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Abstract:

Background: balloon angioplasty for coarctation of the aorta (CoA) in teenagers and adults is sometimes limited by significant residual pressure gradient (>20 mm Hg) in cause of vesse «elastic recoil». To avoid this complication intervention cardiologists use self- and balloon-expandable endovascular stents. In this report we demonstrate our experience in such method of aortic coarctation repair.

Materials and methods: in our instituton since December 2008 to Desember 2013 85 teenagers and adult patients were treated by endovascular stent placement to coarctatec aortic segment. The age of patients was 10 to 60 years (mean 20,3+7,4), weight 20 to 90 kgs (mean 53,2+14,6). Mean systolic arterial pressure was 166+7mm Hg. (range 140 to 200), mean systolic pressure gradient (SPG) was 60,6+9,0 mm Hg (range 25 to 85). The mean cross section at baseline of coarctation was 19,6±6,1 mm2 (range 1 to 95). 61 patients had native coarctation and 3 recoarctation after previous surgical repair. In 21 cases coartation was in combination with other cardiac pathology - patent ductus arteriosus (PDA), restrictive VSD, aortric and mitral valve lesions, and coronary vessel pathology Seven patients had hemodynamically significant aortic atresia. We used 20 Palmaz P-4014, 18 Genesis XD PG-2910 (Cordis Jonson & Jonson) and 45 - CP, CP covered stents, one - Intratherapeutic Doublestrut (EV3), and one Advanta V12 (Atrium) covered stent.

Results: 90 stents were implanted in 85 patients. Procedure was successful in all but one cases, one patient with postsurgical recoarctation had residual systolic pressure gradient > 25 mm Hg after stent placement. The peak systolic gradient decreased from a mean value of 60 mm Hg.(range 25 to 85) to a mean 7 mm Hg (range 0 to 25). Systolic blood pressure normalized in 64 cases, twenty one patients require additional drug therapy Coarctation site cross section increased from a mean of 19,6 mm2 to 236,3 mm2. PDA was closed simultaneously with the stenting by coils, and for eleven patients with other cardiac malformations endovascular coarctation repair was as a first step in complex cardiac surgical treatment. In one case of 56 years old male we had acute aortic dissection which was stabilized without surgical intervention. Two patients with complete hemodynamically significant aortic atresia developed stent fracture, which was recognized on CT scan 6 months after procedure. In one case it was treated with covered stent placement. In another patient stent fragment was treated surgically We had three stent migration with their safe deployment in thoracic aorta and followed by successful repair of aortic narrowing with additional stent.

Conclusion: stent implantation for aortic coarctation is safe and effective procedure. The early and intermediate term result are encouraging, with relatively low incidence of complication in teenagers and adult patients. 

 

References

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