51
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Willey JZ. Stroke and Other Vascular Syndromes of the Spinal Cord. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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52
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Donati F, Figueroa CA, Smith NP, Lamata P, Nordsletten DA. Non-invasive pressure difference estimation from PC-MRI using the work-energy equation. Med Image Anal 2015; 26:159-72. [PMID: 26409245 PMCID: PMC4686008 DOI: 10.1016/j.media.2015.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/21/2015] [Accepted: 08/31/2015] [Indexed: 01/15/2023]
Abstract
Pressure difference is an accepted clinical biomarker for cardiovascular disease conditions such as aortic coarctation. Currently, measurements of pressure differences in the clinic rely on invasive techniques (catheterization), prompting development of non-invasive estimates based on blood flow. In this work, we propose a non-invasive estimation procedure deriving pressure difference from the work-energy equation for a Newtonian fluid. Spatial and temporal convergence is demonstrated on in silico Phase Contrast Magnetic Resonance Image (PC-MRI) phantoms with steady and transient flow fields. The method is also tested on an image dataset generated in silico from a 3D patient-specific Computational Fluid Dynamics (CFD) simulation and finally evaluated on a cohort of 9 subjects. The performance is compared to existing approaches based on steady and unsteady Bernoulli formulations as well as the pressure Poisson equation. The new technique shows good accuracy, robustness to noise, and robustness to the image segmentation process, illustrating the potential of this approach for non-invasive pressure difference estimation.
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Affiliation(s)
- Fabrizio Donati
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
| | - C Alberto Figueroa
- University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48105, United States.
| | - Nicolas P Smith
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Auckland, Engineering School Block 1, Level 5, 20 Symonds St, Auckland 101, New Zealand.
| | - Pablo Lamata
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Oxford, Department of Computer Science, Wolfson Building, Parks Road, Oxford OX1 3QD, United Kingdom.
| | - David A Nordsletten
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
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53
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Nance JW, Ringel RE, Fishman EK. Coarctation of the aorta in adolescents and adults: A review of clinical features and CT imaging. J Cardiovasc Comput Tomogr 2015; 10:1-12. [PMID: 26639936 DOI: 10.1016/j.jcct.2015.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/12/2015] [Accepted: 11/10/2015] [Indexed: 01/06/2023]
Abstract
Coarctation of the aorta (CoA), while usually identified and treated in the neonatal/infant period, is increasingly seen in adults, either primarily or (more often) following repair. Imaging plays a crucial role in the diagnosis, therapeutic planning, and follow-up of patients with CoA. Clinical management of CoA in adults optimally involves a multidisciplinary team; accordingly, imagers should be familiar with the underlying pathology, associations, and management of CoA in addition to imaging protocoling and interpretation. We will review the relevant clinical and imaging features of CoA, with an emphasis on patients beyond childhood.
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Affiliation(s)
- John W Nance
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Richard E Ringel
- Department of Pediatrics, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA.
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54
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Suradi H, Hijazi ZM. Current management of coarctation of the aorta. Glob Cardiol Sci Pract 2015; 2015:44. [PMID: 26779519 PMCID: PMC4710863 DOI: 10.5339/gcsp.2015.44] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/27/2015] [Indexed: 01/16/2023] Open
Abstract
Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be "cured" upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition.
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Affiliation(s)
- Hussam Suradi
- Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, ChicagoIL, USA; St Mary Medical Center, Community Healtare Network, HobartIN, USA
| | - Ziyad M Hijazi
- Rush Center for Congenital & Structural Heart Disease, Rush University Medical Center, ChicagoIL, USA; Sidra Cardiovascular Center of Excellence, Sidra Medical & Research Center, Doha, Qatar
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Kische S, D'Ancona G, Stoeckicht Y, Ortak J, Elsässer A, Ince H. Percutaneous treatment of adult isthmic aortic coarctation: acute and long-term clinical and imaging outcome with a self-expandable uncovered nitinol stent. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001799. [PMID: 25582143 DOI: 10.1161/circinterventions.114.001799] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To present perioperative and long-term results of percutaneous treatment of adult isthmic coarctation of the aorta by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany). METHODS AND RESULTS Preoperative, perioperative, and long-term clinical and computed tomographic angiography data were collected and analyzed prospectively. A total of 52 consecutive patients were treated with the Sinus-XL stent. Mean age was 36.6 (21-67) years, peak invasive trans-coarctation of the aorta gradient was 54.7 ± 9.9 mm Hg, and upper body hypertension unresponsive to medical treatment was present in all patients. Mean stent diameter and length were 24.2 mm (22-28 mm) and 70.4 mm (40-80 mm), respectively. Eight patients (15.4%) required coarctation of the aorta predilatation. All patients underwent poststent dilatation with a noncompliant balloon. Postoperative peak gradient (3.3 ± 2.5 mm Hg) was reduced significantly (P < 0.001) and minimal aortic diameter was increased significantly (4.6 ± 1.9 versus 18.6 ± 2.5 mm; P < 0.001). All patients were discharged home (mean hospitalization, 3.5 days). At follow-up (47.6 months; 12-84), 1 (1.9%) noncardiovascular mortality was reported. Aortic computed tomography confirmed the absence of stent collapse and secondary migration and documented stability in aortic diameter (18.3 ± 2.7 mm). Thirty patients (57.7%) were completely weaned-off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P < 0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P < 0.001). CONCLUSIONS Adult coarctation of the aorta treatment by means of a self-expandable uncovered stent is safe and durable. The peculiar stent design maintains adequate localized radial strength over time with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimization is immediate and persistent even at long-term follow-up.
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Affiliation(s)
- Stephan Kische
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Giuseppe D'Ancona
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
| | - Yannik Stoeckicht
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Jasmin Ortak
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Albrecht Elsässer
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
| | - Hüseyin Ince
- From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.)
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Abstract
Coarctation of the aorta is a common congenital heart defect through which management has rapidly evolved over the last few decades. The role of transcatheter-based therapies is expanding and seems to be an effective treatment option for coarctation, especially in adults. Patients with prior coarctation repair are at risk of long-term complications related to prior surgeries and associated congenital heart defects, in particular, the risk of restenosis and aortic aneurysm development related to the timing and mode of prior intervention. This article outlines the evaluation and management of adults with unrepaired coarctation and patients after coarctation repair.
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Affiliation(s)
- Lan Nguyen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, University of Pittsburgh, Scaife Hall S560.1, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stephen C Cook
- Department of Pediatrics, The Adult Congenital Heart Disease Center, Heart Institute Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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Galiñanes EL, Krajcer Z. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:136-9. [PMID: 27069944 DOI: 10.12945/j.aorta.2015.14.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 07/24/2015] [Indexed: 11/18/2022]
Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Taelman L, Bols J, Degroote J, Muthurangu V, Panzer J, Vierendeels J, Segers P. Differential impact of local stiffening and narrowing on hemodynamics in repaired aortic coarctation: an FSI study. Med Biol Eng Comput 2015; 54:497-510. [PMID: 26142885 DOI: 10.1007/s11517-015-1336-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 06/15/2015] [Indexed: 12/22/2022]
Abstract
Even after successful treatment of aortic coarctation, a high risk of cardiovascular morbidity and mortality remains. Uncertainty exists on the factors contributing to this increased risk among which are the presence of (1) a residual narrowing leading to an additional resistance and (2) a less distensible zone disturbing the buffer function of the aorta. As the many interfering factors and adaptive physiological mechanisms present in vivo prohibit the study of the isolated impact of these individual factors, a numerical fluid-structure interaction model is developed to predict central hemodynamics in coarctation treatment. The overall impact of a stiffening on the hemodynamics is limited, with a small increase in systolic pressure (up to 8 mmHg) proximal to the stiffening which is amplified with increasing stiffening and length. A residual narrowing, on the other hand, affects the hemodynamics significantly. For a short segment (10 mm), the combination of a stiffening and narrowing (coarctation index 0.5) causes an increase in systolic pressure of 58 mmHg, with 31 mmHg due to narrowing and an additional 27 mmHg due to stiffening. For a longer segment (25 mm), an increase in systolic pressure of 50 mmHg is found, of which only 9 mmHg is due to stiffening.
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Affiliation(s)
- Liesbeth Taelman
- IBiTech-bioMMeda, iMinds Medical IT, Faculty of Engineering and Architecture, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Joris Bols
- Department of Flow, Heat and Combustion Mechanics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Joris Degroote
- Department of Flow, Heat and Combustion Mechanics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Vivek Muthurangu
- Centre for Cardiovascular MR, UCL Institute of Child Health, London Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Joseph Panzer
- Paediatric Cardiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Jan Vierendeels
- Department of Flow, Heat and Combustion Mechanics, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Patrick Segers
- IBiTech-bioMMeda, iMinds Medical IT, Faculty of Engineering and Architecture, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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59
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Diagnostic Value of Transthoracic Echocardiography in Patients with Coarctation of Aorta: The Chinese Experience in 53 Patients Studied between 2008 and 2012 in One Major Medical Center. PLoS One 2015; 10:e0127399. [PMID: 26030197 PMCID: PMC4451082 DOI: 10.1371/journal.pone.0127399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/15/2015] [Indexed: 01/09/2023] Open
Abstract
Although aortography is well known as the "gold standard" for the diagnosis of coarctation of aorta (CoA), the method is invasive, expensive and not readily accepted by some patients. Ultrasound diagnosis for CoA is non-invasive, inexpensive, readily accepted by every patient, and can be repeated as frequently as necessary. The purpose of this presentation is to evaluate the applicability of transthoracic echocardiography for the diagnosis of CoA. The echocardiographic appearances of 53 patients with CoA who had undergone surgery during a 5-year period from January 2008 to October 2012 were analyzed retrospectively, and the results were compared with findings at surgery. Fifty-three patients with CoA include six with isolated CoA and 47 of CoA associated with other cardiac anomalies. Of the 53 operated patients, 48 were correctly diagnosed preoperatively by echocardiography, while two were misdiagnosed as interrupted aortic arch and the diagnosis were missed in three other patients. Thus the diagnostic accuracy rate was 90.6%, and the misdiagnosis rate was 9.4%. Preoperative echocardiographic evaluation offers very satisfactory anatomic assessment in most patients with CoA. It makes preoperative angiography unnecessary. Thus transthoracic echocardiography should be the first-line method for the diagnosis of coarctation of the aorta.
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Abstract
A 9-year-old boy, with a history of repair of severe coarctation of the aorta through balloon angioplasty 2 weeks ago, presented in the emergency paediatric department with symptoms consistent with transient cerebral ischaemia. MRI revealed an area of cerebral infarction in the right frontal lobe. Causes of cerebral ischaemia after aortic coarctation repair are briefly discussed.
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61
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Acquired post-traumatic aortic coarctation presenting as new-onset congestive heart failure: treatment with endovascular repair. Ann Vasc Surg 2015; 29:838.e11-5. [PMID: 25681637 DOI: 10.1016/j.avsg.2014.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/02/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
Abstract
Acquired coarctation of the thoracic aorta is a rare phenomenon in adults. The etiology is often idiopathic, but severe stenosis can develop from prior surgery, blunt thoracic aortic injuries, or severe atherosclerotic/atheroembolic disease. Common symptomatic presentations include refractory upper extremity hypertension and new-onset congestive heart failure. We present the case of a 52-year-old man who developed acquired thoracic aortic coarctation 30 years after a blunt trauma and deceleration injuries to the aorta requiring open surgical aortic repair. He presented with poorly controlled hypertension and new-onset heart failure and was treated surgically with endovascular repair.
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Lemaire A, Cuttone F, Desgué J, Ivascau C, Caprio S, Saplacan V, Belin A, Babatasi G. Late complication after repair of aortic coarctation. Asian Cardiovasc Thorac Ann 2014; 23:423-9. [DOI: 10.1177/0218492314557872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coarctation of the aorta is a congenital malformation that has long been considered completely correctable with appropriate surgery in childhood. However, with the aging of these patients, many late complications have been reported, and this notion must be reevaluated. Methods We retrospectively reviewed all patients who underwent reoperation between 1992 and 2012 in our adult cardiac surgery department following surgical correction of coarctation in childhood; 18 patients over 15-years old were included in the study. Results The median time from coarctation repair to reoperation was 25 years. Patients were reoperated on for several late complications: aortic valve disease secondary to bicuspid aortic valve, ascending aortic aneurysm, recoarctation, aortic arch hypoplasia, pseudoaneurysm, associated recoarctation and pseudoaneurysm, subvalvular aortic obstruction, and descending thoracic aortic aneurysm. One patient died due to an intraoperative complication. In the other cases, the surgical results were satisfactory at the 6-month follow-up. According to literature data, age at coarctation repair and surgical technique appear to be essential factors in late complications: older age and surgical repair with prosthesis interposition are associated with a higher rate of reintervention. Conclusion Patients who have undergone repair of aortic coarctation frequently remain asymptomatic for a long time. Late complications can be appropriately treated when diagnosed early. Consequently, all coarctation patients need careful lifelong follow-up, especially those with congenital aortic valve disease or surgery in childhood with interposition of prosthetic material.
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Affiliation(s)
- Anaïs Lemaire
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Fabio Cuttone
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Julien Desgué
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Calin Ivascau
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Sabino Caprio
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Vladimir Saplacan
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Annette Belin
- Department of Cardiology, University of Caen Basse-Normandie and University Hospital of Caen, France
| | - Gérard Babatasi
- Department of Cardiac Surgery, University of Caen Basse-Normandie and University Hospital of Caen, France
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63
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Onohara D, Sato A, Tasaki Y, Yamada T. Co-existence of severe coarctation of the aorta and aortic valve stenosis in a 65-year-old woman: a case report. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:750-3. [PMID: 24492168 DOI: 10.5761/atcs.cr.13-00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coarctation of the aorta is usually diagnosed and corrected early in life. Survival to more than 60 years of age of a patient with unrepaired coarctation of the aorta is extremely unusual, and the optimal management strategies for such patients are controversial. We describe the case of a woman who was first diagnosed as having coarctation of the aorta and aortic valve stenosis at the age of 65 years and underwent successful aortic valve replacement.
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Affiliation(s)
- Daisuke Onohara
- Department of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Oita, Japan
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64
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The spectrum of congenital heart disease and outcomes after surgical repair among children with Turner syndrome: a single-center review. Pediatr Cardiol 2014; 35:253-60. [PMID: 23933717 DOI: 10.1007/s00246-013-0766-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/18/2013] [Indexed: 12/18/2022]
Abstract
Turner syndrome (TS), a genetic abnormality affecting 1 in 2,500 people, is commonly associated with congenital heart disease (CHD). However, the surgical outcomes for TS patients have not been well described. This study reviewed the spectrum of CHD in TS at the authors' center. The authors report outcomes after coarctation of the aorta (CoA) repair or staged palliation of hypoplastic left heart syndrome (HLHS) and then compare the surgical outcomes with those of non-TS patients undergoing like repair. This retrospective chart review was conducted at the Children's Hospital of Wisconsin from 1999 to 2011. Of the 173 patients with TS, 77 (44.5 %) were found to have CHD. Left-sided obstructive lesions were the most common. However, the spectrum of CHD was wide and included systemic and pulmonary venous abnormalities as well as abnormalities of the coronary arteries. In the comparative analysis of CoA repair, the TS patients younger than 60 days had longer aortic cross-clamp times (24 vs. 16 min; p = 0.001) and longer hospital stays (12 vs. 6 days; p ≤ 0.0001) than the non-TS patients. At the follow-up assessment after 8.8 ± 9.1 years, 17 % of the TS patients had hypertension, but no patient had required reintervention, and no deaths had occurred. Finally, three of the four TS patients with HLHS died within the first year. The spectrum of CHD within TS is wide and not limited to bicuspid aortic valve or CoA. Additionally, patients with TS undergoing CoA repair may have a more challenging early postoperative course but experience outcomes similar to those of non-TS patients. Finally, patients who have TS combined with HLHS remain a challenging population with generally poor survival.
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65
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Rekik S, Jacq L, Bourlon F, Bernasconi F, Quaegebeur JM, Dreyfus G. Large compressive proximal pseudoaneurysm after ascending-to-descending aortic bypass in a 62 year-old patient with severe aortic coarctation: first reported case. Int J Cardiol 2014; 172:e453-7. [PMID: 24491869 DOI: 10.1016/j.ijcard.2014.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Sofiene Rekik
- Cardiology Department, Antibes Hospital Center, France.
| | - Laurent Jacq
- Cardiology Department, Antibes Hospital Center, France
| | | | | | - Jan M Quaegebeur
- Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, NY, USA
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Zhou L, Lui GK, Shenoy R, Taub CC. Coarctation of the aorta associated with Dandy-Walker variant. J Cardiovasc Dis Res 2014; 4:182-6. [PMID: 24396258 DOI: 10.1016/j.jcdr.2013.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022] Open
Abstract
This article reports a rare case of coarctation of the aorta associated with Dandy-Walker variant in a 17-year-old girl. Differential diagnoses of coarctation of the aorta and Dandy-Walker variant are extensively discussed. In addition, standard surgical treatment of coarctation as well as new approaches such as endovascular stenting are described in detail to provide therapeutic insights into her management. Although surgical or endovascular repair of coarctation results in significant improvement of systemic hypertension and is associated with better survival, cardiovascular complications are still very common. Thus, long-term follow-up after repair is required, and high-quality imaging studies such as echocardiography, CT and MRI are warranted.
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Affiliation(s)
- Li Zhou
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - George K Lui
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10461, USA ; Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Rajesh Shenoy
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Cynthia C Taub
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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68
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Krieves MA, Merritt GR, Nichols CS, Schwartz LI, Campbell DN, Bruny JL, Fagan TE, Thompson ME, Ing RJ. Aortoesophageal fistula and coarctation of the aorta in a 15-year-old child. Semin Cardiothorac Vasc Anesth 2013; 17:294-7. [PMID: 24122581 DOI: 10.1177/1089253213506789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delayed presentation of coarctation of the aorta can be associated with severe complications. A challenging case of aortoenteric fistula secondary to an aneurysm from coartation of the aorta presented with massive gastrointestinal hemorrhage. The clinical management of this patient and a review of the literature are presented.
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Affiliation(s)
- Michael A Krieves
- 1Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
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69
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Preventza O, Livesay JJ, Cooley DA, Krajcer Z, Cheong BY, Coselli JS. Coarctation-associated aneurysms: a localized disease or diffuse aortopathy. Ann Thorac Surg 2013; 95:1961-7; discussion 1967. [PMID: 23643549 DOI: 10.1016/j.athoracsur.2013.03.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND We evaluated the occurrence and treatment of aortic aneurysms in coarctation patients. METHODS During 1962 to 2011, 943 cases of coarctation were repaired. Aortic aneurysms were identified in 55 patients (5.8%). Forty-eight had prior coarctation repair (median 23 years earlier, interquartile range 18 to 26 years). Forty-two aneurysms were found in the descending thoracic aorta (76.4%), 18 in the ascending aorta (32.7%), 8 in the left subclavian artery (14.5%), and 1 each (1.8%) in the abdominal aorta, iliac artery, and innominate artery. Twenty-three patients (41.8%) had multiple aneurysms. Twenty-five patients (45.4%) had a bicuspid aortic valve. RESULTS Fifty-three patients' aneurysms were treated surgically. Thirty-five (66.0%) had descending thoracic aortic repair, of whom 11 had aorto-left subclavian bypass. Aortic cross-clamping alone was used in 23 patients, left heart bypass in 4, and circulatory arrest in 8. Eleven patients underwent endovascular repair (20.8%). Proximal aortic aneurysms were repaired in 7 patients (13.2%); 1 had simultaneous antegrade endostent delivery. Four patients had ascending-to-descending aortic bypass (7.3%). Concomitant valve-sparing root repair was performed in 2 patients, Bentall in 4, aortic valve replacement in 3, and coronary artery bypass in 1. One 30-day death occurred (1.9%). Three patients (5.7%) had transient neurologic deficits, 2 (3.8%) required tracheostomy, and 11 (20.8%) had vocal cord paralysis. CONCLUSIONS Coarctation is a marker for aortic aneurysm formation in adults and merits long-term surveillance. Anatomic complexity and associated conditions can complicate the surgical repair. Various open, extra-anatomic, and endovascular techniques may be used.
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Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital/Baylor College of Medicine, Houston, Texas, USA
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70
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Hall DJ, Wallis GA, Co-Vu JG, Lossius MN. Coarctation of the aorta in late adolescence. J Pediatr 2013; 162:646-646.e1. [PMID: 23102791 DOI: 10.1016/j.jpeds.2012.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/13/2012] [Indexed: 11/20/2022]
Affiliation(s)
- David J Hall
- College of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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71
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Cuypers J, Leirgul E, Larsen TH, Berg A, Omdal TR, Greve G. Assessment of vascular reactivity in the peripheral and coronary arteries by Cine 3T-magnetic resonance imaging in young normotensive adults after surgery for coarctation of the aorta. Pediatr Cardiol 2013; 34:661-9. [PMID: 23064837 DOI: 10.1007/s00246-012-0522-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/11/2012] [Indexed: 01/22/2023]
Abstract
This study aimed to investigate whether coarctation of the aorta in infancy indicates an altered vascular reactivity in the peripheral and coronary arteries apart from the secondary effect of hypertension or other complications of the disease. Patients with repaired coarctation of the aorta have a high prevalence of premature cardiovascular complications. The etiology still is not fully understood, and the cause is most likely multifactorial. Endothelial function was assessed by peripheral flow mediated dilation (FMD) and coronary flow reserve (CFR) in a study of 10 control subjects and 10 patients with a successfully repaired coarctation of the aorta (mean age, 20.9 years; 20.5 years after repair). No one had re- or rest-coarctation of the aorta, hypertension, pathologic blood pressure response during exercise, or associated cardiac malformations such as bicuspid aortic valve. CFR was achieved by phase-contrast velocity encoding cine magnetic resonance imaging in the coronary sinus before and during infusion with adenosine (0.14 mg/kg/min). FMD was measured in the brachial artery before and after 5 min of arterial occlusion. A normal CFR and FMD was found in both groups. Most studies have been conducted with large, unselected groups. The current study group represented the best outcome of the coarctation spectrum (i.e., patients with no evidence of a residual gradient across the coarctation site or systemic hypertension). The findings reassuringly suggest that significant endothelial dysfunction and atherosclerotic changes were not present in this selected cohort.
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Affiliation(s)
- Jochem Cuypers
- Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway.
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72
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Murakami T, Takeda A, Yamazawa H, Tateno S, Kawasoe Y, Niwa K. Aortic pressure wave reflection in patients after successful aortic arch repair in early infancy. Hypertens Res 2013; 36:603-7. [PMID: 23407242 DOI: 10.1038/hr.2013.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/10/2022]
Abstract
Despite the apparently successful surgical repair of aortic coarctation, subsequent cardiovascular complications have sometimes been encountered. Aortic pressure wave reflection is one of the risk factors for developing cardiovascular diseases, and an enhancement of the pressure wave reflection has been reported in patients after aortic arch repair. To clarify this issue, the increase in pressure wave reflection was evaluated in patients <15 years old who underwent aortic arch repair. This study enrolled 35 patients after aortic arch repair in early infancy. All patients underwent cardiac catheterization, and in 20 patients, there was no pressure difference within the repaired aortic arch. The aortic pressure waveforms in patients after successful aortic arch repair were recorded using a pressure sensor-mounted catheter, and the augmentation index in the ascending aorta was calculated. The augmentation index in patients after an aortic arch repair was increased compared with control subjects, although there was no pressure difference between the ascending and descending aorta (P<0.0001). The increase in the augmentation index was correlated with the patient's age (r=0.8932, P<0.0001) and with the left ventricular posterior wall thickness (r=0.4075, P=0.0373). In patients who undergo aortic arch repair, the pressure wave reflection is accelerated, even when the aortic arch repair is 'successful'. This increase is one of the possible causes of left ventricular hypertrophy.
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Affiliation(s)
- Tomoaki Murakami
- Department of Pediatrics, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
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73
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Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions. J Thorac Cardiovasc Surg 2013; 145:489-495.e1. [DOI: 10.1016/j.jtcvs.2012.03.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 11/19/2022]
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74
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Menon A, Eddinger TJ, Wang H, Wendell DC, Toth JM, LaDisa JF. Altered hemodynamics, endothelial function, and protein expression occur with aortic coarctation and persist after repair. Am J Physiol Heart Circ Physiol 2012; 303:H1304-18. [PMID: 23023871 DOI: 10.1152/ajpheart.00420.2012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Coarctation of the aorta (CoA) is associated with substantial morbidity despite treatment. Mechanically induced structural and functional vascular changes are implicated; however, their relationship with smooth muscle (SM) phenotypic expression is not fully understood. Using a clinically representative rabbit model of CoA and correction, we quantified mechanical alterations from a 20-mmHg blood pressure (BP) gradient in the thoracic aorta and related the expression of key SM contractile and focal adhesion proteins with remodeling, relaxation, and stiffness. Systolic and mean BP were elevated for CoA rabbits compared with controls leading to remodeling, stiffening, an altered force response, and endothelial dysfunction both proximally and distally. The proximal changes persisted for corrected rabbits despite >12 wk of normal BP (~4 human years). Computational fluid dynamic simulations revealed reduced wall shear stress (WSS) proximally in CoA compared with control and corrected rabbits. Distally, WSS was markedly increased in CoA rabbits due to a stenotic velocity jet, which has persistent effects as WSS was significantly reduced in corrected rabbits. Immunohistochemistry revealed significantly increased nonmuscle myosin and reduced SM myosin heavy chain expression in the proximal arteries of CoA and corrected rabbits but no differences in SM α-actin, talin, or fibronectin. These findings indicate that CoA can cause alterations in the SM phenotype contributing to structural and functional changes in the proximal arteries that accompany the mechanical stimuli of elevated BP and altered WSS. Importantly, these changes are not reversed upon BP correction and may serve as markers of disease severity, which explains the persistent morbidity observed in CoA patients.
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Affiliation(s)
- Arjun Menon
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
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75
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Holloway BJ, Rosewarne D, Jones RG. Imaging of thoracic aortic disease. Br J Radiol 2012; 84 Spec No 3:S338-54. [PMID: 22723539 DOI: 10.1259/bjr/30655825] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aortic pathology can be more complex to understand on imaging than is initially appreciated. There are a number of imaging modalities that provide excellent assessment of aortic pathology and enable the accurate monitoring of disease. This review discusses the imaging of the most common disease processes that affect the aorta in adults, with the primary focus being on CT and MRI.
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Affiliation(s)
- B J Holloway
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
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76
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Sridhar A, Tripathi RR, Sundaram M, Subramanyan R, Vaijyanath P, Cherian KM. Mycotic Aneurysm Complicating a Covered Stent Implanted for Coarctation of the Aorta in a Child. World J Pediatr Congenit Heart Surg 2012; 3:379-81. [DOI: 10.1177/2150135112439079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anuradha Sridhar
- Department of Pediatric Cardiology, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Ravi Ranjan Tripathi
- Department of Pediatric Cardiology, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Meenakshi Sundaram
- Cardiac Pathology, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Raghavan Subramanyan
- Department of Pediatric Cardiology, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Prashanth Vaijyanath
- Pediatric Cardiothoracic Surgery, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Kotturathu Mammen Cherian
- Pediatric Cardiothoracic Surgery, Frontier Lifeline Hospital and Dr K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
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77
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Pádua LMS, Garcia LC, Rubira CJ, de Oliveira Carvalho PE. Stent placement versus surgery for coarctation of the thoracic aorta. Cochrane Database Syst Rev 2012:CD008204. [PMID: 22592728 DOI: 10.1002/14651858.cd008204.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND 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. OBJECTIVES To analyze the effectiveness and safety of stent placement compared with open surgery in patients with coarctation of the thoracic aorta. SEARCH METHODS 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. SELECTION CRITERIA Randomized or quasi-randomized controlled clinical trials that compared patients with CoA undergoing open surgery or stent placement. DATA COLLECTION AND ANALYSIS The review authors independently assessed the studies identified for eligibility for inclusion. We excluded studies after a consensus meeting. MAIN RESULTS 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. AUTHORS' CONCLUSIONS There is insufficient evidence with regards to the best treatment for coarctation of the thoracic aorta. This review suggests a need to perform a randomized controlled clinical trial with emphasis on the allocation method, evaluation of primary outcomes, size and quality of the sample, and long-term follow-up.
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78
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Park JH, Chun KJ, Song SG, Kim JS, Park YH, Kim J, Choo KS, Kim JH, Lee SK. Severe aortic coarctation in a 75-year-old woman: total simultaneous repair of aortic coarctation and severe aortic stenosis. Korean Circ J 2012; 42:62-4. [PMID: 22363387 PMCID: PMC3283758 DOI: 10.4070/kcj.2012.42.1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 09/16/2011] [Accepted: 09/27/2011] [Indexed: 11/22/2022] Open
Abstract
Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta.
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Affiliation(s)
- Ju Hyun Park
- Department of Cardiology, Busan St Mary's Medical Center, Busan, Korea
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79
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Shiga Y, Miura SI, Kumagai N, Mitsutake R, Iwata A, Nishikawa H, Matsuo K, Okabe M, Saku K. Coarctation of the aorta with some collaterals presenting as aortic dissection detected by 64-MDCT. J Cardiol Cases 2012; 5:e48-e50. [PMID: 30532901 PMCID: PMC6265213 DOI: 10.1016/j.jccase.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/13/2011] [Accepted: 09/02/2011] [Indexed: 10/16/2022] Open
Abstract
Coarctation of the aorta with aortic dissection is sometimes seen in cases of Turner syndrome, and most cases are type A aortic dissection, whereas coarctation of the aorta with type B aortic dissection is unusual. Only two cases of coarctation of the aorta presenting as aortic dissection have been reported in Japan, and only a few cases have been reported worldwide. We report here a case of coarctation of the aorta with some collaterals presenting as aortic dissection (type B) detected by 64-multidetector row computed tomography (MDCT). A 36-year-old man was brought to the emergency room complaining of sudden chest pain and back pain. Since he showed highly developed collaterals, he might never have exhibited symptoms or any limits on movement. Three-dimensional image reconstruction enabled detection of the coarctation of the aorta with some collaterals and aortic dissection in the best projection, and enabled assessment of precise anatomical relationship. In the present case, MDCT gave more useful information than cardiac catheterization for planning the surgical repair of coarctation of the aorta with some collaterals presenting as aortic dissection.
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Affiliation(s)
- Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Naoko Kumagai
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryoko Mitsutake
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kunihiro Matsuo
- Department of Emergency and Critical Care Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masanori Okabe
- Department of Cardiology, Saiseikai Fukuoka Hospital, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
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80
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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81
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Kau T, Sinzig M, Gasser J, Lesnik G, Rabitsch E, Celedin S, Eicher W, Illiasch H, Hausegger KA. Aortic development and anomalies. Semin Intervent Radiol 2011; 24:141-52. [PMID: 21326792 DOI: 10.1055/s-2007-980040] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Development of the aorta takes place during the third week of gestation. It is a complex process that can lead to a variety of congenital variants and pathological anomalies. In diagnostic and interventional radiology, knowledge of aortic abnormalities and variant branching sequence is crucially important. This article gives a systematic overview of anatomical variability of the aorta.
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Affiliation(s)
- Thomas Kau
- Department of Radiology, Federal Hospital of Klagenfurt, Klagenfurt, Austria
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82
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Abstract
Untreated thoracic aortic coarctation leads to early death predominantly because of hypertension and its cardiovascular sequelae. Surgical treatment has been available for > 50 years and has improved hypertension and survival. More recently, endovascular techniques have offered a minimally invasive alternative to traditional open repair. Early and intermediate results suggest angioplasty and stenting have an important role in the management of aortic coarctation, particularly in adults and older children.
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Affiliation(s)
- D R Turner
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
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83
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Andersen ND, Bhattacharya SD, Williams JB, McCann RL, Hughes GC. Mycotic aneurysm of the thoracoabdominal aorta in a child with end-stage renal disease. J Vasc Surg 2011; 54:1161-3. [PMID: 21723063 DOI: 10.1016/j.jvs.2011.04.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 02/23/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
Abstract
A 5-year-old child with nephrotic syndrome developed a mycotic saccular thoracoabdominal aortic aneurysm (TAAA) involving the visceral segment within a 4-month period following pneumococcal bacteremia and presumed spontaneous bacterial peritonitis (SBP). Due to continued aneurysm growth and progression to end-stage renal disease, TAAA repair was performed, followed by cadaveric kidney transplantation. This is the first known instance of mycotic aortic aneurysm formation as a consequence of SPB and the first report of TAAA repair in preparation for kidney transplantation in a child.
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Affiliation(s)
- Nicholas D Andersen
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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84
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Caruso M, Bracale UM, Incalcaterra E, Vitale G, Bajardi G, Assennato P, Hoffmann E, Novo S. Total occlusion of aortic arch in a 62-year-old man presenting with acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2011; 12:441-3. [DOI: 10.2459/jcm.0b013e32834102c0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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85
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Gurwitz A, Rosner J, Narine B, Anderson V. External aortic diameter ratios: a reliable method to diagnose preductal aortic coarctation. Fetal Pediatr Pathol 2011; 30:286-95. [PMID: 21609160 DOI: 10.3109/15513815.2011.572957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aortic Coarctation (AC) is associated with sudden infantile death. Current pathological diagnosis depends on absolute vessel size which is prone to errors due to different rates of development. This study explores the use of ratios of the external diameter between the aortic isthmus (AI), ascending aorta (AA) and the descending aortas (DA). Our study found that while the vessel diameter increased with gestational age, the ratios remained constant and are therefore preferable than absolute size. This simple and highly reproducible method will allow more cases of AC that may be misdiagnosed to get a proper pathological diagnosis.
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Affiliation(s)
- Avrahom Gurwitz
- Department of Pediatrics, New York University Langone Medical Center, New York, NY 10016, USA.
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86
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Cicek D, Haberal C, Ozkan S, Muderrisoglu H. A severe coarctation of aorta in a 52-year-old male: a case report. Int J Med Sci 2010; 7:340-1. [PMID: 20975843 PMCID: PMC2962261 DOI: 10.7150/ijms.7.340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/05/2010] [Indexed: 11/05/2022] Open
Abstract
Aortic coarctation is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 52-year-old male. Our patient was relatively asymptomatic until he presented with exertional dyspnea and fatigue in his fifth decade of life. The patient was managed by surgery of aorta. After the 1-year follow-up visit, the patient was in good clinical condition.
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Affiliation(s)
- Davran Cicek
- Başkent University School of Medicine, Department of Cardiology, Antalya, Turkey.
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87
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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88
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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89
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Kountouris E, Potsis T, Nikas D, Siogas K. A severe coarctation of aorta in a 72-year-old female: a case report. CASES JOURNAL 2009. [DOI: 10.1186/1757-1626-0002-0000006308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Aortic coarctation is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 72-year-old female. Our patient was relatively asymptomatic until she presented with exertional dyspnea and fatigue in her seventh decade of life. The patient was managed conservatively with aggressive antihypertensive medication. After the 1-year follow-up visit, the patient was in good clinical condition, without, however, adequate control of blood pressure.
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90
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A severe coarctation of aorta in a 72-year-old female: a case report. CASES JOURNAL 2009; 2:6308. [PMID: 19829783 PMCID: PMC2740002 DOI: 10.4076/1757-1626-2-6308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/11/2009] [Indexed: 11/24/2022]
Abstract
Aortic coarctation is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 72-year-old female. Our patient was relatively asymptomatic until she presented with exertional dyspnea and fatigue in her seventh decade of life. The patient was managed conservatively with aggressive antihypertensive medication. After the 1-year follow-up visit, the patient was in good clinical condition, without, however, adequate control of blood pressure.
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Chung JH, Gunn ML, Godwin JD, Takasugi J, Kanne JP. Congenital thoracic cardiovascular anomalies presenting in adulthood: A pictorial review. J Cardiovasc Comput Tomogr 2009; 3:S35-46. [DOI: 10.1016/j.jcct.2008.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 10/23/2008] [Accepted: 11/25/2008] [Indexed: 01/03/2023]
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93
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Raffel OC, Abraham A, Ruygrok PN, Finucane AK, McGeorge AD, French RL. Cardiac transplantation and aortic coarctation repair in severe heart failure. Asian Cardiovasc Thorac Ann 2008; 14:522-4. [PMID: 17130333 DOI: 10.1177/021849230601400618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 37-year-old man presented with severe dilated cardiomyopathy secondary to occult aortic coarctation. He was successfully managed with combined orthotopic heart transplantation and aortic coarctation repair.
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94
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Tarzamni MK, Nezami N, Ardalan MR, Etemadi J, Noshad H, Samani FG, Toufan M. Serendipitous diagnosis of aortic coarctation by bilateral parvus et tardus renal Doppler flow pattern. Cardiovasc Ultrasound 2007; 5:44. [PMID: 18039358 PMCID: PMC2211282 DOI: 10.1186/1476-7120-5-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 11/26/2007] [Indexed: 12/02/2022] Open
Abstract
Background Aorta Coarctation (AC) is uncommon condition that in most adult patients is asymptomatic. Diagnosis of AC is made during routine physical examination by detection of Blood Pressure (BP) difference between arm and leg. Aim To describe a novel renal artery Doppler flow pattern pathognomonic of aortic coarctation. Methods We enrolled 4 consecutive patients referred to renal artery Doppler Ultrasonography (DU) for diagnostic work-up of secondary arterial hypertension. All met the following inclusion criteria: 1) arterial hypertension at age <30 years; 2) referred for renal DU to rule out renovascular hypertension. Results We found in all 4 patients (age range 10 to 27 years) a bilateral "parvus-tardus" renal Doppler flow pattern. In all, echocardiographic and angiographic work-ups showed aortic coarctation. Conclusion Careful physical examination should be performed in all hypertensive patients. Furthermore, the suspicion of AC can be raised by a bilateral renal arteries "parvus-tardus" Doppler flow pattern in young hypertensive patients screened for secondary hypertension.
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Inoue Y, Ueda T, Taguchi S, Kashima I, Koizumi K, Kimura T. Nonaneurysmal rupture 30 years after patch aortoplasty for coarctation. J Thorac Cardiovasc Surg 2006; 132:1480-1. [PMID: 17140988 DOI: 10.1016/j.jtcvs.2006.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 08/08/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Yoshito Inoue
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.
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Grant P, Murala JSK, Kolli R, Numa A, Awad J, Dilley AV. Massive hematemesis in a child with undiagnosed aortic coarctation and mycotic aneurysm. J Thorac Cardiovasc Surg 2006; 132:1482-3. [PMID: 17140989 DOI: 10.1016/j.jtcvs.2006.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 08/07/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Peter Grant
- Department of Cardiothoracic Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.
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Celik T, Kursaklioglu H, Iyisoy A, Turhan H, Amasyali B, Kocaoglu M, Isik E. Hypoplasia of the descending thoracic and abdominal aorta: a case report and review of literature. J Thorac Imaging 2006; 21:296-9. [PMID: 17110855 DOI: 10.1097/01.rti.0000213555.61752.3a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coarctation of the aorta has been found at necropsy in approximately 1 of every 1550 individuals. The most common location for segmental coarctation (juxtaductal) is the attachment of the ductus arteriosus to the thoracic aorta, which accounts for 98% of focal lesions. Less commonly, a relatively long segment of constriction extends beyond the left subclavian artery. When longer segments of the aorta are narrowed, the term "hypoplasia" is often used. Aortic hypoplasia, an exceedingly rare cardiovascular anomaly, has been described in all portions of the thoracic and abdominal aorta. In the current case report, we described a 21-year-old man presenting with severe hypertension in whom the diagnosis of hypoplasia of the descending thoracic and abdominal aorta was made using with magnetic resonance imaging.
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Affiliation(s)
- Turgay Celik
- Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey.
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98
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Kriaa S, Zbidi M, Hafsa C, Brahem R, Majdoub S, Golli M, Gannouni A. Tardus-parvus Doppler waveform in the renal arteries of an adult patient suggesting aortic coarctation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:458-60. [PMID: 16960881 DOI: 10.1002/jcu.20267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 19-year-old man presented with arterial hypertension without blood pressure difference between his upper and lower extremities. Duplex Doppler sonography was performed to rule out renal artery stenosis and revealed a tardus-parvus pattern in both renal arteries as well as in the abdominal aorta, whereas the left subclavian artery showed a normal waveform, suggesting a more distal obstruction. Aortography confirmed a severe aortic coarctation. Because the typical signs and symptoms of aortic coarctation may not be present, especially in adults, a tardus-parvus pattern in the abdominal aorta and its branches, contrasting with a normal pattern in the supra-aortic arteries, should suggest the diagnosis.
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Affiliation(s)
- Soulef Kriaa
- Department of Radiology, Fattouma Bourguiba Hospital, Rue du ler juin 1995, Monastir 5000, Tunisia
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Lai YQ, Zhou QW, Wei H, Zhang C, Zhang ZG. Intrapulmonary channel for one-stage correction of aortic arch obstruction. Asian Cardiovasc Thorac Ann 2006; 14:402-6. [PMID: 17005888 DOI: 10.1177/021849230601400511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are several methods of surgical repair of aortic coarctation or interruption; the optimal technique is still controversial. The purpose of this study was to assess a new surgical method: intrapulmonary channel for one-stage repair of aortic coarctation or interruption associated with intracardiac anomalies. Between 1993 and 1995, 4 patients with aortic coarctation or interruption and intracardiac anomalies received one-stage surgical correction. Their ages ranged from 5 to 26 years (mean, 16 years). The aortic arch lesions were preductal coarctation in 2, and type B interruption in 2. Coexisting anomalies consisted of patent ductus arteriosus in 4, ventricular septal defect in 3, and aortopulmonary window in 1. An intrapulmonary channel was constructed in all patients, and co-existing anomalies were corrected simultaneously. There was no hospital death or late mortality. A cerebral complication occurred in one patient because of air embolism. Mean follow-up was 9.5 years (range, 8.5-11.5 years). There was no evidence of recoarctation or late aneurysm formation. For selected patients with aortic coarctation or interruption and intracardiac anomalies, an intrapulmonary channel might be an option for one-stage correction.
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Affiliation(s)
- Yong-Qiang Lai
- Division of Cardiac Surgery, Beijing Anzhen Hospital, Capital University of Medical Sciences, 36 Wuluju, Chaoyang District, Beijing 100 029, China.
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Shih MCP, Tholpady A, Kramer CM, Sydnor MK, Hagspiel KD. Surgical and Endovascular Repair of Aortic Coarctation: Normal Findings and Appearance of Complications on CT Angiography and MR Angiography. AJR Am J Roentgenol 2006; 187:W302-12. [PMID: 16928909 DOI: 10.2214/ajr.05.0424] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A variety of treatment options exist for aortic coarctation, both surgical and catheter-based. Knowledge of the normal radiologic appearance of these, as well as their typical complications, is essential for interpretation of CT and MR angiographic studies in these patients. CONCLUSION CT and MR angiography are noninvasive techniques that are well suited to follow patients after coarctation repair.
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Affiliation(s)
- Ming-Chen Paul Shih
- Division of Noninvasive Cardiovascular Imaging, Department of Radiology, University of Virginia Health System, 1215 Lee St., PO Box 800170, Charlottesville, VA 22908, USA
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