JAW Vol.20.No.2 Au@~.t1992:381-5
381
Patch aortoplasty repair of coarctation of the aorta has been performed since 1957(I, 1 as an alternative procedure to resection or subclavian ap angioplasty. Several reports (3-4), however, have demonstrated a 5% to 25% incidence rate of aortic aneurysm formation 3 to I8 years after patch aortoplasty, the primary complication of this procedure. In a previous study (7), we prospectively evaluated 23 patients who underwent patch aortoplasty at the C.S. Mott Children’s Hospital between 1967and 1984and found a prevalence of aortic aneurysmal dilation of 23%. However, there are no data documenting the natural history of aortic aneurysm after patch aortoplasty. The purpose of the present study was to evaluate the natural history of aortic aneurysm in these patients. Longitudinal data were obtained to identify evidence of possible progression of aneurysmai dilation. In
From the Department of Pediatrics, Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan Medical Center, Ann Arbor, Michigan. This studi was presented in part at the Meeting of the Society for Pediatric Research, April 30, 1991. New Orleans, Louisiana. Manuscript received October IO, 1991; revised mantlsctipt received January 9, 1942, accepted February 6, 1992. Address for corresoondw: Robert H. Beekman HI. MD,Department of Pediatrics, Division of Pediatric Cardiology, Box 0204, F 1312, C.S. Mott Children’s Hospital, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109. 01992 by the Amerirs.r
College of Cardiology
addition, we sought to elucidate t alien& and to progressive snrurysmal dilation.
resence of new aneurisk factors for
atients. The study group reported in our previous investigation (7) consisted of 29 consecutive patients evaluated in the pediatric cardiologyclinic between 1985and 1986 e prior patch aortoplasty for coarctatio~ who had und weera 1967 and 1984). Initially, a chest of the aorta radiograph, two-dimensionalechocardiogram and compu?ed tomographic scan were performed in these patients an average of 5.6 k I years (range 2 to 19) after surgical repair. Aortic dilation was definedas sbnormal when the ratio of the diameter of the repair site to that of the was ~1.5. Patients demonstrating abnormalitiesby ~o~i~vasive studies underwent aortography to provide deft data regarding the presence of aneurysm (angi phic aorinto two tic ratio zz1.5) (Fig. I). Patients were claG groups depending on the presence (Group A, n = 7) or absence {Croup 5, n = 22) of a~e~rysmal aortic dilation as defined by the aortic ratio. 0735-1097/92/85.00
382
JACC Vol. 20. No. 2 August 1992:381-5
MENDELSOHN ET AL. ANEURYSM PROGRESSION AFTER PATCH ANGlOPLASTY
gable 1. Pertinent Clinical Data in 26 Patients ~~d~rgo~~g Patch Angioplasty Repair -~ Group A (n=6) Age at
o:>eration (yrJ
Ao rah (5.5 yr postop) Follow-up duration from initial evaluation 10 current study (yrl
Initial
Currrnt a8-e (yrl Systolic BP (mm Hg) Residual pndienr (curreen~ study)
5.73i
1.47
Group B (n=20)
4.39+ 1.19
p Value*
NS
1.64 + 0.06
1.22 f 0.03
0.001
4.17 + 0.17
3.88 4 0.26
NS
15.5 i 2.1
13.2 + 1.6 121 + 4.5
NS
129 + 5.7 17 + 6.4
10 lr 3.4
NS
NS
(mm Hg) *p = NS al
381
Patch aortoplasty repair of coarctation of the aorta has been performed since 1957(I, 1 as an alternative procedure to resection or subclavian ap angioplasty. Several reports (3-4), however, have demonstrated a 5% to 25% incidence rate of aortic aneurysm formation 3 to I8 years after patch aortoplasty, the primary complication of this procedure. In a previous study (7), we prospectively evaluated 23 patients who underwent patch aortoplasty at the C.S. Mott Children’s Hospital between 1967and 1984and found a prevalence of aortic aneurysmal dilation of 23%. However, there are no data documenting the natural history of aortic aneurysm after patch aortoplasty. The purpose of the present study was to evaluate the natural history of aortic aneurysm in these patients. Longitudinal data were obtained to identify evidence of possible progression of aneurysmai dilation. In
From the Department of Pediatrics, Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan Medical Center, Ann Arbor, Michigan. This studi was presented in part at the Meeting of the Society for Pediatric Research, April 30, 1991. New Orleans, Louisiana. Manuscript received October IO, 1991; revised mantlsctipt received January 9, 1942, accepted February 6, 1992. Address for corresoondw: Robert H. Beekman HI. MD,Department of Pediatrics, Division of Pediatric Cardiology, Box 0204, F 1312, C.S. Mott Children’s Hospital, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109. 01992 by the Amerirs.r
College of Cardiology
addition, we sought to elucidate t alien& and to progressive snrurysmal dilation.
resence of new aneurisk factors for
atients. The study group reported in our previous investigation (7) consisted of 29 consecutive patients evaluated in the pediatric cardiologyclinic between 1985and 1986 e prior patch aortoplasty for coarctatio~ who had und weera 1967 and 1984). Initially, a chest of the aorta radiograph, two-dimensionalechocardiogram and compu?ed tomographic scan were performed in these patients an average of 5.6 k I years (range 2 to 19) after surgical repair. Aortic dilation was definedas sbnormal when the ratio of the diameter of the repair site to that of the was ~1.5. Patients demonstrating abnormalitiesby ~o~i~vasive studies underwent aortography to provide deft data regarding the presence of aneurysm (angi phic aorinto two tic ratio zz1.5) (Fig. I). Patients were claG groups depending on the presence (Group A, n = 7) or absence {Croup 5, n = 22) of a~e~rysmal aortic dilation as defined by the aortic ratio. 0735-1097/92/85.00
382
JACC Vol. 20. No. 2 August 1992:381-5
MENDELSOHN ET AL. ANEURYSM PROGRESSION AFTER PATCH ANGlOPLASTY
gable 1. Pertinent Clinical Data in 26 Patients ~~d~rgo~~g Patch Angioplasty Repair -~ Group A (n=6) Age at
o:>eration (yrJ
Ao rah (5.5 yr postop) Follow-up duration from initial evaluation 10 current study (yrl
Initial
Currrnt a8-e (yrl Systolic BP (mm Hg) Residual pndienr (curreen~ study)
5.73i
1.47
Group B (n=20)
4.39+ 1.19
p Value*
NS
1.64 + 0.06
1.22 f 0.03
0.001
4.17 + 0.17
3.88 4 0.26
NS
15.5 i 2.1
13.2 + 1.6 121 + 4.5
NS
129 + 5.7 17 + 6.4
10 lr 3.4
NS
NS
(mm Hg) *p = NS al
