Cherpak B. Percutaneous stenting of coarctation of the aorta in patients of different age groups

The dissertation contains a theoretical substantiation and a practical solution to a topical scientific task in the field of medicine - coarctation of the aorta hemodynamic correction effectiveness increasing by implementing a differential approach to percutaneous stenting of the isthmus of the aorta depending on the defect anatomical features and the age of the patients. The work was based on the follow-up of 194 patients at the age of 3 days to 60 years with different anatomical and morphological variants of the aortic artery, who were transferred to the inpatient clinic at the "National Amosov Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine" during 2008-2020 pp. There were no cases of in-hospital mortality among patients older than 5 years. The optimally necessary means for endovascular stenting of coarctation of the aorta in children with a discrete form and recoarctation are stents with an open cell, in the case of acute coarctation - endografts; in patients 18-25 years old with a discrete form and recoarctation - stents with an open cell, in cases of sharp coarctation and the presence of a hemodynamic interruption of the aortic isthmus - endografts. Patients over 25 years of age need to use endografts only in cases of hypoplasia of segment A of the aortic arch, presence of aneurysmal protrusion from collaterals, fibromuscular dysplasia, and hemodynamic interruption of the aortic isthmus. In cases of hypoplasia of segment A of the aortic arch, endovascular stenting of CoA can be performed in patients of this age category, both with the use of stents with an open cell and stent-grafts, depending on the availability of technical means and the qualification of a specialist doctor. With a discrete form and recoarctation, patients after the age of 25 should use stents with an open cell. During follow-up pregnant women's cohort (from 2 months to 10 years), all 10 women are alive, have no recoarctation, and no long-term postoperative complications have been identified. Patients who, according to clinical examination and echocardiography, have been diagnosed with CoA during pregnancy with a SBP of more than 160 mmHg, refractory to drug therapy, require MRI during pregnancy and, after that, endovascular stenting of the coarctation site. Algorithms for endovascular treatment of coarctation of the aorta in pregnant women and patients of various ages were developed and put into practice, which allowed to reduce the risk of complications and avoid cases of in-hospital mortality, and to make the procedure safe for the pregnant woman and the fetus.