls had taken place during the past five years. A 39yearold male patient presented with complaints of cough and hemoptysis. Rapid progression of aortic aneurysms after patch aortoplasty repair of coarctation of the aorta. Thin, knitted cardiovascular patch are indicated for cardiac and vascular patch grafting. Aneurysm formation after patch aortoplasty repair the annals of. Aortoplasty definition of aortoplasty by medical dictionary. Is reduction aortoplasty with or without external wrap. Carotid endarterectomy is the most frequent op eration performed by vascular surgeons today. Traditionally, surgery has been the treatment of choice for coa. The incidence of aneurysms after patch aortoplasty is reported to be between 5% 2, 9 and 38% 1, 4, 5.
Aortic root stability in bicuspid aortic valve disease. Using a partial occluding clamp, the pseudoaneurysm was excised and the aorta repaired with a 3. Both reduction aortoplasty and modified david type repair, paired with patch augmentation of the incompetent bicuspid valve, provide excellent midterm results. The indications for intervention in the aneurysm group are still in evolution but are clearly age and lesiondependant. Patch aortoplasty for aortic coarctation orange county surgeons. This site is not optimized for internet explorer 8 or older. Dacron patch aortoplasty repair of coarctation of the aorta carries an inherent risk of aneurysm development.
She was discharged home in 7 days and has successfully undergone stenting of the left subclavian artery and right and left carotid endarterectomy. In response to that problem, the patch aortoplasty was introduced in 1957. Comparison of polytetrafluoroethylene patch aortoplasty and. Congenital diseases of the aorta tend to be obstructive when they present early in life, and aneurysmal when they present later in life. The fabrics are also recommended for use in patients requiring systemic heparinization prior to, or during, surgery. Aortopulmonary fistula after coarctation repair with dacron. The aorta is incised longitudinally across the segment of coarctation and then augmented with a synthetic patch. In 1957 vosschulte introduced the concept of patch aortoplasty, which developed into the onlay dacron patch repair. Computed tomography scan showed a giant and saccular 10cm diameter patch false aneurysm. A dacron sleeve around the dilated ascending aorta is a simple technique that retains the smoothness of the internal surface of the dacron graft. A unique approach to surgical repair of descending thoracic aortic saccular aneurysm due to penetrating atherosclerotic ulcer is described in a. The first successful surgical repair of coarctation of the. He had a history of aortic coarctation repair with the use of dacron patch aortoplasty 19 years before.
Use of patch aortoplasty as a reoperation after resection with endtoend anastomosis may increase the risk of aneurysm formation. Techniques of reduction aortoplasty are widely published in the literature with conflicting results. The repair is completed by suturing a dacron patch over the aortotomy. 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. 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. Patch aortoplasty with prosthetic material, such as dacron dupont. There were six redilatations in the aortoplasty group, of which five were due to the wrap slipping distally.
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 computed tomography scan diagnosed an aortic postductal coarctation, which we treated with aortoplasty with dacron patch. 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. 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. Isthmic aortic false aneurysm postpatch coarctation. 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. The aortic segment including the prosthetic patch was resected and replaced with a dacron tubular vascular prosthesis. Aortic aneurysm after patch aortoplasty repair of coarctation. The fistula, inducing intermittent hemoptysis, arose from the suture line between the prosthetic fabric and the aorta. Surgical vs percutaneous treatment of aortic coarctation. The management of these patients is always problematic, with frequent complications and increased mortality rates. Chest xray of a 31yearold male patient, depicting a huge ballooning of the descending aorta arrows suggestive of ao.
Aneurysms arising from dacron patch aortoplasty are, however, common. 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. Dacron patch aortoplasty was primarily performed in 9 patients and subclavian flap aortoplasty in 2 patients. The guideline stripe on the hemashield knitted double velour fabric and the hemashield platinum. Patch aortoplasty is an alternative option for patients with limited mobility of aortic tissue. 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. In our patient group with dacron patch aortoplasty, two patients died of a ruptured aneurysm. Comparison of polytetrafluoroethylene patch aortoplasty and endto. 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. Our experience with dacron patch aortoplasty in 26 unselected patients of coarctation of thoracic aorta has been presented. Among a variety of surgical techniques, we have continued to perform patch. Surgery on the thoracic aorta is in some respects similar to other types of openheart surgery. Aortopulmonary fistula after coarctation repair with.
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