Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T20:15:05.754Z Has data issue: false hasContentIssue false
  • English
  • Français

Intravascular ultrasonic assessment of post-operative remodelling of aortic coarctation repaired by use of a subclavian flap

Published online by Cambridge University Press:  18 April 2005

Takashi Shimizu ,
Gengi Satomi  and
Satoshi Yasukochi
Takashi Shimizu
Affiliation:
Nagano Children's Hospital, Department of Pediatric, Nagano, Japan
Gengi Satomi
Affiliation:
Nagano Children's Hospital, Department of Pediatric, Nagano, Japan
Satoshi Yasukochi
Affiliation:
Nagano Children's Hospital, Department of Pediatric, Nagano, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: We have used intravascular ultrasound in an attempt to clarify the extent of vascular remodelling of the aortic arch after the repair of aortic coarctation by use of a subclavian flap. Methods: We investigated 13 patients with coarctation of the aorta, ranging in age from 1.4 to 43.0 months, with a mean of 20.8 months, who underwent aortoplasty by incorporation of a subclavian flap. The mean postoperative period was 19.6 months, with a range from 0.03 to 41.2 months. The luminal morphology of the aortic arch was evaluated by intravascular ultrasound at the time of post-operative catheterization. Results: We observed 3 cases longitudinally. Over the period of observation, we found three types of morphology of the aorta at the site of incorporation of the subclavian flap, namely a snowman shape with two inflection points, a pisiform shape with one inflection point, and a round shape without any points of inflection. There was a correlation between the cross-sectional shapes at the site of the subclavian flap in the postoperative period (p < 0.01). In each case, we measured the cross-sectional area at the site of subclavian flap, at the descending aorta, and at the distal aortic arch. The cross-sectional area, and the increment of the cross-sectional area at the site of subclavian flap, was larger. Conclusion: The shape of the lumen subsequent to repair of aortic coarctation changes progressively from a snowman, to a pisiform, and finally to a round shape. Greater growth of the subclavian flap compared to the native wall of the aorta was observed for at least the first 4 years after repair. This finding may improve our understanding of the remodelling process of the arterial trunks after surgical repair.

Keywords

Intravascular ultrasoundcoarctation of aortasurgical repairremodelling
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 1 , February 2003 , pp. 53 - 57
Copyright
© 2003 Cambridge University Press

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

Pandian NG, Weintraub A, Kreis A, Schwartz SL, Konstam MA, Salem DN. Intracardiac, intravascular, two-dimensional, high-frequency ultrasound imaging of pulmonary artery and its branches in humans and animals. Circulation 1990; 81: 2007–2012.Google Scholar
Ge J, Erbel R, Gorge G, et al. Intravascular ultrasound imaging of arterial wall architecture. Echocardiography 1992; 9: 475–483.Google Scholar
Zehr KJ, Gillinov AM, Redmond JM, et al. Repair of coarctation of the aorta in neonates and infants: a thirty-year experience. Ann Thorac Surg 1995; 59: 33–41.Google Scholar
Cobanoglu A, Thyagarajan GK, Dobbs JL. Surgery for coarctation of the aorta in infants younger than 3 months: end-to-end repair versus subclavian flap angioplasty: is either operation better? Eur J Cardiothorac Surg 1998; 14: 19–26.Google Scholar
Chandran KB, Vonesh MJ, Roy A, et al. Computation of vascular flow dynamics from intravascular ultrasound images. Med Eng Phys 1996; 18: 295–304.Google Scholar
Hardt SE, Just A, Bekeredjian R, Kubler W, Kirchheim HR, Kuecherer HF. Aortic pressure-diameter relationship assessed by intravascular ultrasound: experimental validation in dogs. Am J Physiol. 1999; 276 (3 Pt 2): H1078–1085.Google Scholar
Tong AD, Rothman A, Atkinson RL, Shiota T, Ricou F, Sahn DJ. Intravascular ultrasound imaging of coarctation of the aorta: animal and human studies. Am J Card Imaging 1995; 9: 250–256.Google Scholar
Higashidate Y, Tsuda T, Takamuro M, Tomita H. Intravascular ultrasound imaging shortly after balloon angioplasty of native aortic coarctation in two neonates. Pediatr Cardiol 1999; 20: 377–379.Google Scholar
Kornet L, Jansen JR, Gussenhoven EJ, Versprille A. Determination of the mean cross-sectional area of the thoracic aorta using a double indicator dilution technique. Pflugers Arch 1996; 432: 1069–1073.Google Scholar
Delachartre P, Cachard C, Finet G, Gerfault FL, Vray D. Modeling geometric artefacts in intravascular ultrasound imaging. Ultrasound Med Biol 1999; 25: 567–575.Google Scholar
Ivy DD, Neish SR, Knudson OA, et al. Intravascular ultrasonic characteristics and vasoreactivity of the pulmonary vasculature in children with pulmonary hypertension. Am J Cardiol 1998; 81: 740–748.Google Scholar
Nakamoto A, Yoshitake J, Hase T, et al. Intravascular ultrasound imaging of the pulmonary arteries in primary pulmonary hypertension. Respirology 2000; 5: 71–78.Google Scholar
Mellgren G, Friberg LG, Bjorkerud S. Can we predict the long-term function of the subclavian flap angioplasty? J Thorac Cardiovasc Surg 1992; 104: 932–937.Google Scholar
Kino K, Sano S, Sugawara E, Kohmoto T, Kamada M. Late aneurysm after subclavian flap aortoplasty for coarctation of the aorta. Ann Thorac Surg 1996; 61: 1262–1264.Google Scholar