Evaluation of Follow-up Results of Pediatric Patients with Diagnosis of Aortic Coarctation

Yıl 2022, Cilt: 24 Sayı: 2, 245 - 253, 31.08.2022

Merve Türkay Karaavcı , Hasim Olgun , Fuat Laloğlu , İrfan Oğuz Şahin , Canan Yolcu , Mühlike Güler , Naci Ceviz

https://doi.org/10.24938/kutfd.1007586

Öz

Objective: In this study, clinical features, and follow-up results of pediatric patients with aortic coarctation were examined.

Material and Methods: The echocardiography records of our clinic were reviewed and the patients who were diagnosed with aortic coarctation between January 2000 and January 2017 were determined. The medical records of the patients were retrospectively evaluated and demographic (age, gender, etc.) and clinical features (complaints, accompanying structural heart disease, etc.) and follow-up results (treatment applications, treatment results, etc.) were obtained.

Results: Data of the 98 patients were analyzed. Eighty-two (83.7%) of the patients were diagnosed and treated initially in our clinic. The most common complaint was murmur (42.8%) and the least common complaint was hypertension (1.02%). At first presentation, 10 (10.2%) of the patients had clinical signs of heart failure. Dilated cardiomyopathy was detected in nine patients (9.1%) at diagnosis. The coarctation was isolated in 20.4% of the patients, while the remaining patients had at least one congenital heart disease. Thirty-six of the patients were treated by balloon angioplasty in our clinic, eight patients were treated surgically, and four patients were treated with stent implantation.

Conclusion: Coarctation of the aorta is one of the common congenital heart diseases. In patients who underwent balloon angioplasty, the recoarctation rate is high, but it is an effective method that corrects the patient's clinical condition in the early period. Surgery is an efficient method. Stent angioplasty can be recommended in older children and adolescents.

Anahtar Kelimeler

Aortic coarctation, child, treatment

AORT KOARKTASYONU TANISI ALAN ÇOCUK HASTALARIN İZLEM SONUÇLARININ DEĞERLENDİRİLMESİ

Öz

Amaç: Bu çalışmada aort koarktasyonu tanısı almış çocuk hastaların klinik özellikleri ve izlem sonuçları incelendi.

Gereç ve Yöntemler: Kliniğimizde ekokardiyografi kayıtları için kullanılan program kayıtları taranarak Ocak 2000-Ocak 2017 tarihleri arasında aort koarktasyonu tanısı almış olan hastalar belirlendi. Olguların tıbbi kayıtları retrospektif olarak incelendi ve olguların demografik (yaş, cinsiyet vb.) ve klinik özellikleri (başvuru şikayetleri, eşlik eden yapısal kalp hastalığı vb.) ve izlem sonuçları (tedavi uygulamaları, tedavi sonuçları vb.) çıkarıldı.

Bulgular: Doksan sekiz hastanın verileri analiz edildi. Hastaların 82’si (%83.7) koarktasyon tanılarını ilk kez kliniğimizde alıp tedavi edilmişti. En sık başvuru yakınması üfürüm (%42.8) ve en az yakınma hipertansiyon (%1.02) idi. İlk başvuruda hastaların 10’unda (%10.2) kalp yetersizliğine ait klinik bulgular mevcuttu. Dokuz hastada (%9.1) tanı sırasında dilate kardiyomiyopati varlığı saptandı. Hastaların %20.4’ünde koarktasyon izole olarak bulunurken kalan hastalarda eşlik eden en az bir doğuştan kalp hastalığı mevcut idi. Kliniğimizde 36 hastaya balon anjioplasti uygulanırken, sekiz hasta cerrahi yolla, dört hasta ise stent implantasyonu ile tedavi edildi.

Sonuç: Aort koarktasyonu sık görülen doğuştan kalp hastalıklarından biridir. Balon anjioplasti yapılan hastalarda rekoarktasyon oranı yüksek olmasına karşılık erken dönemde hastanın kliniğini düzelten etkin bir yöntemdir. Cerrahi etkin bir tedavi yöntemidir. Stent anjioplasti büyük çocuk ve adölesanlarda önerilebilir.

Anahtar Kelimeler

Aort koarktasyonu, çocuk, tedavi

Kaynakça

• 1. Capozzi G, Caputo S, Pizzuti R, Martina L, Santoro M, Santoro G et al. Congenital heart disease in live-born children: incidence, distribution, and yearly changes in the Campania Region. J Cardiovasc Med (Hagerstown). 2008;9(4):368-74.
• 2. Gerlis LM. Covert congenital cardiovascular malformations discovered in an autopsy series of nearly 5,000 cases. Cardiovasc Pathol. 1996;5(1):11-9.
• 3. Torok RD, Campbell MJ, Fleming GA, Hill KD. Coarctation of the aorta: Management from infancy to adulthood. World J Cardiol. 2015;7(11):765-75.
• 4. Beekman RH. Coarctation of the Aorta. In: Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F, eds. Moss & Adams’ Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult. 9th ed. China. Wolters Kluwer, 2016:1108-25.
• 5. Rothman A. Interventional therapy for coarctation of the aorta. Curr Opin Cardiol. 1998;13(1):66-72.
• 6. Bernstein D. Epidemiology and Genetic Basis of Congenital Heart Disease. In: Kliegman RM, St. Geme III JW, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia. Elsevier Saunders, 2020:2367-71.
• 7. Yokoyama U, Ichikawa Y, Minamisawa S, Ishikawa Y. Pathology and molecular mechanisms of coarctation of the aorta and its association with the ductus arteriosus. J Physiol Sci. 2017;67(2):259-70.
• 8. 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(2):462-70.
• 9. Mendelsohn AM, Lloyd TR, Crowley DC, Sandhu SK, Kocis KC, Beekman RH. Late follow-up of balloon angioplasty in children with a native coarctation of the aorta. Am J Cardiol. 1994;74(7):696-700.
• 10. Fettah A. Aort koarktasyonu tanısı ile izlenen hastaların retrospektif incelenmesi (tez). Ankara. T.C. Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, 2010.
• 11. O’Brien P, Marshall AC. Coarctation of the aorta. Circulation. 2015;131(9):e363-5.
• 12. Winer HE, Kronzon I, Glassman E, Cunningham JN, Madayag M. Pseudocoarctation and mid-arch aortic coarctation. Chest. 1977;72(4):519-21.
• 13. Bondy C, Bakalov VK, Cheng C, Olivieri L, Rosing DR, Arai AE. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome. J Med Genet. 2013;50(10):662-5.
• 14. Wong SC, Burgess T, Cheung M, Zacharin M. The prevalence of Turner syndrome in girls presenting with coarctation of the aorta. J Pediatr. 2014;164(2):259-63.
• 15. Rothman A. Coarctation of the aorta: an update. Curr Probl Pediatr. 1998;28(2):37-60.
• 16. 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(1):19-26.
• 17. Matsumura S, Masutani S, Senzaki H. Spontaneous regression of severe aortic coarctation in trisomy 18. Cardiology in the Young. 2018;28(5):771-2.
• 18. Chehab G, Abdel-Massih T, Smayra T, Saliba Z. [Spontaneous regression of coarctation of the aorta in infants]. J Med Liban. 2014;62(3):168-72.
• 19. Parra-Bravo JR, Reséndiz-Balderas M, Francisco-Candelario R, García H, Chávez-Fernández MA, Beirana-Palencia LG et al. Balloon angioplasty for native aortic coarctation in children younger than 12 months: immediate and medium-term results. Arch Cardiol Mex. 2007;77(3):217-25.
• 20. He L, Wu L, Liu F, Qi C, Lu Y, Zhang D et al. Balloon angioplasty for native coarctation in children: one year follow-up results. Zhonghua Er Ke Za Zhi. 2014;52(7):535-9.
• 21. Hu ZP, Wang ZW, Dai XF, Zhan BT, Ren W, Li LC et al. Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the aorta: a meta-analysis. Ann Vasc Surg. 2014;28(2):394-403.
• 22. Marshall AC, Perry SB, Keane JF, Lock JE. Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J. 2000;139(6):1054-60.
• 23. Bigdelian H, Sedighi M. Repair of aortic coarctation in infancy: A 10-year clinical experience. Asian Cardiovasc Thorac Ann. 2016;24(5):417-21.
• 24. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Pract ice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714-833.
• 25. Maheshwari S, Bruckheimer E, Fahey JT, Hellenbrand WE. Balloon angioplasty of postsurgical recoarctation in infants: the risk of restenosis and long-term follow-up. J Am Coll Cardiol. 2000;35(1):209-13.
• 26. Lee CL, Lin JF, Hsieh KS, Lin CC, Huang TC. Balloon angioplasty of native coarctation and comparison of patients younger and older than 3 months. Circ J. 2007;71(11):1781-4.
• 27. Shaddy RE, Boucek MM, Sturtevant JE, Ruttenberg HD, Jaffe RB, Tani LY et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation. 1993;87(3):793-9.
• 28. Rao PS, Chopra PS, Koscik R, Smith PA, Wilson AD. Surgical versus balloon therapy for aortic coarctation in infants <or = 3 months old. J Am Coll Cardiol. 1994;23(6):1479-83.
• 29. Molaei A, Merajie M, Mortezaeian H, Malakan Rad E, Haji Heidar Shemirani R. Complications of Aortic Stenting in Patients below 20 Years Old: Immediate and Intermediate Follow-Up. J Tehran Heart Cent. 2011;6(4):202-5.