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Preoperative and postoperative "aneurysm" associated with coarctation of the aorta
S R Parikh1, R A Hurwitz, J E Hubbard
1Department of Pediatrics and Cardiovascular Surgery, Indiana University Hospitals, Indianapolis.
Insights
Aortic aneurysm after coarctation repair is rare, developing in only 5% of patients. Aneurysm formation was exclusively observed in patients who underwent Dacron patch repair, highlighting the importance of preoperative imaging for accurate diagnosis.
Area of Science:
- Cardiology
- Pediatric Surgery
- Vascular Surgery
Background:
- Aortic coarctation repair can lead to aortic aneurysm, but incidence rates vary.
- Pre-existing aneurysmal bulges are common in patients with aortic coarctation.
Purpose of the Study:
- To determine the incidence of aneurysm formation at the surgical repair site after aortic coarctation surgery.
- To assess the role of different surgical techniques in aneurysm development.
Main Methods:
- Retrospective review of preoperative and postoperative cineangiograms from 65 patients.
- Analysis of repair types: prosthetic patch, end-to-end anastomosis, and subclavian flap.
- Definition of aneurysm based on contour changes and dimensional ratios compared to preoperative imaging.
Main Results:
- No significant changes were observed in pre-existing aneurysmal bulges above the ductus arteriosus post-surgery.
- Aneurysm developed at the repair site in 3 (5%) of 65 patients during childhood.
- Significant changes at the repair site occurred only in patients who received Dacron patch repair.
Conclusions:
- Preoperative imaging is crucial for differentiating pre-existing aneurysms from those caused by coarctation repair.
- Aneurysm formation at the repair site was exclusively associated with Dacron patch repair techniques.
Abstract:
The reported incidence of aortic aneurysm after surgical repair or balloon angioplasty for aortic coarctation varies widely. To determine the incidence of aneurysm formation after surgery, preoperative and postoperative cineangiograms from 65 patients who underwent operation at age 1.5 +/- 3.4 years were examined. Repair included a prosthetic patch in 14 patients, end to end anastomosis in 28 and subclavian flap in 23. Aneurysm was documented by change in contour or irregularities in contour at the repair site or by abnormal dimensions at the repair site, defined by the ratio of the widest measurement at the repair site to the measurement of the aorta at the diaphragm. An aneurysmal bulge above the ductus diverticulum was identified in 14 (23%) of 60 patients preoperatively; the area showed no change 4.72 +/- 4.07 years after surgery. Significant changes at the repair site were seen in only three patients, all of whom had Dacron patch repair. One patient had a change in contour at the repair site, one had an abnormally high repair site to diaphragmatic aorta ratio and one had a progressive increase in this ratio. Thus, during childhood years, 3 (5%) of 65 patients were diagnosed as having aneurysm at the surgical repair site. In conclusion, 1) comparison with preoperative cineangiograms, especially for aneurysmal bulges above the ductus arteriosus, is essential before an aneurysm can be attributed to coarctation repair by any technique, and 2) aneurysm developed only in patients subjected to Dacron patch repair.