RESUMO
This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.
RESUMO
La coartación de aorta (CoAo) es una cardiopatía congénita caracterizada por un estrechamiento de la aorta descendente distal al origen de la arteria subclavia izquierda, lo que determina una obstrucción al flujo sanguíneo. Es imperativo realizar un diagnóstico precoz y tratamiento oportuno para evitar complicaciones y la muerte en algunos casos. Se describen las características clínicas y anatómicas, así como el tratamiento y la evolución en niños menores de 15 años asistidos en un hospital pediátrico de referencia de Uruguay.
Coarctation of the aorta (CoAo) is a congenital heart disease characterized by a narrowing of the descending aorta distal to the origin of the left subclavian artery, which determines an obstruction to blood flow. It is imperative to make an early diagnosis and timely treatment to avoid complications and death in some cases. The clinical and anatomical characteristics are described, as well as the treatment and evolution in children under 15 years of age attended in a reference pediatric hospital in Uruguay.
A coarctação da aorta (CoAo) é uma doença cardíaca congênita caracterizada por estreitamento da aorta descendente distal à origem da artéria subclávia esquerda, o que determina uma obstrução ao fluxo sanguíneo. É imperativo fazer um diagnóstico precoce e tratamento oportuno para evitar complicações e morte em alguns casos. São descritas as características clínicas e anatômicas, bem como o tratamento e a evolução em crianças menores de 15 anos atendidas em um hospital pediátrico de referência no Uruguai.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Coartação Aórtica/diagnóstico , Coartação Aórtica/cirurgia , Coartação Aórtica/mortalidade , Estudos Retrospectivos , Distribuição por Idade e SexoRESUMO
Resumen Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.
Abstract Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.
RESUMO
Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.
Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.
RESUMO
A Coarctação de Aorta (CoA) é uma doença congênita que causa estreitamento do vaso ao longo de seu trajeto. Corresponde aproximadamente 5% das doenças cardíacas congênitas. A CoA frequentemente ocorre no arco distal ou na região descendente. As manifestações clínicas são diversas, sendo a hipertensão arterial um marcador importante de gravidade e lesões em orgãos-alvo. Muitos apresentam cefaleia, tontura, pulsação da cabeça e pescoço, fraqueza, claudicação de membros inferiores. Os aneurismas cerebrais correspondem a 50% nos pacientes com CoA, descritos em 1871 por Eppinger. A fisiopatologia é incerta, contudo é de conhecimento o baixo risco de ruptura e que seu tamanho é menor que os demais aneurismas. Raramente os aneurismas são encontrados em pessoas acima de 50 anos sendo mais comum entre 20-30 anos. Os pacientes que sobrevivem após os dois anos sem intervenção evoluem sem complicações nas maioria dos casos. Relato de Caso: paciente, 46 anos, engenheiro e jogador de futebol de salão master federado desde os 15 anos de idade. Apresentou-se na emergência com quadro de cefaleia de forte intensidade, a pior da vida, com paraparesia de membros inferiores, náuseas e vômitos. Ao exame físico estava em mal estado geral, sopro sistólico contínuo em região interescapular e sopro em diamante em região de precordio, pressão arterial de 180 x100 mmHg, normocardio, força muscular grau 2 em membros inferiores, ausência de pulsos pediosos em membros inferiores e anisocoria. Realizado tomografia de crâneo que evidencia a hemorragia subaracnoidea fisher 2, posteriormente com a angiotomografia cerebral constatou dois aneurismas saculares. Realizado eletrocardiograma, ecocardiograma e fundo de olho sem lesões de órgãos-alvo. Devido à característica do sopro evidenciado no exame e ao Rx de tórax com Sinal de Rosler e 3 invertido solicitou-se uma angiotomografia de aorta que mostrou uma CoA da aorta descendente. Comentários: o caso apresentando apresenta um paciente de 46 anos, jogador de futebol profissional sem sintomas até o presente momento, em tratamento irregular para hipertensão arterial desde os 24 anos de idade. Na grande maioria dos casos de CoA os pacientes adultos jovens e idosos evoluem com lesões de órgãos-alvo e complicações decorrentes da hipertensão de longa data. O presente caso demonstra a necessidade de um exame físico completo, a investigação ativa de hipertensão secundária em pacientes jovens
Coarctation of the Aorta (CoA) is a congenital disease that causes narrowing of the vessel along its way. Measure up 5 % of congenital heart disease. CoA often occurs in the distal arch or descending aorta. Clinical manifestations are diverse, arterial hypertension being an important marker of severity and lesions in organs, many show with headache, dizziness, pulsation of the head and neck, weakness, claudication of the legs. Described in 1871 by Eppinger, Cerebral aneurysms correspond to 50% in patients with CoA. Rarely, aneurysms are found in people over 50 years of age and are more common in the 20-30 year age group. Patients who survive without the necessity of intervention, after two years, have being develop uncomplicated. Case Report: patient, 46 years old, engineer and federated master soccer player since 15 years old. Admited in the emergency department reporting the worst headache of his life, associated, paraparesis of lower limbs, nausea and vomiting. At physical exam: continuous systolic murmur in interscapular region and diamond shaped systolic murmur at precordium. Arterial blood pressure was 180 x100 mmHg, normocardium, muscle strength level 2 in lower limbs , absence of pedis's pulses in lower limbs and anisocoria. Cranial CT scan showed hemorrhage subarachnoid (Fisher 2) and the cerebral angiotomography revealed two saccular aneurysms. Electrocardiogram, echocardiogram and fundus of the eye without lesions. Owing to the characteristic of the murmur evidenced at physical exam and the Rosler's Signal, "3 Sign" seen and at chest X- Ray, an aortic angiotomography was performed which showed a Coa of the descending aorta. Conclusion: the case presents a patient of 46 years, professional soccer player with no symptoms until the present moment, in irregular treatment for hypertension since the 24 years of age. In majority of cases of CoA, young-adult and elderly patients develop with target organ damage and complications resulting from long-standing hypertension. Therefore, a complete physical examination, the active investigation of secondary hypertension in young patients, becomes essential.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Coartação Aórtica/diagnóstico , Aneurisma/diagnósticoRESUMO
Objective: The aim of this study was to investigate the presence of early left ventricular (LV) systolic dysfunction in adult patients with aortic coarctation (AoCo) and systemic arterial hypertension (SAH) compared to systemic hypertensive patients without coarctation and healthy controls by speckle tracking. Methods: Sixty-one subjects were studied, who attended consecutively to external consultation. All were submitted to clinical history, resting electrocardiogram, conventional echocardiogram and with Speckle Tracking. Results: 15 patients with AoCo and SAH were in functional class NYHA I, and five in functional class NYHA II. A significant inverse correlation was observed between the global longitudinal deformation and the left ventricular mass index in the AoCo and SAH group and in the hypertensive patients (r = 0.53, p = 0.02; r = 0.52, p < 0.0001, respectively). Conclusions: In patients with AoCo and SAH, global longitudinal deformation and left ventricular mass index are significantly related to subclinical LV dysfunction. These parameters are important and should be taken into account to regulate timely therapeutic behavior.
Assuntos
Coartação Aórtica/complicações , Ecocardiografia/métodos , Hipertensão/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Disfunção Ventricular Esquerda/complicações , Adulto JovemRESUMO
Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8-39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs. 74.39 ± 22.07 g/m(2), p < 0.0001) values did not normalize. There was no significant change in FMD, NMD, PWV and CC or RSCA IMT. In patients with CoA, arterial reactivity is impaired and LV mass, arterial stiffness and thickness are increased. Although stenting is successful to relieve the obstruction resulting in better LV function and mass reduction, arterial structure and function remains abnormal after 1 year of follow-up.
Assuntos
Coartação Aórtica/terapia , Artéria Braquial , Artérias Carótidas , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia , Adolescente , Adulto , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Aortografia/métodos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Brasil , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Criança , Angiografia por Tomografia Computadorizada , Ecocardiografia , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Análise de Onda de Pulso , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Volume Sistólico , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Remodelação Vascular , Rigidez Vascular , Vasodilatação , Função Ventricular Esquerda , Adulto JovemRESUMO
La coartación de aorta es una de las cardiopatías congénitas intervenidas más frecuentes en la edad adulta. En estos pacientes, hay una mayor incidencia de hipertensión arterial durante las actividades diarias y el ejercicio, a pesar de una correcta cirugía reparadora. Dado que la hipertensión arterial, en ocasiones, solo se demuestra al realizar un monitoreo de la tensión arterial (hipertensión arterial oculta), debemos también estar atentos a la aparición de signos indirectos, como el desarrollo de hipertrofia ventricular izquierda.(AU)
Coarctation of the aorta, repaired in childhood, is a congenital heart disease frequently seen in adulthood. In these patients there is a higher incidence ofhypertension during daily activities and exercise despite a correct surgical repair. Since hypertension may only be seen by ambulatory blood pressure monitoring (occult arterial hypertension) we should also look for indirect signs, such as the development of left ventricular hypertrophy.(AU)
RESUMO
La coartación de aorta es una de las cardiopatías congénitas intervenidas más frecuentes en la edad adulta. En estos pacientes, hay una mayor incidencia de hipertensión arterial durante las actividades diarias y el ejercicio, a pesar de una correcta cirugía reparadora. Dado que la hipertensión arterial, en ocasiones, solo se demuestra al realizar un monitoreo de la tensión arterial (hipertensión arterial oculta), debemos también estar atentos a la aparición de signos indirectos, como el desarrollo de hipertrofia ventricular izquierda.
Coarctation of the aorta, repaired in childhood, is a congenital heart disease frequently seen in adulthood. In these patients there is a higher incidence ofhypertension during daily activities and exercise despite a correct surgical repair. Since hypertension may only be seen by ambulatory blood pressure monitoring (occult arterial hypertension) we should also look for indirect signs, such as the development of left ventricular hypertrophy.
Assuntos
Humanos , Masculino , Adolescente , Coartação Aórtica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Hipertrofia Ventricular Esquerda , Síndrome de Down , Doenças Assintomáticas , Hipertensão/diagnósticoRESUMO
Relata-se um caso de uma paciente de 50 anos, dislipidêmica, tabagista e hipertensa, que se queixava de claudicação intermitente progressiva há seis anos (durante primeira consulta ao deambular 100 metros). Ao exame clínico inicial, apresentava-se hipertensa (PA: 150 x 70 mmHg) e baixa amplitude de pulso nas artérias femorais, já em uso de quatro classes diferentes de anti-hipertensivos. Durante investigação diagnóstica, detectou-se, na angioressonância, estenose de 75% do lumen da aorta, 5 cm abaixo das artérias renais. Foi submetida à aortoplastia com stent, com satisfatória evolução clínica e normalização dos níveis pressóricos. Dessa forma, com as características clínicas descritas e com o tratamento utilizado para esta paciente, ilustramos um caso de coarctação atípica da aorta abdominal infrarrenal, patologia rara e com mecanismo fisiopatológico pouco compreendido. Destaca-se a importância do diagnóstico precoce e do tratamento adequado dessa síndrome.
We report a case of a 50 years-old patient, with dyslipidemia, that smokes and has hypertension, who complained of progressive intermittent claudication six years ago (during the first visit when walking 100 meters). The initial clinical examination revealed hypertension (BP: 150 x 70 mmHg) and low pulse width in femoral arteries, already in use in four different classes of antihypertensive drugs. During diagnostic investigation was detected in magnetic resonance angiography, 75% stenosis of the aorta lumen 5 cm below the renal arteries. She underwent angioplasty with a stent, a good outcome and normal blood pressure. Thus, with the clinical characteristics and the treatment used for this patient, we illustrate a case of atypical coarctation of the aorta abdominal below-renal, rare disease with poorly understood pathophysiological mechanism. We emphasize the importance of early diagnosis and appropriate treatment of this syndrome.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Coartação Aórtica , Dislipidemias , HipertensãoRESUMO
OBJECTIVE: To determine the prevalence of Turner syndrome in girls presenting with coarctation of the aorta (CoA). STUDY DESIGN: A total of 132 girls with known structural CoA was identified. Those girls who had no previous karyotype analysis performed were asked to participate in a research study in which a banded karyotype with 50-cell count was performed. RESULTS: Of 132 girls with CoA, 55 (41.7%) had karyotype analysis within 6 months of cardiac diagnosis. Three girls underwent karyotyping later because of clinical concerns. Of the 74 girls with CoA who had not had a karyotype, 38 (51.4%) consented to the study. Results were available for 37 girls. All were 46,XX. Five patients with Turner syndrome were identified in the 95 girls with CoA who had karyotype analysis (4 from early karyotype and 1 diagnosed later), which translated into a minimum prevalence of 5.3% of Turner syndrome in this group of girls with CoA. In addition, one infant with a 20-cell 46,XX karyotype had features of Turner syndrome. CONCLUSION: Our study demonstrated for the first time in a large cohort that 5.3% of girls presenting with CoA are found to have Turner syndrome when karyotyping is performed. Given the spectrum of preventable and treatable health problems after the diagnosis of Turner syndrome, we believe that all girls with CoA should have a karyotype analysis, ideally with at least 50-cell count, at the time of diagnosis of CoA.
Assuntos
Anormalidades Múltiplas/diagnóstico , Coartação Aórtica/diagnóstico , Síndrome de Turner/epidemiologia , Coartação Aórtica/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Cariotipagem , Fenótipo , Prevalência , Estudos Retrospectivos , Síndrome de Turner/diagnóstico , Síndrome de Turner/genética , Vitória/epidemiologiaRESUMO
OBJECTIVE: To investigate the existence of racial/ethnic disparity in mortality risk among children with individual congenital heart defects and identify any other risk factors. STUDY DESIGN: The study cohort, comprising children born between 1983 and 2006 with a selected congenital heart defect, was matched to death records to ascertain vital status. The birth and maternal risk factors were obtained from birth certificates. RESULTS: After adjusting for covariates using a multivariate regression model, the risk of mortality was significantly higher in children of non-Hispanic black mothers with transposition of the great arteries (hazard ratio (HR), 1.31; 95% CI, 1.07-1.60), tetralogy of Fallot (HR, 1.34; 95% CI, 1.06-1.69), and coarctation of the aorta (HR, 1.40; 95% CI, 1.10-1.79), compared with children of non-Hispanic white mothers. Time trends analysis examining the mortality risk by survival age and birth period found a significant decrease in 5-year mortality risk from 1983 to 2003 births, with a nearly 50% reduction for hypoplastic left heart syndrome and coarctation of the aorta across 3 maternal racial/ethnic groups examined. CONCLUSION: Our findings may help identify at-risk populations and mortality risk factors and thereby contribute to improved survival and quality of life for these children across the lifespan.
Assuntos
Cardiopatias Congênitas/etnologia , Mães , Adolescente , Adulto , Negro ou Afro-Americano , Coartação Aórtica/etnologia , Criança , Pré-Escolar , Estudos de Coortes , Suscetibilidade a Doenças , Feminino , Cardiopatias Congênitas/mortalidade , Hispânico ou Latino , Humanos , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Risco , Transposição dos Grandes Vasos/etnologia , Resultado do Tratamento , População Branca , Adulto JovemRESUMO
A Coarctação da aorta (CoA) é responsável por 5% a 7% das cardiopatias congênitas, com uma incidência de 0,3 a 0,4 por 1000 nascidos vivos. A cirurgia foi a única forma de terapia para CoA até 1982, quando a angioplastia tornou-se uma alternativa disponível para o seu tratamento. Recoarctação, aneurisma e dissecção da aorta permaneceram desvantagens de ambos os tratamentos. Para evitar estes inconvenientes, em 1990, endopróteses vasculares foram introduzidas para coarctação nativa e recoarctação e desde então, tornaramse uma abordagem alternativa. A melhor abordagem para o tratamento da CoA, se cirurgia aberta ou a colocação de endoprótese vascular, não está estabelecida. Analisar a efetividade e a segurança da colocação de endoprótese vascular em comparação com a cirurgia aberta em pacientes com CoA. O Grupo Peripheral Vascular Diseases da Cochrane realizou a busca em seu Registro Especializado (última busca Setembro de 2011) e na Central (2011, nº 3). Nós também procuramos em MEDLINE, EMBASE, CINAHL, AMED, Web of Science e LILACS (última busca em setembro de 2011). Foram avaliadas as referências encontradas e aplicados os critérios de inclusão para os estudos selecionados. Não houve restrição de linguagem. Ensaios clínicos controlados aleatorizados ou quase-aleatorizados que compararam pacientes com CoA submetidos a cirurgia aberta ou a colocação de endoprótese vascular. Os autores da revisão avaliaram independentemente os estudos identificados para a elegibilidade de inclusão. Nós excluímos estudos após reunião de consenso. Os critérios de seleção foram aplicados para avaliação do título e resumo de todos os estudos identificados. No total, foram selecionados cinco estudos para a análise de texto completo...
Coarctation of the aorta (CoA) accounts for 5% to 7% of congenital heart disease, with an incidence of 0.3 to 0.4 per 1000 live births. Surgery was the only choice of therapy for CoA until 1982 when balloon angioplasty became an available alternative for its treatment. Re-coarctation, aneurysm and aortic dissection remain the disadvantages of both treatments. To avoid those disadvantages, in 1990 endovascular stents were introduced for native coarctation and re-coarctation and since then they have become an alternative approach to surgical repair. The best approach to treat the CoA, whether open surgery or by stent placement, is not clear. To analyze the effectiveness and safety of stent placement compared with open surgery in patients with coarctation of the thoracic aorta. The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched September 2011) and CENTRAL (2011, Issue 3).We also searched MEDLINE, EMBASE, CINAHL, AMED, Web of Science and LILACS (last searched in September 2011). We evaluated the located references and applied the inclusion criteria to selected studies. There was no restriction on language. Randomized or quasi-randomized controlled clinical trials that compared patients with CoA undergoing open surgery or stent placement. The review authors independently assessed the studies identified for eligibility for inclusion. We excluded studies after a consensus meeting. All identified studies were screened and had the selection criteria applied to the title and abstract. In total, we selected five studies for full-text analysis. After detailed evaluation, we excluded all studies because there was no comparison between stent placement and open surgery...