Pathogenesis of aneurysm formation opposite prosthetic patches used for coarctation repair. An experimental study

A. DeSanto, R. G. Bills, H. King, B. Waller, John Brown

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Abstract

Patch graft angioplasty for coarctation repair has been associated with late aneurysm formation opposite the prosthetic patch in some patients. Etiologic possibilities for this aneurysm formation include congenital abnormality of the aortic wall, surgical interruption of the vasa vasorum, intimal disruption because of extensive excision of the coarctation web, and rigidity of the prosthetic patch. To assess the effect of extensive intimal excision on the development of aneurysms, we operated on 12 dogs, performing a left thoracotomy and aortoplasty with Dacron (n = 6) or polytetrafluoroethylene patches (n = 6) and concomitant intimal excision opposite the patch. Ten control dogs underwent angioplasty with Dacron (n = 5) and polytetrafluoroethylene patches (n = 5) without excision of the intima. Serial aortograms of all animals showed aneurysm formation of the aorta opposite the patch in eight of the 12 dogs undergoing intimal excision. In contrast, no aneurysms developed in the control dogs (p < 0.001). An additional five dogs underwent longitudinal aortotomy, intimal excision, and primary closure. Three dogs in this group demonstrated an aneurysm angiographically (p < 0.02). Histologic analysis of the aneurysms and the control aortas revealed hyperplastic ingrowth of the intima over the denuded surface in the animals undergoing intimal excision. The elastic fibers in the media were intact and organized except in two aneurysmal specimens. We conclude that extensive resection of the intima with or without patch angioplasty predisposes aneurysm formation opposite the aortotomy and should be avoided during coarctation repair.

Original languageEnglish
Pages (from-to)720-723
Number of pages4
JournalJournal of Thoracic and Cardiovascular Surgery
Volume94
Issue number5
StatePublished - 1987

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Tunica Intima
Aneurysm
Dogs
Angioplasty
Polyethylene Terephthalates
Polytetrafluoroethylene
Aorta
Vasa Vasorum
Elastic Tissue
Thoracotomy
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Pathogenesis of aneurysm formation opposite prosthetic patches used for coarctation repair. An experimental study. / DeSanto, A.; Bills, R. G.; King, H.; Waller, B.; Brown, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 94, No. 5, 1987, p. 720-723.

Research output: Contribution to journalArticle

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N2 - Patch graft angioplasty for coarctation repair has been associated with late aneurysm formation opposite the prosthetic patch in some patients. Etiologic possibilities for this aneurysm formation include congenital abnormality of the aortic wall, surgical interruption of the vasa vasorum, intimal disruption because of extensive excision of the coarctation web, and rigidity of the prosthetic patch. To assess the effect of extensive intimal excision on the development of aneurysms, we operated on 12 dogs, performing a left thoracotomy and aortoplasty with Dacron (n = 6) or polytetrafluoroethylene patches (n = 6) and concomitant intimal excision opposite the patch. Ten control dogs underwent angioplasty with Dacron (n = 5) and polytetrafluoroethylene patches (n = 5) without excision of the intima. Serial aortograms of all animals showed aneurysm formation of the aorta opposite the patch in eight of the 12 dogs undergoing intimal excision. In contrast, no aneurysms developed in the control dogs (p < 0.001). An additional five dogs underwent longitudinal aortotomy, intimal excision, and primary closure. Three dogs in this group demonstrated an aneurysm angiographically (p < 0.02). Histologic analysis of the aneurysms and the control aortas revealed hyperplastic ingrowth of the intima over the denuded surface in the animals undergoing intimal excision. The elastic fibers in the media were intact and organized except in two aneurysmal specimens. We conclude that extensive resection of the intima with or without patch angioplasty predisposes aneurysm formation opposite the aortotomy and should be avoided during coarctation repair.

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