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Shafeeq A, M N, G P, Ramesh R, Christudhas A. Pseudocoarctation of the Aorta: A Rare Incidental Finding During a Preoperative Assessment. Cureus 2024; 16:e65574. [PMID: 39192894 PMCID: PMC11349246 DOI: 10.7759/cureus.65574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/29/2024] Open
Abstract
Pseudocoarctation of the aorta (PCoA) is a rare congenital anomaly characterized by the abnormal kinking of the thoracic aorta. It is often incidentally diagnosed but gained clinical significance due to its propensity to develop aortic aneurysm and rupture. A standard diagnostic and treatment algorithm for PCoA is lacking, and also, the natural history of the disease is not well studied. We present here a case of PCoA with a fusiform aneurysm of the thoracic aorta to emphasize the need to differentiate it from true coarctation and to rule out associated complications.
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Nair PJ, Pfaller MR, Dual SA, McElhinney DB, Ennis DB, Marsden AL. Non-invasive Estimation of Pressure Drop Across Aortic Coarctations: Validation of 0D and 3D Computational Models with In Vivo Measurements. Ann Biomed Eng 2024; 52:1335-1346. [PMID: 38341399 DOI: 10.1007/s10439-024-03457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
Blood pressure gradient ( Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0D and 3D deformable wall simulations. Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17). 0D simulations were performed first and used to tune boundary conditions and initialize 3D simulations. Δ P across the CoA estimated using both 0D and 3D simulations were compared to invasive catheter-based pressure measurements for validation. The 0D simulations were extremely efficient ( ∼ 15 s computation time) compared to 3D simulations ( ∼ 30 h computation time on a cluster). However, the 0D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3D simulations improved this to 88%. Overall, a combined approach, using 0D models to efficiently tune and launch 3D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Affiliation(s)
- Priya J Nair
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Martin R Pfaller
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Seraina A Dual
- Department of Biomedical Signaling and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Doff B McElhinney
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Daniel B Ennis
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA.
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA.
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA.
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Renz DM, Böttcher J, Eckstein J, Huisinga C, Pfeil A, Lücke C, Gutberlet M. [Imaging of congenital heart defects with a focus on magnetic resonance imaging and computed tomography]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:382-391. [PMID: 38656344 DOI: 10.1007/s00117-024-01301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
CLINICAL ISSUE Due to advances in diagnostics and therapy, the survival rate of patients with congenital heart defects is continuously increasing. The aim of this review is to compare various imaging modalities that are used in the diagnosis of congenital heart defects. METHODS Transthoracic echocardiography is the imaging method of choice in the presence of a congenital heart defect because of its wide availability and non-invasiveness. It can be complemented by transesophageal echocardiography, cardiac catheterization, computed tomography (CT), and magnetic resonance imaging (MRI) of the heart and vessels close to the heart. METHODICAL INNOVATIONS The radiation exposure of CT examinations of the heart is continuously decreasing because of improved technologies. MRI is also being continuously optimized, e.g., by the acquisition of MR angiographies without contrast medium application or a thin three-dimensional (3D) visualization of the entire heart with the possibility of reconstruction in all spatial planes (whole-heart technique) as well as 2D to 4D flow. PRACTICAL RECOMMENDATION Due to the complexity of congenital heart defects and the variety of possible pathologies, the choice of imaging modality and its exact performance has to be coordinated in an interdisciplinary context and individually adapted.
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Affiliation(s)
- Diane Miriam Renz
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | | | - Jan Eckstein
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Carolin Huisinga
- Institut für Diagnostische und Interventionelle Radiologie, Arbeitsbereich Kinderradiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Lücke
- Abteilung für Diagnostische und Interventionelle Radiologie, Universität Leipzig - Herzzentrum Leipzig, Leipzig, Deutschland
| | - Matthias Gutberlet
- Abteilung für Diagnostische und Interventionelle Radiologie, Universität Leipzig - Herzzentrum Leipzig, Leipzig, Deutschland
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Martins MM, Saraiva S, Cunha S, Rasteiro C, Silva AMD, Costa C. Kinking of the Aorta in the Third-trimester Ultrasound Scan. J Med Ultrasound 2024; 32:93-95. [PMID: 38665351 PMCID: PMC11040496 DOI: 10.4103/jmu.jmu_226_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/09/2022] [Accepted: 05/27/2022] [Indexed: 04/28/2024] Open
Affiliation(s)
- Matilde Matos Martins
- Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Susana Saraiva
- Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Sara Cunha
- Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Cátia Rasteiro
- Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
- Health Science Faculty, Beira Interior University, Covilhã, Portugal
| | - António Marinho Da Silva
- Department of Pediatric Cardiology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
| | - Cristina Costa
- Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
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Yoshitatsu M, Kakizawa Y, Misumi Y, Shirasaki Y, Kitahara M, Nishi H. An operative case of pseudocoarctation with chronic dissection. Asian Cardiovasc Thorac Ann 2023; 31:805-808. [PMID: 37844582 DOI: 10.1177/02184923231205966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
A 47-year-old man with a history of hypertension was found to have a prominent aortic knob on routine chest X-ray and was referred to our hospital. Enhanced computed tomography angiography showed severe flexion at the proximal descending aorta with chronic type B dissection localized to the flexion region. Graft replacement of the distal aortic arch was performed. Surgical management of chronic pseudocoarctation dissection is sparsely reported in the literature because of its rare occurrence. We present an operative case of a patient with chronic dissection of distal aortic arch pseudocoarctation.
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Affiliation(s)
- Masao Yoshitatsu
- Department of Cardiovascular Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yumi Kakizawa
- Department of Cardiovascular Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Yusuke Misumi
- Department of Cardiovascular Surgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukie Shirasaki
- Department of Cardiovascular Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Nair PJ, Pfaller MR, Dual SA, McElhinney DB, Ennis DB, Marsden AL. Non-invasive estimation of pressure drop across aortic coarctations: validation of 0D and 3D computational models with in vivo measurements. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.05.23295066. [PMID: 37732242 PMCID: PMC10508787 DOI: 10.1101/2023.09.05.23295066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Purpose Blood pressure gradient (Δ P ) across an aortic coarctation (CoA) is an important measurement to diagnose CoA severity and gauge treatment efficacy. Invasive cardiac catheterization is currently the gold-standard method for measuring blood pressure. The objective of this study was to evaluate the accuracy of Δ P estimates derived non-invasively using patient-specific 0 D and 3 D deformable wall simulations. Methods Medical imaging and routine clinical measurements were used to create patient-specific models of patients with CoA (N = 17 ). 0 D simulations were performed first and used to tune boundary conditions and initialize 3 D simulations. Δ P across the CoA estimated using both 0 D and 3 D simulations were compared to invasive catheter-based pressure measurements for validation. Results The 0 D simulations were extremely efficient (~15 secs computation time) compared to 3 D simulations (~30 hrs computation time on a cluster). However, the 0 D Δ P estimates, unsurprisingly, had larger mean errors when compared to catheterization than 3 D estimates (12.1 ± 9.9 mmHg vs 5.3 ± 5.4 mmHg). In particular, the 0 D model performance degraded in cases where the CoA was adjacent to a bifurcation. The 0 D model classified patients with severe CoA requiring intervention (defined as Δ P ≥ 20 mmHg) with 76% accuracy and 3 D simulations improved this to 88%. Conclusion Overall, a combined approach, using 0 D models to efficiently tune and launch 3 D models, offers the best combination of speed and accuracy for non-invasive classification of CoA severity.
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Affiliation(s)
- Priya J. Nair
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Martin R. Pfaller
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Seraina A. Dual
- Department of Biomedical Signaling and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Doff B. McElhinney
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Daniel B. Ennis
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Division of Radiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Alison L. Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department of Pediatrics - Cardiology, Stanford University, Stanford, CA, USA
- Maternal and Child Health Research Institute, Stanford University, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
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van Staveren MDB, Grinwis GCM, den Toom ML, Szatmári V. Preductal Segmental Tubular Aortic Hypoplasia in Perinatally Died Stabyhoun Puppies. Animals (Basel) 2023; 13:2423. [PMID: 37570236 PMCID: PMC10417157 DOI: 10.3390/ani13152423] [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: 05/12/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND A high perinatal mortality rate in the Stabyhoun breed prompted one of the Dutch breeding organizations to start an investigation. Preductal segmental tubular aortic hypoplasia is an extremely rarely documented congenital vascular anomaly in dogs, and it is suspected to be the result of constriction of ectopic ductal tissue in the aortic wall at birth. METHODS Over a period of 18 months, Stabyhoun puppies that were stillborn, died or were euthanized before 3 weeks of age were submitted to post-mortem examination at the reporting institution. Pathologic findings were documented. RESULTS Eight Stabyhoun puppies were submitted during the study period. In five of them, a severe preductal segmental tubular aortic hypoplasia was found. Two of the five puppies were stillborn, and three died spontaneously or were euthanized. CONCLUSIONS Preductal tubular aortic hypoplasia was found in an unusually high frequency in the examined Stabyhoun puppies. Because the condition is believed to cause clinical signs only after birth, this anomaly cannot explain the death of the stillborn puppies. However, it might be responsible for cardiogenic pulmonary edema in the postnatal period. Routine dissection of the great vessels in perinatally deceased puppies would help to establish the prevalence of congenital anomalies of the aorta.
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Affiliation(s)
- Marie D. B. van Staveren
- Department Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Guy C. M. Grinwis
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Marjolein L. den Toom
- Department Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Viktor Szatmári
- Department Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
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Gong T, Zhang F, Feng L, Zhu X, Deng D, Ran T, Li L, Kong L, Sun L, Ji X. Diagnosis and surgical outcomes of coarctation of the aorta in pediatric patients: a retrospective study. Front Cardiovasc Med 2023; 10:1078038. [PMID: 37554364 PMCID: PMC10405080 DOI: 10.3389/fcvm.2023.1078038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) is a common congenital cardiovascular malformation, and improvements in the diagnostic process for surgical decision-making are important. We sought to compare the diagnostic accuracy of transthoracic echocardiography (TTE) with computed tomographic angiography (CTA) to diagnose CoA. METHODS We retrospectively reviewed 197 cases of CoA diagnosed by TTE and CTA and confirmed at surgery from July 2009 to August 2019. RESULTS The surgical findings confirmed that 19 patients (9.6%) had isolated CoA and 178 (90.4%) had CoA combined with other congenital cardiovascular malformations. The diagnostic accuracy of CoA by CTA was significantly higher than that of TTE (χ2 = 6.52, p = 0.01). In contrast, the diagnostic accuracy of TTE for associated cardiovascular malformations of CoA was significantly higher than that of CTA (χ2 = 15.36, p < 0.0001). Infants and young children had more preductal type of CoA, and PDA was the most frequent cardiovascular lesion associated with CoA. The pressure gradient was significantly decreased after the first operation, similar at 6 months, 1 year, and 3 years follow-ups by TTE. CONCLUSIONS CTA is more accurate as a clinical tool for diagnosing CoA; however, TTE with color Doppler can better identify associated congenital cardiovascular malformations. Therefore, combining TTE and CTA would benefit clinical evaluation and management in patients suspected of CoA. TTE was valuable for post-operation follow-up and clinical management.
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Affiliation(s)
- Ting Gong
- Department of Ultrasound, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyan Zhang
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Lingxin Feng
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Deng
- School of Medical Imaging, Changsha Medical University, Changsha, China
| | - Tingting Ran
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liling Li
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kong
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Xiaojuan Ji
- Department of Ultrasound, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
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Abuji K, Vaddavalli VV, Kumar D, Maheshwari N, Gorsi U, Kaman L, Savlania A. Coarctation of the aorta in a young female treated with left subclavian artery to descending thoracic aorta bypass: a case report. J Vasc Bras 2023; 21:e20220018. [PMID: 36660101 PMCID: PMC9844980 DOI: 10.1590/1677-5449.202200182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/22/2022] [Indexed: 01/15/2023] Open
Abstract
Coarctation of the aorta is a rare congenital abnormality, with an incidence of 6-8% of all congenital heart problems. It is usually diagnosed in childhood during routine clinical examination and adults mostly present with hypertension. Various investigations like transthoracic echocardiography, computed tomography, and magnetic resonance angiography can help with diagnosis. Prognosis depends on age at presentation and the severity of coarctation. Treatment options available are open and endovascular repair. Extra-anatomical bypass is the preferred option in cases with unfavorable anatomy. Long term follow up is required post repair due to risk of restenosis and aneurysm formation. Here is a case in which a young female presented with hypertension, was diagnosed with coarctation of the aorta, and was treated a left subclavian artery to descending thoracic aorta bypass. Her postoperative course was uneventful and she had improvement in hypertension.
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Affiliation(s)
- Kishore Abuji
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | | | - Deepak Kumar
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Naveen Maheshwari
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Ujjwal Gorsi
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Lileswar Kaman
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
| | - Ajay Savlania
- Post Graduate Institute of Medical Education and Research - PGIMER, Chandigarh, India.
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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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Gupta VS, Popp EC, Ebanks AH, Greenleaf CE, Annavajjhala V, Patel N, Robie DK, LaPar DJ, Lally KP, Harting MT. Isolated aortic arch anomalies are associated with defect severity and outcome in patients with congenital diaphragmatic hernia. Pediatr Surg Int 2022; 39:69. [PMID: 36580203 DOI: 10.1007/s00383-022-05354-1] [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] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Congenital diaphragmatic hernia (CDH) patients often have suspected isolated aortic arch anomalies (IAAA) on imaging. The purpose of this work was to describe the incidence and outcomes of CDH + IAAA patients. METHODS Cardiovascular data were collected for infants from the CDH Study Group born between 2007 and 2019. IAAA were defined as coarctation of aorta, hypoplastic aortic arch, interrupted aortic arch, and aortic aneurysmal disease on early, postnatal echocardiography. Patients with major cardiac malformations and/or chromosomal abnormalities were excluded. Primary outcomes included the rate of aortic intervention, rates of extracorporeal life support (ECLS) utilization, and mortality. RESULTS Of 6357 CDH infants, 432 (7%) were diagnosed with a thoracic aortic anomaly. Of these, 165 were diagnosed with IAAA, most commonly coarctation of the aorta (n = 106; 64%) or hypoplastic aortic arch (n = 58; 35%). CDH + IAAA patients had lower birthweights (3 kg vs. 2.9 kg) and Apgar scores (7 vs. 6) than patients without IAAA (both χ2 p < 0.001). CDH + IAAA were less likely to undergo diaphragm repair (72 vs. 87%, p < 0.001), and overall mortality was higher for CDH + IAAA infants (58 vs. 24%, p < 0.001). When controlling for defect size, birth weight, and Apgar, IAAA were significantly associated with mortality (OR 3.3, 95% CI 2.2-5.0; p < 0.01) but not associated with ECLS (OR 0.98, 95% CI 0.65-1.50; p = 0.90). Only 17% (n = 28) of CDH + IAAA patients underwent aortic intervention. CONCLUSIONS IAAA in CDH are associated with increased mortality. This often simply reflects severity of the defect and thoracic anatomic derangement, as opposed to unique aortic pathology, given few CDH + IAAA patients undergo aortic intervention.
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Affiliation(s)
- Vikas S Gupta
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Elizabeth C Popp
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Ashley H Ebanks
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Christopher E Greenleaf
- Division of Pediatric and Congenital Heart Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Vidhya Annavajjhala
- Department of Pediatrics, Division of Pediatric Cardiology, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children Glasgow, Glasgow, Scotland
| | | | - Damien J LaPar
- Division of Pediatric and Congenital Heart Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center and Children's Memorial Hermann Hospital, 6431 Fannin St, MSB 5.233, Houston, TX, 77030, USA.
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12
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Wan Q, Zhang X. Left subclavian artery aneurysm complicating aortic pseudocoarctation. Asian J Surg 2022; 45:1428-1429. [PMID: 35232639 DOI: 10.1016/j.asjsur.2022.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Qiaohao Wan
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
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13
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Minotti C, Scioni M, Castaldi B, Guariento A, Biffanti R, Di Salvo G, Vida V, Padalino MA. Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience. Pediatr Cardiol 2022; 43:17-26. [PMID: 34341850 PMCID: PMC8766375 DOI: 10.1007/s00246-021-02685-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/23/2021] [Indexed: 12/02/2022]
Abstract
To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7-17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6-15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.
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Affiliation(s)
- Chiara Minotti
- Pediatric Cardiology, Department of Women's and Children's Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Manuela Scioni
- grid.5608.b0000 0004 1757 3470Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Biagio Castaldi
- grid.5608.b0000 0004 1757 3470Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Alvise Guariento
- grid.5608.b0000 0004 1757 3470Pediatric and Congenital Cardiac Surgery, Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy ,grid.42327.300000 0004 0473 9646Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Roberta Biffanti
- grid.5608.b0000 0004 1757 3470Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- grid.5608.b0000 0004 1757 3470Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Vladimiro Vida
- grid.5608.b0000 0004 1757 3470Pediatric and Congenital Cardiac Surgery, Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo A. Padalino
- grid.5608.b0000 0004 1757 3470Pediatric and Congenital Cardiac Surgery, Department of Cardiothoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Murakami AN, Croti UA, Cajueiro FCM, Arteaga G, Pike RB, Moscardini AC, Marchi CHD, Cardoso MRR, Santos FCGB, Borim BC. Isolated Coarctation Repair in Neonates and Infants Through Left Thoracotomy: Short-Term Outcomes. Braz J Cardiovasc Surg 2021; 36:461-467. [PMID: 34617427 PMCID: PMC8522329 DOI: 10.21470/1678-9741-2020-0554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction End-to-end anastomosis and extended end-to-end anastomosis are typically
used as surgical approaches to coarctation of the aorta (CoAo) with access
at the subclavian artery or an interposition graft. The objective of this
study is to analyze the impact of surgical and anatomical characteristics
and techniques on early outcomes after surgical treatment of CoAo without
cardiopulmonary bypass through left thoracotomy. Methods This is a quantitative, observational, and cross-sectional analysis of
patients who underwent repair of CoAo between July 1, 2010 and December 31,
2017. Seventy-two patients were divided into three groups according to age:
34 in group A (≤ 30 days), 24 in group B (31 days to one year), and
14 in group C (≥ 1 year to 18 years). Results Aortic arch hypoplasia was associated in 30.8% of the cases, followed by
ventricular septal defect (13.2%). The preductal location was more frequent
in group A (73.5%), ductal in group B (41.7%), and postductal in group C
(71.4%). Long coarcted segment was predominant in groups A and C (61.8% and
71.4%, respectively) and localized in group B (58.3%). Extended end-to-end
anastomosis technique was prevalent (68%), mainly in group A (91.2%).
Mortality in 30 days was 1.4%. Conclusion Most of the patients were children under one year of age, and extended
end-to-end anastomosis was the most used technique, secondary to arch
hypoplasia. Further, overall mortality was low in spite of moderate
morbidity in the first 30 postoperative days.
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Affiliation(s)
- Alexandre Noboru Murakami
- Cardiology Surgery Department, Serviço de Cirurgia Cardíaca do Norte do Paraná, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Ulisses Alexandre Croti
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Francisco Candido Monteiro Cajueiro
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Grace Arteaga
- Department of Pediatric and Adolescent Medicine, Children's Center, Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Roxann Barnes Pike
- Department of Pediatric and Adolescent Medicine, Children's Center, Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Airton Camacho Moscardini
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Carlos Henrique De Marchi
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Mariana Ribeiro Rodero Cardoso
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Fernando Cesar Gimenes Barbosa Santos
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Bruna Cury Borim
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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15
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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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16
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Bravo-Valenzuela NJ, Nacif MS, Araujo Júnior E. Prenatal diagnosis of aortic arch anomalies: Echocardiography, 3D-ultrasonography, and computed tomography angiogram findings. A case-report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:423-427. [PMID: 33037630 DOI: 10.1002/jcu.22935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
We report the case of a fetus presenting aortic arch anomalies associated with a ventricular septal defect (VSD). This fetus, which was referred at 25 weeks of gestation, was suspected to have coarctation of aorta (CoA) evidenced by enlarged right chambers at the four-chamber view during a routine obstetric ultrasonographic scan. The prenatal diagnosis of CoA remains a challenge. Here, we review the ultrasonographic findings that could contribute to this diagnosis.
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Affiliation(s)
| | - Marcelo Souto Nacif
- Department of Radiology, Fluminense Federal University (UFF), Niterói, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicina, Federal University of São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
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17
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Gunn AJ, Kalva SP, Majdalany BS, Craft J, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Russell RR, Sutphin PD, Vijay K, Wang DS, Dill KE. ACR Appropriateness Criteria® Nontraumatic Aortic Disease. J Am Coll Radiol 2021; 18:S106-S118. [PMID: 33958105 DOI: 10.1016/j.jacr.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.
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Affiliation(s)
- Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama, Director, Interventional Oncology, Director, Ambulatory Clinic, Assistant Program Director, Diagnostic Radiology Residency, Assistant Program Director, Interventional Radiology Residency, University of Alabama at Birmingham, Member, American College of Radiology-Radiologic Society of North America Patient Information Committee.
| | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital
| | | | - Jason Craft
- St. Francis Hospital, Catholic Health Services of Long Island, Roslyn, New York, Society for Cardiovascular Magnetic Resonance
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, Society of Cardiovascular Computed Tomography
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies at Mayo Clinic Rochester
| | - Minhajuddin S Khaja
- University of Virginia, Charlottesville, Virginia, Vice-Chair ACR Vascular Imaging Panel 2, Program Director, Independent IR Residency, UVA Health
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, Nuclear cardiology expert, Program Director, Cardiology Fellowship, Director, Nuclear Cardiology, Director, Cardio-Oncology Program, Rhode Island Hospital
| | | | | | - David S Wang
- Stanford University Medical Center, Stanford, California
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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18
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ALTINBAŞ Ö, MERCAN I, TABAN VB, TANYELİ Ö, EGE E. Two Staged Surgical Treatment of Aortic Coarctation Accompanied by Aortic Stenosis in a 63-Year-Old Patient. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.792989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Demircan T, Kizilca Ö, Yilmaz N, Zihni C, Kir M, Ünal N. Evaluation of left ventricular functions by speckle-tracking echocardiography in coarctation patients. Echocardiography 2021; 38:410-416. [PMID: 33576053 DOI: 10.1111/echo.14993] [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: 11/06/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIM Two-dimensional speckle-tracking echocardiography (2D-STE) is a novel method that allows the assessment of regional myocardial function. The aim of our study was to use 2D-STE to assess left ventricular deformation in patients with coarctation of the aorta (CoA). METHODS In this prospective study, patients with CoA (n = 42) and healthy controls (n = 39) were recruited. Children with CoA who visited the outpatient clinic between 2013 and 2014 were included. The data were compared with those obtained from the sex- and age-matched controls. RESULTS The mean age of the patients was 5.8 ± 4.5 years. Global longitudinal strain based on all three apical views and total global strain values did not appear to be different between the patient and the control groups (P = .59, P = .51, P = .15, P = .38). Hypertension was detected in 14 (33.3%) patients with CoA. There were significant differences between the global longitudinal strain values of the normotensive CoA subgroup and the hypertensive CoA subgroup (P < .05). CONCLUSIONS In our study, we found that 2D-STE total strain analysis of patients with CoA was not different from comparative healthy controls. However, we determined that 2D-STE parameters were lower in the hypertensive CoA subgroup compared to the normotensive CoA subgroup.
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Affiliation(s)
- Tülay Demircan
- Department of Pediatric Cardiology, SBU, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Özgür Kizilca
- Department of Pediatric Cardiology, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
| | - Nuh Yilmaz
- Department of Pediatric Cardiology, Medical Faculty of Mustafa Kemal University, Hatay, Turkey
| | - Cüneyt Zihni
- Department of Pediatric Cardiology, SBU, Behçet Uz Children Hospital, İzmir, Turkey
| | - Mustafa Kir
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylül University, İzmir, Turkey
| | - Nurettin Ünal
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylül University, İzmir, Turkey
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20
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Carmona-Levario P, Sandoval DM, Farjat-Pasos JI. "Figure 3" Sign in a 20-Year-Old Man With Secondary Hypertension. CJC Open 2020; 3:128-129. [PMID: 33458642 PMCID: PMC7801207 DOI: 10.1016/j.cjco.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Daniel Manzur Sandoval
- Cardiovascular Critical Care Unit. Ignacio Chávez National Heart Institute, Mexico City, Mexico
- Corresponding author: Daniel Manzur Sandoval, National Heart Institute Ignacio Chávez, Juan Badiano 1, Belisario Domínguez – Sección XVI, Tlalpan, Mexico City, PO 14080, Mexico. Tel.: +1-011-52-55-55732911.
| | - Julio Iván Farjat-Pasos
- Department of Interventional Cardiology. Ignacio Chávez National Heart Institute, Mexico City, Mexico
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21
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Pseudocoarctation of aorta: a very rare anatomic anomaly. Indian J Thorac Cardiovasc Surg 2020; 36:530-532. [PMID: 33061169 DOI: 10.1007/s12055-020-00976-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022] Open
Abstract
Pseudocoarctation of the aorta (PCOA) is a rare anomaly of the aortic arch and its presentation is often an incidental finding. We present the case of a 66-year-old patient with a history of high blood pressure, who was admitted for surgical management of bicuspid aortic valve disease with severe insufficiency and who was incidentally detected to have a PCOA. It was decided to manage the latter conservatively and go ahead with surgical aortic valve replacement, to address the problem that led to his admission to the hospital. The patient had a favorable postoperative course and was discharged in a stable condition with an advice for periodic follow-up as out-patient consultations.
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22
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Hede SV, DeVore G, Satou G, Sklansky M. Neonatal management of prenatally suspected coarctation of the aorta. Prenat Diagn 2020; 40:942-948. [PMID: 32277716 DOI: 10.1002/pd.5696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES (a) To determine the false-positive rate among newborns with prenatally suspected coarctation of the aorta (CoA) within the UCLA Health system, (b) to compare patient and maternal interventions and outcomes between false-positive cases and normal controls, and (c) to determine the timing of clinical presentation of CoA. METHODS We performed a single-center, retrospective case control study of all fetuses with suspected isolated CoA who underwent both fetal echocardiographic evaluation and subsequent delivery at UCLA between January 1, 2011, and December 31, 2018. Maternal and neonatal medical records were reviewed for demographic and clinical data, for cases of suspected CoA and for controls. A separate review of our institution's surgical database was performed to identify characteristics of all patients (neonatal and pediatric) with isolated CoA who underwent surgical repair during the same time period. RESULTS Among the 50 fetal cases of isolated suspected CoA who delivered at our institution, 47 patients (94%) were found to be normal (false positives). Compared with normal controls, patients with suspected CoA were more likely to have delayed maternal bonding, delayed feeding, admission to the intensive care unit, performance of neonatal echocardiograms, initiation of intravenous fluids and initiation of prostaglandin E1, and a longer length of hospital stay. Among the 38 patients undergoing CoA repair at our institution during the study period, four patients were prenatally diagnosed and no patient presented clinically with symptoms before 48 hours after delivery. CONCLUSION Compared with normal controls, patients with prenatally suspected coarctation are more likely to have delayed maternal bonding, delayed feeding, more frequent neonatal echocardiograms, and longer length of hospital stay. Further refinement of neonatal management may improve postnatal care.
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Affiliation(s)
- Sannya V Hede
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Greggory DeVore
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gary Satou
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mark Sklansky
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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23
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Vivekanantham H, Cook S, Stauffer JC. An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617494 PMCID: PMC7319839 DOI: 10.1093/ehjcr/ytaa105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/12/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
Background Aortic pseudocoarctation (PsCoA) is an elongation of the supra-isthmic aorta with kinking and low-grade narrowing. Consequently, no collateral circulation is found. It is frequently associated with other congenital heart anomalies, such as bicuspid aortic valve (BAV). Case summary We report the case of 60-year-old patient who presented to the ED with acute chest pain. Physical examination was remarkable for an elevated blood pressure (BP) and the presence of a systolic murmur on the left lower sternal border. An acute coronary syndrome was suspected and the patient underwent urgent coronary angiogram which showed an occluded obtuse marginal artery. Additionally, the presence of an aortic anomaly was noted during the aortography, and additional work-up, including a thoracic computed tomography angiography and transoesophageal echocardiography, revealed a BAV and a PsCoA of the descending aorta. The patient was discharged after optimizing BP control with oral medication and periodical follow-up was arranged. Discussion Aortic PsCoA may mimic true coarctation (CoA), but the absence of a haemodynamically significant descending aortic narrowing and of the typical clinical findings associated with aortic CoA, distinguishes both entities. Treatment is therefore conservative and based on the control of cardiovascular risk factors and in particular of arterial hypertension. Work-up should include imaging of the entire aorta and the search for associated congenital cardiac anomalies, which, if present, should be managed in consequence.
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Affiliation(s)
- Hari Vivekanantham
- Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
| | - Jean-Christophe Stauffer
- Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
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24
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Keen SK, Johnson MR. Unusual Presentation of Acute Systolic Heart Failure Caused by Acquired Post-Traumatic Aortic Coarctation. Circ Heart Fail 2019; 12:e006267. [PMID: 31805781 DOI: 10.1161/circheartfailure.119.006267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan K Keen
- Department of Medicine (S.K.K.), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maryl R Johnson
- Division of Cardiovascular Medicine, Department of Medicine (M.R.J.), University of Wisconsin School of Medicine and Public Health, Madison, WI
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25
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Zhong YL, Ma WG, Zhu JM, Qiao ZY, Zheng J, Liu YM, Sun LZ. Surgical repair of cervical aortic arch: An alternative classification scheme based on experience in 35 patients. J Thorac Cardiovasc Surg 2019; 159:2202-2213.e4. [PMID: 31376997 DOI: 10.1016/j.jtcvs.2019.03.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cervical aortic arch (CAA) is rare and difficult to repair. Clinical experience is limited. We report the surgical techniques and midterm outcomes in 35 patients with CAA based on an alternative classification scheme. METHODS Of 35 patients with CAA, 30 (85.7%) had left-sided aortic arch and 5 had (14.3%) right-sided aortic arch (all 5 had a vascular ring). Mean age was 34.2 ± 13.1 years, 23 were female (65.7%), and 18 were asymptomatic (51.4%). Surgical access and procedure were chosen according to an alternative classification scheme that is based on the presence or absence of vascular ring and relationship of descending aorta to the side of the aortic arch. In the left-sided aortic arch group, aortic arch reconstruction though median sternotomy was performed in 15 patients, and distal arch and descending thoracic aortic replacement via left thoracotomy in 15 patients. In the right-sided aortic arch group, ascending-to-descending aortic bypass was done via median sternotomy in 2 patients and right thoracotomy in 1, and distal arch and descending thoracic aortic replacement via right thoracotomy in 2 patients. RESULTS Neither death nor spinal cord injury occurred. Left recurrent laryngeal nerve injury, prolonged ventilation, and reexploration for bleeding occurred in 1 each. In 11 patients with coarctation, the upper-lower limb gradient decreased significantly postoperatively (from 34.0 ± 12.7 to 10.2 ± 2.7 mm Hg; P < .01). The diseased aortic segment was excluded in 34 patients, except 1 with residual aneurysm in the proximal descending thoracic aorta. Follow-up was complete in 100% at mean 4.4 ± 2.0 years. No late death, limb ischemia, or stroke occurred. Endovascular repair was performed in 1 patient, and ascending aortic dilation occurred in 1 patient. The residual aorta remained nondilated in 33 patients. Aortic grafts were patent in 100%, with no anastomotic leak or pseudoaneurysm. At 6 years, the incidences of death, aortic events, and event-free survival were 0%, 6.5%, and 93.5%, respectively. CONCLUSIONS Open repair of CAA can achieve favorable early and midterm outcomes. Surgical accesses and procedures should be chosen based on type of CAA, anatomic variations and associated anomalies. Our alternative categorization scheme of CAA is intuitive and comprehensive, which may facilitate classification and surgical decision making.
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Affiliation(s)
- Yong-Liang Zhong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
| | - Zhi-Yu Qiao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Yong-Min Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
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Arakawa M, Yuri K, Takeuchi T, Okamura H. Thoracic endovascular aortic repair for ruptured pseudocoarctation. J Thorac Cardiovasc Surg 2019; 157:e101-e103. [DOI: 10.1016/j.jtcvs.2018.09.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
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Padalino MA, Bagatin C, Bordin G, Tua L, Francescato A, Pradegan N, Piperata A, Vida VL, Castaldi B, Boccuzzo G, Stellin G. Surgical repair of aortic coarctation in pediatric age: A single center two decades experience. J Card Surg 2019; 34:256-265. [PMID: 30866121 DOI: 10.1111/jocs.14019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/28/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in infants and children. METHODS A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. RESULTS Three hundred forty-one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10-143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end-to-end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty-day mortality was 1.4%. At a median follow-up of 10.2 years (IQR, 6-15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. CONCLUSIONS Surgical repair of CoAo by EEEA without CPBP is a safe and low-risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long-term, and only a few require antihypertensive therapy.
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Affiliation(s)
- Massimo A Padalino
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Clara Bagatin
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Giulia Bordin
- Department of Woman and Child's Health, Section of Pediatric Cardiology, Medical School, University of Padua, Padua, Italy
| | - Lorenzo Tua
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Annalisa Francescato
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Nicola Pradegan
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Antonio Piperata
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Vladimiro L Vida
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Biagio Castaldi
- Department of Woman and Child's Health, Section of Pediatric Cardiology, Medical School, University of Padua, Padua, Italy
| | - Giovanna Boccuzzo
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Pediatric and Congenital Cardiac Surgery, Medical School, University of Padua, Padua, Italy
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Dawkins JD, Cedars AM, Schussler JM. Transulnar access for coronary intervention in a 23-year-old with accelerated coronary atherosclerosis due to congenital aortic hypoplasia. Clin Case Rep 2019; 7:435-437. [PMID: 30899466 PMCID: PMC6406211 DOI: 10.1002/ccr3.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/11/2022] Open
Abstract
The use of alternative arterial access and advanced imaging is not only applicable to mainstream adult cardiology, but helpful and sometimes necessary in taking care of adult patients with complex congenital heart disease.
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Affiliation(s)
| | - Ari M. Cedars
- Texas A&M College of MedicineBryanTexas
- Division of Cardiology, Department of Internal MedicineBaylor University Medical CenterDallasTexas
| | - Jeffrey M. Schussler
- Texas A&M College of MedicineBryanTexas
- Division of Cardiology, Department of Internal MedicineBaylor University Medical CenterDallasTexas
- The Baylor Scott & White Heart and Vascular HospitalDallasTexas
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Nakai H, Shun M, Tanaka H. Successful treatment of hypoplastic aortic arch and pseudocoarctation of the aorta in an octogenarian. Interact Cardiovasc Thorac Surg 2019; 29:150-151. [DOI: 10.1093/icvts/ivy366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/03/2018] [Accepted: 12/27/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hidekazu Nakai
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Meng Shun
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Abstract
Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6–8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.
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Affiliation(s)
- Arpan R Doshi
- Pediatric Cardiology, Children's Mercy Hospitals and Clinics, Wichita, USA
| | - Sathish Chikkabyrappa
- Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, USA
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Priya S, Thomas R, Nagpal P, Sharma A, Steigner M. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther 2018; 8:S26-S44. [PMID: 29850417 DOI: 10.21037/cdt.2017.10.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Congenital anomalies of the aortic arch include diverse subgroups of malformations that may be clinically silent or may present with severe respiratory or esophageal symptoms especially when associated with complete vascular rings. These anomalies may be isolated or may be associated with other congenital heart diseases. Volume rendered computed tomography (CT) and magnetic resonance angiography (MRA) help in preoperative surgical planning by providing information about the complex relationship of aortic arch and its branches to the trachea and esophagus. Three dimensional capabilities of both computed tomography angiography (CTA) and MRA are helpful in determining evidence of tracheal or esophageal compression or other high-risk features in patients with a complete vascular ring.
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Affiliation(s)
- Sarv Priya
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Thomas
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa, USA
| | - Arun Sharma
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Steigner
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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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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Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart 2017; 103:1148-1155. [PMID: 28377475 DOI: 10.1136/heartjnl-2017-311173] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/06/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
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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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Zuo ZL, Tsauo JY, Chen M, Feng Y. Successful percutaneous stent implantation for isolated dismal transverse aortic arch kinking. Medicine (Baltimore) 2017; 96:e6089. [PMID: 28272200 PMCID: PMC5348148 DOI: 10.1097/md.0000000000006089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Isolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered. PATIENT CONCERNS We report a 46-year-old woman who suffered from recurrent migraine and refractory hypertension with a significant systolic blood pressure difference between upper limbs. DIAGNOSES The woman was diagnosed with isolated dismal transverse aortic arch kinking with refractory hypertension. INTERVENTIONS Percutaneous stent implantation was performed. Due to the kinking nature of the diseased transverse aortic arch, the first covered stent moved forward to the proximal transverse aortic arch during deploying without the left common carotid artery occlusion. And then, a second stent was placed to cover the residual kinked part of the dismal transverse arch. OUTCOMES Angiography and post-procedural computed tomography angiography revealed fully corrected of the diseased segment. At 6-month follow-up after procedure, the patient was free of any symptoms and had a normal blood pressure under antihypertensive treatment. LESSONS This case indicates that transverse aortic arch kinking in isolation can be well treated by percutaneous stent implantation in adult patients. Unlike pure aortic coarctation, elongation and bucking give the rise to the occurrence rate of stent sliding and migration and sometimes a second stent is needed.
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Denniss AR, Gregory AT. Countdown to a Silver Jubilee for Heart, Lung and Circulation Journal in 2016 – Looking Back in Order to Move Forward. Heart Lung Circ 2015; 24:1137-40. [DOI: 10.1016/s1443-9506(15)01460-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yamane Y, Morimoto H, Mukai S. Single-Stage Repair of Thoracic Aortic Aneurysm through a Median Sternotomy in a Patient with Pseudocoarctation of the Aorta and Severe Aortic Valve Stenosis. Ann Vasc Dis 2015; 8:128-30. [PMID: 26131037 DOI: 10.3400/avd.cr.15-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
Pseudocoarctation of the aorta is a rare anomaly and considered a benign condition. Pseudocoarctation of the aorta has been associated with aneurysm formation in the thoracic aorta, which may cause sudden rupture or dissection. Thus, the presence of an aneurysm in combination with pseudocoarctation of the aorta is thought to be an indication for surgery. We present a case of pseudocoarctation of the aorta associated with thoracic aortic aneurysm and severe aortic valve stenosis with a bicuspid aortic valve. In our case, single-stage repair was performed through a median sternotomy using our "pleural-window approach."
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Affiliation(s)
- Yoshitaka Yamane
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
| | - Hironobu Morimoto
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
| | - Shogo Mukai
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Hiroshima, Japan
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