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Mahadevappa M, Kulkarni P, Attri L, Basavaraj N. Pseudocoarctation of the Arch and the Abdominal Aorta: A Review. Curr Cardiol Rev 2023; 19:73-82. [PMID: 36999416 PMCID: PMC10518887 DOI: 10.2174/1573403x19666230329135028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/25/2022] [Accepted: 01/27/2023] [Indexed: 04/01/2023] Open
Abstract
Pseudocoarctaion of the aorta is a rare congenital anomaly occurring in isolation or with other congenital heart diseases. The anatomical basis of the condition is linked to an elongated, redundant aorta which may affect the arch, or the abdominal aorta rarely giving rise to kink and buckling without causing any significant functional stenosis. It should be carefully differentiated from the common true coarctation of the aorta. No clinical features are specific to pseudo coarctation and are often diagnosed incidentally. Although asymptomatic in the majority, few patients can have nonspecific symptoms and complications due to aneurysm formation, dissection, or rupture of the aorta. Hence Pseudocoarctaion should be closely followed for the onset of symptoms or possible complications. Without recommendations, no specific therapy is indicated in asymptomatic patients, although symptoms and complications warrant definitive treatment. As the natural history of the disease is unknown, the condition, when diagnosed, should be closely followed up for the occurrence of any complications. This article reports a pseudo aortic coarctation involving the arch and a brief literature review of this rare congenital anomaly.
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Affiliation(s)
- Manjappa Mahadevappa
- Department of Cardiology, JSS Hospital, JSSAHER, Mysuru, Karnataka 570004, India
| | | | - Lakshay Attri
- Department of Clinical Pharmacy, JSS College of Pharmacy & JSS Hospital, Mysuru, Karnataka 570004, India
| | - Nidhi Basavaraj
- Department of Medicine, JSSMC, JSSAHER, Mysuru, 570015, India
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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Arıkan AA, Omay O, Çakır Ö, Cesur S, Çardaközü T, Durmaz A, Küçük B, Kanko M. A Pseudocoarctation of the Aorta With a Left Subclavian Artery Aneurysm, A Case Report and A Review of the Literature. Vasc Endovascular Surg 2021; 55:889-896. [PMID: 34142624 DOI: 10.1177/15385744211022536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Here we present a 47-year-old male diagnosed with a pseudocoarctation of the aorta and a funnel-like subclavian artery aneurysm with a large orifice and severe aortic valve insufficiency. The patient underwent a two-stage repair for both pathologies. After an aortic valve replacement, postcardiotomy pericardial effusion occurred and was medically managed. Six months later, the patient underwent a distal arcus aorta and subclavian artery replacement with a left posterolateral thoracotomy as the second stage. Due to the strict adhesions, pulmonary veins were not cannulated and an extracorporeal bypass between the pulmonary artery and femoral artery was used for distal body perfusion. The coincidence of subclavian aneurysms and a pseudocoarctation of the aorta is rare and a literature review was performed to identify treatment options for this pathology.
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Affiliation(s)
- Ali Ahmet Arıkan
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Oğuz Omay
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Özgür Çakır
- Department of Radiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Sevim Cesur
- Department of Anesthesiology and Reanimation, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Tülay Çardaközü
- Department of Anesthesiology and Reanimation, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Ayşegül Durmaz
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Burhan Küçük
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Muhip Kanko
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
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5
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Cordeiro F, Silva Carvalho S, Ferreira A, Moreira JI. Aortic pseudocoarctation: a very rare finding. BMJ Case Rep 2018. [DOI: 10.1136/bcr-2017-222924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim IS, Yun SJ, Lee SH, Kim DH, Cho HH, Kim M. Pseudocoarctation of the aorta presented as chest discomfort with a pulsatile left supraclavicular mass and left arm coldness. Am J Emerg Med 2017; 35:523.e1-523.e3. [DOI: 10.1016/j.ajem.2016.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 01/16/2023] Open
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7
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Hanneman K, Newman B, Chan F. Congenital Variants and Anomalies of the Aortic Arch. Radiographics 2017; 37:32-51. [DOI: 10.1148/rg.2017160033] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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8
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Hypoplasia, Pseudocoarctation and Coarctation of the Aorta – A Systematic Review. Heart Lung Circ 2015; 24:110-8. [DOI: 10.1016/j.hlc.2014.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/23/2014] [Accepted: 08/11/2014] [Indexed: 11/23/2022]
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Akhundova A, Abbasov F, Abbasov E. Kinking of the aorta with calcified aortic valve stenosis: A case report. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:86-87. [PMID: 29450179 PMCID: PMC5801273 DOI: 10.1016/j.ijchv.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/03/2014] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
Congenital kinking of the aorta is an uncommon anomaly consisting of elongation of the aortic arch with kinking at the level of the ductal ligament. Herein we report a case of congenital kinking of the aorta with calcified aortic valve stenosis. The combination of a kinked aorta with severe calcified valve stenosis is very unusual.
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Affiliation(s)
- Afag Akhundova
- Cardiac Surgery Dept., M. Topchubashov Surgical Research Center, Azerbaijan
| | - Fazil Abbasov
- Cardiac Surgery Dept., M. Topchubashov Surgical Research Center, Azerbaijan
| | - Eyvaz Abbasov
- Radiology Dept., M. Topchubashov Surgical Research Center, Azerbaijan
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Atalay MK, Kochilas LK. Familial pseudocoarctation of the aorta. Pediatr Cardiol 2011; 32:692-5. [PMID: 21347833 DOI: 10.1007/s00246-011-9933-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 02/07/2011] [Indexed: 11/30/2022]
Abstract
Pseudocoarctation of the aorta (PCOA) is an unusual congenital malformation of the aortic arch characterized by an acute anterior angulation of the aortic arch at the level of the ligamentum arteriosum with little or no obstruction. This report describes the occurrence of PCOA and other aortic arch abnormalities including true coarctation, right aortic arch, and aneurysms of the proximal and distal aortic arch in three generations of a single family. To our knowledge, a familial form of PCOA has not been described.
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Affiliation(s)
- Michael K Atalay
- Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert School of Medicine of Brown University, Providence, RI 02903, USA
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Sebastià C, Quiroga S, Boyé R, Perez-Lafuente M, Castellà E, Alvarez-Castells A. Aortic stenosis: spectrum of diseases depicted at multisection CT. Radiographics 2003; 23 Spec No:S79-91. [PMID: 14557504 DOI: 10.1148/rg.23si035506] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aortic stenosis, or narrowing of the aortic lumen, has many causes. It may originate in coarctation or pseudocoarctation of the aorta, midaortic dysplastic syndrome, atherosclerosis, Takayasu arteritis, aortic dissection, or various intraaortic and periaortic diseases or as a result of aortic surgical repair. The impedance of blood flow through the stenotic segment may lead to the development of various collateral arterial pathways, according to the location of stenosis. Aortography is the standard technique for evaluating aortic stenosis; however, helical computed tomography (CT), particularly multisection CT, may provide additional information or in some cases may be used instead of arteriography. Multisection CT can depict the aorta and thoracoabdominal collateral pathways in less than 1 minute and provide high-quality arterial-phase imaging data suitable for multiple two-dimensional and three-dimensional reformations. To produce a useful differential diagnosis, the imaging specialist must be able to recognize the type of stenosis and the configuration of collateral circulatory pathways.
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Affiliation(s)
- Carmen Sebastià
- Institut de Diagnòstic per la Imatge, Vall d'Hebron Teaching Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Al Fadley F, Al Manea W, Nykanen DG, Al Fadley A, Bulbul Z, Al Halees Z. Severe tortuosity and stenosis of the systemic, pulmonary and coronary vessels in 12 patients with similar phenotypic features: a new syndrome? Cardiol Young 2000; 10:582-9. [PMID: 11117390 DOI: 10.1017/s1047951100008854] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe what is, to the best of our knowledge, a previously unreported association in patients with similar facial features, skin and joint laxity, of lengthening and tortuosity of systemic, pulmonary and coronary vessels. We evaluated 12 patients with similar phenotypes, from eight different families. Detailed echocardiographic and angiographic evaluations were performed in all, and biopsies of the skin in seven. All patients have elongated facies, prominent ears, micrognathia and laxity of their joints. Angiographic pictures showed a varying degree of lengthening and tortuosity of systemic, pulmonary, and coronary arteries. Pulsatile carotid arteries formed cervical masses in 2 patients, and three had severe renal arterial stenoses. All showed varying degrees of branch and peripheral pulmonary arterial stenosis, necessitating placement of stents in six. Biopsy of the skin proved normal in all seven patients studied, thus excluding cutis laxa, Ehlers-Danlos and Marfan syndromes. The constellation of abnormalities suggests a genetic syndrome of connective tissue etiology. Further genetic studies, and gene mapping, are underway.
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Affiliation(s)
- F Al Fadley
- Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Galeote G, Oliver JM, Domínguez FJ, Fuertes J, Calvo L, Sobrino JA. [Aortic pseudocoarctation complicated by a giant pseudoaneurysm]. Rev Esp Cardiol 2000; 53:287-9. [PMID: 10734760 DOI: 10.1016/s0300-8932(00)75092-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pseudocoarctation of the aorta is an infrequent anomaly caused by the elongation and the congenital kinking of the aorta. We present a case of pseudocoarctation of the aorta with saccular aneurysm complicated with a large pseudoaneurysm. Both, magnetic resonance and aortography showed an aneurysm of the aortic isthmus that extended/progressed as pseudoaneurysm towards the neck. The patient was asymptomatic but due to the high risk of rupture, she underwent surgical reparation. The revision of the literature and our experience with this case show that pseudocoarctation of the aorta is not always a benign pathology and that surgical reparation should be performed in all those cases that are complicated by aneurysm.
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Affiliation(s)
- G Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid.
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