Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Percutaneous Coronary Intervention [PCI] has been a revolutionary advance in cardiology, and many lives have been saved as a result of the widespread application of primary PCI. However, elective PCI has not yet been proven to save lives or reduce the risk of myocardial infarction. Despite this lack of
evidence, elective PCI has been misused and in some cases, abused for nonmedical reasons. The considerable cost of elective PCI can be reduced, and the resources could potentially be utilized for better public health outcomes. The following.article intends to highlight the lack of evidence supporting the use of elective PCI, which is a problem not only in North America and Europe but also throughout the world.
Better regulation of the elective PCI procedure could reduce health care expenditures and divert resources to cardiovascular disease prevention.
Percutaneous Coronary Intervention [PCI] has been a revolutionary advance in cardiology, and many lives have been saved as a result of the widespread application of primary PCI. However, elective PCI has not yet been proven to save lives or reduce the risk of myocardial infarction. Despite this lack of
evidence, elective PCI has been misused and in some cases, abused for nonmedical reasons. The considerable cost of elective PCI can be reduced, and the resources could potentially be utilized for better public health outcomes. The following.article intends to highlight the lack of evidence supporting the use of elective PCI, which is a problem not only in North America and Europe but also throughout the world.
Better regulation of the elective PCI procedure could reduce health care expenditures and divert resources to cardiovascular disease prevention.
Transcatheter closure of atrial septal defect in symptomatic childrenRamachandra Barik
Atrial septal defect (ASD) constitutes 8%–10% of the
congenital heart defects in children. The secundum
ASD accounts for nearly 75% of all ASDs. Since
the introduction of transcatheter device closure for
secundum ASDs in 1976 by King et al., there has been
a paradigm shift in their management. Over the years,
the procedure has evolved significantly to become a
treatment of choice in many institutions. The Amplatzer
septal occluder (ASO) is the most widely used device
owing to its user-friendliness and high success rate.
Various studies have reported transcatheter closure
to be as effective, and with lower complication rate, as
compared to surgical closure.[4,5] However, most of these
studies have included bigger children, adolescents, and
adults. Although a few studies have demonstrated
the feasibility and reasonable safety of transcatheter
ASD device closure in very young children,[7-10] none of
them have addressed important issues like how large
a defect is too large for device closure, how to select
the size of the device, does the length of the interatrial
septum (IAS) matter in the device selection, and is
there a need for using modified techniques to achieve
successful deployment of the device in this subset of
patients which is characterized by relatively large defects
in small hearts.
Background: Arterial stiffness is an independent predictor of cardiovascular disease. Independent of aging and other cardiovascular risk factors, arterial stiffness increases from the proximal to the distal arterial compartments. The overall aim of this work is to establish a longitudinal mechanical mapping of the arterial tree in healthy individuals.
Methods: We report preliminary data quantifying stiffness of the abdominal aorta (AAA), common carotid artery (CCA) and brachial artery (BA) in adolescents. In group-1 subjects (from Melbourne, Australia), cine-loops of the AAA and CCA B-mode data were digitally recorded, whereas in group-2 (from Montreal, Canada), cine-loops of the CCA and BA B-mode data were acquired at the same clinical evaluation. Arterial wall elastic moduli (EIBM) were estimated off-line using our proprietary non-invasive imaging-based biomarker algorithm(ImBioMark).
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. were examined, and heart rate and blood pressure (BP) were
measured in the right arm with the subject in a sitting position. Right
and left lower-extremity limb length was measured from the anterior
superior iliac crest to the plantar surface of the heel. The sites of
maximum Doppler signal for the radial and posterior tibial arteries
were located and marked. Supine systolic blood pressure in all 4
extremities was measured with a Doppler probe and an appropriately
sized cuff on the proximal arm or thigh. The residual resting systolic
coarctation gradient was calculated as the difference in systolic BP
between the right arm and the lower extremity with the highest
measured systolic BP.
Subjects underwent exercise treadmill testing with a standard
Bruce protocol with continuous ECG monitoring. Once fatigued,
subjects immediately assumed a supine position. BP cuffs were
applied simultaneously to each extremity, and systolic BP was
determined with a Doppler probe over the previously marked pulse
site. BP was measured in succession: right arm, right leg, left leg, and
finally left arm. A large-volume air pump allowed rapid cuff
inflation such that all 4 measurements were complete within 1
minute. Resting heart rate and right arm BP were again recorded with
the subject in a sitting position 10 minutes after exercise termination.
Magnetic resonance angiography was performed and interpreted
by a pediatric radiologist who was blinded to the patient’s treatment
history. Measurements of the aorta were obtained in both anteropos-
terior and lateral views just distal to the left common carotid artery,
at the isthmus, at the coarctation repair site, and at the diaphragm. An
aneurysm was defined as an area of dilation that was 150% of the
aortic diameter at the diaphragm or a discrete saccular dilation at the
site that was not present before intervention.4
Subjects who could not be reached or were unable to return for
follow-up evaluation as part of the present study were classified as
group II. For these subjects, the most recent clinical records were
reviewed for aortic arch imaging results and any additional interven-
tions performed since initial BA or surgery.
Comparison of treatment strategies with regard to BP, exercise
performance, and magnetic resonance angiography measurements
was performed with a 2-tailed Student t test. Categorical data
comparisons were performed with a Fisher exact test. Nonparametric
data were compared by the Mann-Whitney U test. Differences were
considered statistically significant for PϽ0.05. All data are ex-
pressed as meanϮSD unless otherwise stated.
Results
Among the 36 original participants randomized to BA
(nϭ20) or surgery (nϭ16), 21 subjects returned for evalua-
tion (11 BA, 10 surgery) between April 2001 and November
2002. The demographics for these group I subjects are
summarized in Table 1. At the time of follow-up evaluation,
there were no significant differences in height, weight, age,
time since initial intervention, or right versus left leg length
between treatment groups. Information gathered from the
most recent clinical records for group II subjects included
data for the remaining 9 BA and 6 surgical subjects (Table 2).
The combined demographics for all subjects initially enrolled
are summarized in Table 3 (groups I and II combined).
Group I Baseline BP Measurements
None of the group I subjects were taking antihypertensive or
other cardiovascular medications at the time of evaluation.
Average resting BPs and coarctation gradients were not
statistically different for either treatment strategy. Relief of
obstruction was achieved with both treatment modalities with
no significant systolic BP gradient measured at rest.
Group I Exercise Testing
Exercise performance for group I subjects is summarized in
Table 4. The range in systolic BP gradient with exercise was
14 to 128 mm Hg for the BA group and Ϫ17 to 152 mm Hg
for the surgical group. The mean difference in BP between
TABLE 1. Long-Term Follow-Up Patient Demographics (Group I)
Demographic
Balloon
Angioplasty Surgery P
No. of subjects 11 10 NS
Age at follow-up, y 20.6Ϯ2.4 18.6Ϯ1.8 NS
Time since initial intervention, y 13.7Ϯ1.9 13.8Ϯ1.2 NS
Age at initial treatment, y 6.8Ϯ2.0 4.9Ϯ1.5 0.02
Weight at initial treatment, kg 23.5Ϯ9.8 17.7Ϯ2.7 NS
Body surface area at initial treatment, m2
0.9Ϯ0.2 0.7Ϯ0.1 NS
Balloon diameter, mm 12.8Ϯ2.2 NA
NA indicates not applicable.
TABLE 2. Chart Review Patient Demographics (Group II)
Demographic Balloon Surgery P
No. of subjects 9 6 NS
Age at follow-up, y 12.5Ϯ4.5 14.3Ϯ3.6 NS
Time since initial intervention, y 6.8Ϯ4.3 7.2Ϯ2.6 NS
Age at initial treatment, y 5.7Ϯ2.0 7.1Ϯ2.4 NS
Body surface area at initial treatment, m2
0.8Ϯ0.1 0.9Ϯ0.2 NS
Weight at initial treatment, kg 19.5Ϯ5.1 22.8Ϯ6.5 NS
Balloon diameter, mm 12.6Ϯ2.5 NA
NA indicates not applicable.
TABLE 3. Combined Group I and Group II Patient Demographics
Demographic
Balloon
Angioplasty Surgery P
No. of subjects 20 16 NS
Age at follow-up, y 16.9Ϯ5.4 17.0Ϯ3.3 NS
Time since initial intervention, y 10.6Ϯ4.7 11.3Ϯ3.7 NS
Age at initial treatment, y 6.3Ϯ2.0 5.7Ϯ2.1 NS
Weight at initial treatment, kg 21.7Ϯ8.1 19.9Ϯ5.2 NS
Body surface area at initial treatment, m2
0.8Ϯ0.2 0.8Ϯ0.2 NS
Balloon diameter, mm 12.7Ϯ2.3 NA
Time since initial intervention to aortic imaging, y 9.9Ϯ5.2 (nϭ19) 11.0Ϯ4.9 (nϭ13) NS
NA indicates not applicable.
3454 Circulation June 28, 2005
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4. upper and lower extremity with exercise exceeded 50 mm Hg
irrespective of initial treatment (PϽ0.001). BA subjects
developed a greater difference in BP between the lower
extremities than was seen among surgical subjects, which was
not present at rest. Heart rate and BP measurements 10
minutes after exercise for group I subjects are also summa-
rized in Table 4. The mean diastolic BP 10 minutes after
exercise was statistically higher for the BA subjects
(PϽ0.05).
Group I Magnetic Resonance Angiography
MRI of the aortic arch was declined by 1 group I surgical
subject because of claustrophobia. Quantitative, noninvasive
imaging of aortic arch dimensions among group I subjects
demonstrated no statistically significant differences between
treatment strategies. The ratio of the aortic diameter at the site
of initial intervention to the diameter of the aorta at the
diaphragm was 0.9Ϯ0.3 for the BA group and 0.9Ϯ0.2 for
the surgical group (PϭNS).
Repeat Interventions
Among the 20 subjects initially treated with BA, 3 underwent
repeat BA, and 3 underwent surgical repair (2 for aneurysm
resection). Two subjects initially treated surgically underwent
BA. One of these subjects later returned for repeat surgery.
Fisher exact test analysis of repeat interventions demon-
strated no difference between treatment groups (PϾ0.05).
Aneurysm Formation
Aneurysms were detected in 7 (35%) of the 20 BA subjects (4
diffuse, 3 discrete). No aneurysms were detected among the
16 surgical subjects (Pϭ0.011). Aneurysms were detected
among 4 BA subjects at a median of 1.03 (range 0.17 to 1.44)
years after their initial intervention. One of these subjects was
referred for elective surgical repair 6.8 years after initial BA
at the discretion of his cardiologist, at which time an
interposition graft was placed. No repeat interventions have
been performed on the other 3 subjects in whom aneurysms
were detected early. Late aneurysms developed in 3 addi-
tional BA subjects despite negative imaging performed Ϸ1
year after the initial procedure. An aneurysm was first
detected in 1 subject 6.4 years after initial intervention. This
subject was electively referred for surgical intervention 4.9
years later, at which time the aneurysm was resected and
patch aortoplasty performed. One subject who initially un-
derwent BA and subsequently underwent surgical resection
and end-to-end anastomosis for recurrent CoA 0.8 years after
BA had no evidence of aneurysm formation 8.4 years after
initial intervention. Repeat imaging performed 6.1 years later
(14.5 years after initial BA) demonstrated an aneurysm at the
former repair site. This subject has not yet been referred for
additional intervention. A third late aneurysm was detected
8.3 years after initial BA. No additional interventions have
been performed given a stable appearance for the past 8 years.
Discussion
Surgical technique for CoA has evolved to overcome ob-
served problems with persistent or recurrent obstruction or
aneurysm formation. An extended end-to-end anastomosis is
currently the preferred treatment for CoA during childhood in
some centers, with BA reserved only for recurrent obstruc-
tion. The report of BA in the treatment of native CoA in an
infant with congestive heart failure in 19835 initiated a
controversy that persists today. Although BA for CoA during
infancy is now rarely performed because of the high inci-
dence of recurrent obstruction, this alternative to surgery in
the treatment of CoA in children remains in widespread
practice. Acute and 1-year follow-up results of a prospective
comparison of BA and surgery for native CoA showed a
similar immediate gradient reduction but a higher risk of
aneurysm formation and possibly restenosis with BA among
36 patients aged 3 to 10 years.1 Because of the continued
controversy about the selection of BA or surgery for the
treatment of native CoA in children, we sought to examine
the long-term outcomes among this previously randomized
group of 36 subjects.
Effective relief of obstruction nearly 14 years after initial
treatment was demonstrated in the present study with both
BA and surgery. Baseline BP measurements and exercise
performance were also equivalent between the 2 groups,
perhaps as a result of the effective relief of aortic arch
obstruction. A statistically significant gradient with exercise
in subjects from both groups was noted and is most likely
related to the inherent vascular dysfunction of the upper
segment known to occur in association with coarctation.6–9
The more rapid normalization of diastolic BP among the
surgical subjects 10 minutes after exercise termination is
interesting but of unknown significance.
The potential development of aneurysms has long been
considered a major limitation to BA. A strikingly higher
TABLE 4. Group I Exercise Performance
Exercise Data Balloon Surgery P
Exercise duration, min 13.5Ϯ2.8 11.4Ϯ3.8 NS
Peak right arm BP, mm Hg 169Ϯ36 162Ϯ34 NS
Peak heart rate, bpm 193Ϯ14 184Ϯ25 NS
Right arm lower-extremity BP difference, mm Hg 53Ϯ33 55Ϯ45 NS
Right vs left lower-extremity BP difference, mm Hg 22Ϯ15 8Ϯ5 Pϭ0.01
10 minutes after exercise
Heart rate, bpm 99Ϯ14 97Ϯ14 NS
Systolic BP, mm Hg 118Ϯ12 118Ϯ12 NS
Diastolic BP, mm Hg 80Ϯ11 68Ϯ12 Pϭ0.03
Cowley et al Balloon Angioplasty vs Surgery for Coarctation 3455
by on October 18, 2007circ.ahajournals.orgDownloaded from
5. incidence of aneurysm formation after BA (35% versus 0%
for surgery) was seen in the present study, with the develop-
ment of 3 aneurysms more than 5 years after the initial
intervention. The 35% incidence of aneurysm formation
among BA patients in the present series is similar to some
early reports in which aneurysm formation occurred in 36%
to 43% of children treated with BA.10,11 More recently,
however, Walhout et al12 found no aneurysms among 32
children with native CoA treated with BA, but the duration of
follow-up was shorter than in the present study. The late
development of aneurysms in the present series demonstrates
the importance of long-term imaging in patients who have
undergone BA. The recently reported 8% incidence of aneu-
rysms among adolescents and adults treated with BA for
native coarctation is much lower than that observed in the
present study, but this may be due to a variety of factors,
including greater vessel wall thickness in older patients.13
Aneurysm formation after surgery in subjects initially treated
with BA, as occurred in 1 subject in the present study, has not
been widely reported. On the contrary, successful surgical
repair after BA in subjects who develop recurrent stenosis has
been described.14 However, the presence of an aneurysm may
complicate surgical intervention, in some cases necessitating
the use of interposition grafts or patches.
In addition to the higher incidence of aneurysm formation,
a greater discrepancy between right and left lower-extremity
BP with exercise was observed among subjects initially
treated with BA. This difference in lower-extremity BP with
exercise is most likely due to femoral artery injury sustained
at the time of intervention. Previous studies have reported the
incidence of iliofemoral stenosis or occlusion after aortic
valvotomy or coarctation BA to be 22% to 58%.15–17 Al-
though we found no associated higher incidence of lower-
limb-length discrepancy in the BA group, and no subjects
complained of asymmetric claudication, the potential for
progressive arterial insufficiency as previously reported may
prove problematic for these subjects.17 The current availabil-
ity of lower-profile balloon catheters may decrease the
incidence of this complication.
These data demonstrate good relief of obstruction and an
equivalent need for repeat interventions for both surgery and
BA in the treatment of CoA in childhood; however, a higher
incidence of aneurysm formation was observed among BA
subjects, with some aneurysms first detected more than 5
years after initial intervention. Although some clinicians may
consider these to be acceptable risks, knowing that future
surgery can still be performed among patients initially re-
ferred for BA, only 50% of subjects initially treated with BA
were free of detected aneurysms and had not been referred for
additional interventions compared with 87.5% of surgical
subjects (Pϭ0.03). Although caution is warranted in extrap-
olating the results of procedures initially performed on this
cohort of children nearly 20 years ago to the current era, the
relatively uncontrolled vascular tearing inherent to BA ap-
pears to be associated with the development of aneurysms,
some of which may develop late. Clinicians should consider
these differences in outcomes and the need for long-term
imaging studies among patients treated with BA when rec-
ommending treatment for native CoA during childhood.
Acknowledgment
This investigation was supported by Public Health Services research
grant number M01-RR00064 from the National Center for Research
Resources.
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