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Background: The objectives of this study were to compare, in the current era, the immediate results, complications, and midterm outcomes obtained by surgical repair versus transcatheter treatment of coarctation of the aorta (CoA). Methods: The study was of retrospective nature and included 80 consecutive patients ≥1 year old (mean age 12 ± 10 years) treated for an isolated CoA in 4 university centers in Quebec between 1998 and 2004. Fifty patients underwent aortic angioplasty, with stent implantation in 19, and 30 had surgical repair. Immediate results, procedural complications, clinical events, and the incidence of aortic aneurysm at follow-up were compared between groups. Results: There were no differences between the 2 groups in clinical baseline characteristics. Percentage reduction in peak systolic pressure gradient across the coarctation was similar between the 2 groups (angioplasty 72% ± 23% vs surgery 75% ± 18%, P = .55). Procedure-related complications occurred more frequently after surgical repair compared with angioplasty (50% vs 18%, P = .005), and median hospitalization time was longer in the surgical than in the angioplasty group (7 vs 1 day, P < .001). At 38 ± 21 months'' follow-up, no patient in the surgical group and 16 patients in the angioplasty group had at least 1 aortic reintervention (0% vs 32%, P < .0001). The presence of an aortic aneurysm was diagnosed more frequently in the angioplasty group compared with the surgical group (24% vs 0%, P = .01). Conclusion: Aortic angioplasty provided comparable immediate hemodynamic results to surgery, with reduced morbidity and hospitalization length for the treatment of CoA in patients ≥1 year old. However, angioplasty was associated with a higher rate of reintervention and aneurysm formation at a mean follow-up of 3 years. [Copyright &y& Elsevier]

This study compared gradient echo magnetic resonance imaging, spin echo magnetic resonance imaging, echocardiography, and echocardiography with x-ray cineangiography in the evaluation of major aortopulmonary collateral arteries. Twelve patients (ages 9 months to 35 years, mean 11 +/- 11 years) with known or suspected major aortopulmonary collateral arteries were studied. The aortic insertion and proximal course of 29 major aortopulmonary collateral arteries demonstrated by x-ray contrast angiography were shown in all 29 cases by gradient echo magnetic resonance imaging but in only 23 of the 29 cases by spin echo magnetic resonance imaging. Color Doppler-echocardiography detected aortopulmonary collateral arteries in four patients but did not define the proximal course or distal anatomy. Gradient echo images of distal aortopulmonary collateral anatomy were qualitatively superior to spin echo images. The contrast-to-noise ratio between the vessel lumen and adjacent lung was greater for gradient echo (6.06 +/- 2.91) than for spin echo (1.45 +/- 1.13)(p < 0.05). Gradient echo magnetic resonance imaging is a useful method for identification and characterization of aortopulmonary collateral arteries in patients of all ages and is superior to spin echo magnetic resonance imaging and echocardiography.

Transcatheter Gianturco coil embolization of 26 superfluous but hemodynamically significant vascular connections was attempted in 19 patients with congenital heart disease. There were 18 aortopulmonary collaterals, two vessels involved in pulmonary sequestration, two surgical aortopulmonary shunts (one inadvertently connected from the left subclavian artery to a left upper pulmonary vein), two cases of patent ductus arteriosus, one regurgitant left ventricular-to-descending aorta conduit, and a left superior vena cava-to-left atrium post Fontan procedure. The mean ratio of coil to vessel diameter was 1.6 +/- 0.7, and a mean of 1.5 +/- 1.1 coils were used per vessel. Occlusion was achieved in 24 of 26 attempts (92%), being complete in 21 (81%) and near complete (> 80% decrease in flow) in three (12%). Two attempts failed; a tortuous aortopulmonary collateral was engaged by the delivery catheter but the coil could not be advanced past an acute angle, and another aortopulmonary collateral had a narrow origin and enlarged distally, resulting in coil migration to a distal pulmonary artery branch. One patient had a transient decrease in leg pulses that resolved spontaneously. Fever occurred in four patients (21%) within 12 hours of coil placement, and resolved in all without sequelae or complications. A variety of undesirable vascular connections in patients with congenital heart disease can be safely and effectively treated by percutaneous coil embolization.

Twelve patients more than 8 years of age with complex congenital heart disease were evaluated prospectively with nuclear magnetic resonance (NMR) imaging and with echocardiographic and angiographic imaging techniques. The subpulmonary region, main pulmonary artery, right and left pulmonary arteries, and aorticopulmonary shunts were clearly visualized by means of NMR imaging in all patients. Angiography defined the subpulmonary region and main pulmonary artery in all patients, the right and left pulmonary arteries along their length in 11 of 12 patients, and aorticopulmonary shunts in seven of eight patients. Except for the right pulmonary artery, echocardiography defined the remaining structures in less than or equal to 50% of patients. Measurement of the pulmonary artery diameters on NMR images correlated well with the angiographic measurements of both the left (r = 0.96) and right (r = 0.94) pulmonary arteries. These results suggest that NMR imaging may be the preferable noninvasive imaging technique for defining the anatomy of the subpulmonary region, main and left pulmonary arteries, and aorticopulmonary shunts in older patients with congenital cardiovascular disease and that it compares well with the angiographic standard.

Although aortic valve atresia is usually associated with severe underdevelopment of the mitral apparatus and left ventricle in rare cases of aortic atresia, the left ventricle may be of normal size, or even enlarged. This occurrence seems related to the presence of a significant ventricular septal defect. We have presented the morphologic findings in seven patients with aortic atresia and normally developed left ventricle, (six necropsied patients, and one studied angiocardiographically). Four autopsied patients had conal type ventricular septal defects, characterized in three by conoventricular malalignment. Subaortic atresia in these patients resulted from leftward deviation of the conal septum. One patient with aortic atresia and well-developed left ventricle had a membranous defect, and one patient had a complete A-V canal. The ventricular septal defect in the patients with conoventricular malalignment are very similar to the conal VSD observed in patients with aortic arch interruptions. Although ultimate survival with these uncommon groupings of anomalies necessitates patency of the ductus arteriosus, clinical recognition rests on (1) awareness of its existence, (2) ultrasonography, and (3) selective biventricular and aortic angiography. It is possible that some of these patients might be candidates for ventriculo-aortic reconstitiution.

The diameters of the ascending aorta, coronary ostia, and proximal coronary arteries were measured in autopsy specimens from 51 infants with hypoplastic left heart syndrome and 18 normal infant heart specimens. Standard cross sections were prepared from 35 of the hypoplastic left heart syndrome hearts, and histologic indices of myocardial viability and fibrosis were determined. The diameters of the coronary arteries and ostia in hypoplastic left heart syndrome were not different from the values in control specimens. Little fibrosis was found but extensive myocardial necrosis was present. The degree of fibrosis and necrosis did not correlate significantly with any of the arterial or ostial diameters. The extent of myocardial preservation in the hypoplastic left heart syndrome, which may substantially limit the success of surgical palliation, cannot be predicted from these morphologic measurements. The observed myocardial damage appeared to be acquired postnatally, implying that early vigorous treatment of these infants may be necessary to preserve myocardial function.