Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn
| Autor: | Thomas J. Dorsey, Melville I. Singer, Marshall Rowen |
|---|---|
| Rok vydání: | 1982 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coarctation of the aorta Aortic Coarctation Right ventricular hypertrophy Internal medicine Angioplasty medicine.artery Ascending aorta medicine Humans Cardiac catheterization medicine.diagnostic_test Respiratory distress business.industry Angiography Infant Newborn medicine.disease Blood pressure Cardiology Cardiology and Cardiovascular Medicine Chest radiograph business Respiratory Insufficiency Angioplasty Balloon |
| Zdroj: | American heart journal. 103(1) |
| ISSN: | 0002-8703 |
| Popis: | Postoperative restenosis following coarctation of the aorta (CGA) repair presents a therapeutic dilemma in the newborn. Medical management frequently fails to prevent further deterioration, and reoperation carries a significant risk. The present report demonstrates a new alternative mode of therapy, that of transluminal aortic balloon angioplasty. A male newborn was noted to have cyanosis of the lower half of the body in the first few hours of life. Blood gases revealed ~0~ of 57 torr in the right arm and 27 torr in the right leg. Physical examination on admission demonstrated marked tachypnea with respiratory rate between 80 and go/minute. The pulses were equal in intensity, although the femoral pulses appeared to be slightly delayed when compared to brachial pulses. There was a grade II/VI systolic murmur at the lower left sternal border. Chest radiograph showed no abnormality and the ECG indicated right ventricular hypertrophy. Cardiac catheterization and selective angiocardiography demonstrated COA proximal to a restricted, right-to-left shunting, patent ductus arterious (PDA). Neither a guide wire nor a catheter could be passed across the coarctation into the ascending aorta. The foramen ovale was not patent. The infant was taken to surgery the same day. The PDA was ligated and the COA repaired with Teflon patch graft. He was discharged 3 weeks after surgery on digoxin, furosemide, and formula feedings. He was readmitted at 7 weeks of age because of irritability, difficult breathing, and poor feeding for 2 days. There was moderately severe respiratory distress with respiratory rate 80/minute and heart rate 140 bpm. Systolic blood pressure in the right arm was 108 mm Hg, but the femoral pulses were weakly palpable. The liver was enlarged and chest radiograph demonstrated cardiomegaly, vascular congestion, and interstitial edema. His condition deteriorated over the next 48 hours with progressive respiratory failure. Endotracheal intubation, assisted ventilation, infusion of dopamine, and increased diuretics stabilized his condition without significant improvement. Left heart catheterization performed with a No. 4 French Gensini catheter via the right femoral artery demonstrated a 65 mm Hg peak systolic gradient at the COA level and angiography confirmed the constriction (Fig. 1) with the distal post-stenotic segment clearing slowly. The left ventricle was small with diminished |
| Databáze: | OpenAIRE |
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