Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T05:14:50.775Z Has data issue: false hasContentIssue false
  • English
  • Français

Histopathological evaluation of aortic coarctation after conventional balloon angioplasty in neonates

Published online by Cambridge University Press:  18 January 2018

Atakan Atalay ,
Aysenur Pac ,
Tugba Avci ,
Neslihan İnci Zengin ,
Nadide Demir Amac ,
Deniz Eris ,
Irfan Tasoglu  and
Mustafa Pac
Atakan Atalay*
Affiliation:
Department of Cardiovascular Surgery, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Aysenur Pac
Affiliation:
Department of Pediatric Cardiology, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Tugba Avci
Affiliation:
Department of Cardiovascular Surgery, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Neslihan İnci Zengin
Affiliation:
Department of Pathology, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Nadide Demir Amac
Affiliation:
Department of Cardiovascular Surgery, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Deniz Eris
Affiliation:
Department of Pediatric Cardiology, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Irfan Tasoglu
Affiliation:
Department of Cardiovascular Surgery, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
Mustafa Pac
Affiliation:
Department of Cardiovascular Surgery, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
*
Author for correspondence: Dr A. Atalay, Turkiye Yuksek Ihtisas Hospital, Ankara 06460, Turkey. Tel: +90 5053593390; Fax: +90 312 3061469; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Optimal management strategy for native aortic coarctation in neonates and young infants is still a matter of debate. The surgical procedure, histopathologic research, and clinical outcome in 15 neonates who underwent surgery after successful balloon angioplasty is the basis of this study.

Method

Between 01 October, 2014 and 01 August, 2017, we enrolled 15 patients with native aortic coarctation for this study. These patients had complications regarding recoarctation, following balloon angioplasty intervention at our institute and other centres. Surgically extracted parts were examined histopathologically and patient’s data were collected retrospectively.

Result

The reasons for recurrence of recoarctation after balloon angioplasty are as follows: patients with higher preoperative echocardiographic gradients had recoarctation earlier, neointimal proliferation, aortic intimal fibrosis at the region of ductal insertion, and ductal residual tissue debris after balloon angioplasty. No repeat intervention was required in the 15 patients who underwent surgery followed by balloon angioplasty. Early mortality was seen in one patient after surgery. Postoperative complication in the surgical group occurred in the form of chylothorax in one patient.

Conclusion

In centres in which the neonatal ICU is inexperienced, balloon angioplasty is particularly recommended. In developing neonatal clinics, balloon angioplasty, when performed on patients at their earliest possible age, delays actual corrective operation to a later date, which in turn provides less risky surgical outcomes in infants who are gaining weight, growing, and do not have any haemodynamic complaints.

Keywords

Coarctationneonatalhistopathology
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 683 - 687
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
2. Lababidi, Z. Neonatal transluminal balloon coarctation angioplasty. Am Heart J 1983; 106: 752–753.CrossRefGoogle ScholarPubMed
3. Campbell, M. Natural history of coarctation of the aorta. Br Heart J 1970; 32: 633–640.Google Scholar
4. Crafoord, C, Nylin, G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 1945; 14: 347.CrossRefGoogle Scholar
5. Blalock, A, Park, EA. The surgical treatment of experimental coarctation (atresia) of the aorta. Ann Surg 1944; 119: 445–456.CrossRefGoogle ScholarPubMed
6. Vossschulte, K. Surgical correction of coarctation of the aorta by an “isthmusplastic” operation. Thorax 1961; 16: 338–345.Google Scholar
7. Waldhausen, JA, Nahrwold, DL. Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg 1966; 51: 532–533.Google Scholar
8. van Heurn, LW, Wong, CM, Spiegelhalter, DJ, et al. Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990. Success of extended end-to-end arch aortoplasty. J Thorac Cardiovasc Surg 1994; 1994: 74–85; (discussion 85–86).Google Scholar
9. Torok, RD, Campbell, MJ, Fleming, GA, Hill, KD. Coarctation of the aorta: management from infancy to adulthood. World J Cardiol 2015; 7: 765–775.CrossRefGoogle ScholarPubMed
10. Yetman, AT, Nykanen, D, McCrindle, BW, et al. Balloon angioplasty of recurrent coarctation: a 12-year review. J Am Coll Cardiol 1997; 30: 811–816.CrossRefGoogle ScholarPubMed
11. Hellenbrand, WE, Allen, HD, Golinko, RJ, et al. Balloon angioplasty for aortic recoarctation: results of valvuloplasty and angioplasty of congenital. 1990; 65: 793–797.CrossRefGoogle Scholar
12. Rao, PS. Balloon angioplasty of native coarctation of the aorta. J. Invasive Cardiol. 2000; 12: 407–409.Google ScholarPubMed
13. Beekman, RH, Rocchini, AP, Dick, M 2nd, et al. Percutaneous balloon angioplasty for native coarctation of the aorta. J Am Coll Cardiol 1987; 10: 1078–1084.Google Scholar
14. Rao, PS, Galal, O, Smith, PA, Wilson, AD. Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol 1996; 27: 462–470.CrossRefGoogle ScholarPubMed
15. Wong, D, Benson, LN, Van Arsdell, GS, Karamlou, T, McCrindle, BW. Balloon angioplasty is preferred to surgery for aortic coarctation. Cardiol Young 2008; 18: 79–88.CrossRefGoogle ScholarPubMed
16. Yokoyama, U, Minamisawa, S, Quan, H, et al. Chronic activation of the prostaglandin receptor EP4 promotes hyaluronan-mediated neointimal formation in the ductus arteriosus. J Clin Invest 2006; 116: 3026–3034.Google Scholar
17. Yokoyama, U, Minamisawa, S, Ishikawa, Y. Regulation of vascular tone and remodeling of the ductus arteriosus. J Smooth Muscle Res 2010; 46: 77–87.Google Scholar
18. Yokoyama, U, Iwatsubo, K, Umemura, M, Fujita, T, Ishikawa, Y. The prostanoid EP4 receptor and its signaling pathway. Pharmacol Rev 2013; 65: 1010–1052.CrossRefGoogle ScholarPubMed
19. Yokoyama, U. Prostaglandin E-mediated molecular mechanisms driving remodeling of the ductus arteriosus. Pediatr Int 2015; 57: 820–827.CrossRefGoogle ScholarPubMed
20. Mataıchı, O, Ken, T, Masahıko, K, Katsumı, A, Yuıchıro, Y. Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation. Pediatrics International 2004; 46: 39–47.Google Scholar