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Cardiology Clinics Aug 2020Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular... (Review)
Review
Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and lifelong surveillance to identify long-term complications.
Topics: Aorta; Aortic Coarctation; Heart Ventricles; Humans; Multimodal Imaging; Risk Adjustment; Vascular Surgical Procedures
PubMed: 32622489
DOI: 10.1016/j.ccl.2020.04.003 -
Journal of Cardiovascular Medicine... Feb 2007In severe aortic coarctation in the neonatal period, surgical repair is required soon after clinical stabilization. Elective repair of isolated aortic coarctation is... (Review)
Review
In severe aortic coarctation in the neonatal period, surgical repair is required soon after clinical stabilization. Elective repair of isolated aortic coarctation is nowadays indicated at 3-6 months of life or at the time of diagnosis. At present, no single operation appears to have a clear superiority. However, during the first months of life, an extended end-to-end anastomosis is considered the best option by most authors, even though weight at operation and anatomy of the aortic arch are also significant determinants of late recoarctation. In cases of aortic arch hypoplasia, which occurs in up to 70% of neonatal and infant coarctations, especially when associated anomalies are present, surgery seems the treatment of choice. After 3 months of age and in the adult population, balloon angioplasty and stent placement are considered a suitable option. Recently, we adopted a median sternotomy approach without the use of extracorporeal circulation for the treatment of aortic coarctation with a hypoplastic aortic arch. We treated 11 patients with satisfactory results at an average follow-up of 40 months.
Topics: Adult; Age Factors; Anastomosis, Surgical; Angioplasty, Balloon; Aortic Coarctation; Blood Vessel Prosthesis Implantation; Child; Humans; Incidence; Patient Selection; Subclavian Artery; Surgical Flaps; Time Factors; Vascular Surgical Procedures
PubMed: 17299295
DOI: 10.2459/01.JCM.0000260215.75535.64 -
The Journal of Thoracic and... Jul 2021
Topics: Aorta; Aortic Coarctation; Humans; Vascular Surgical Procedures
PubMed: 33189343
DOI: 10.1016/j.jtcvs.2020.10.026 -
Cardiology Journal 2011Coarctation of the aorta was once viewed as a simple discrete narrowing of the aortic isthmus that could be 'cured' by surgical intervention. It is now clear that this... (Review)
Review
Coarctation of the aorta was once viewed as a simple discrete narrowing of the aortic isthmus that could be 'cured' by surgical intervention. It is now clear that this condition may: (1) affect the aortic arch in a highly variable manner; (2) be associated with a host of other left sided heart lesions; (3) represent a wider vasculopathy within the pre-coarctation arterial tree, leading to significant prevalence of hypertension by adolescence, and subsequent risk of early morbidity and death. This review outlines the evaluation and treatment of this disease from pre-natal to adult life.
Topics: Adolescent; Adult; Age Factors; Aging; Angioplasty, Balloon; Aortic Coarctation; Child; Child, Preschool; Humans; Hypertension; Infant; Infant, Newborn; Practice Guidelines as Topic; Predictive Value of Tests; Prenatal Diagnosis; Stents; Treatment Outcome; Young Adult
PubMed: 21947983
DOI: 10.5603/cj.2011.0003 -
Minerva Cardioangiologica Dec 2009Patients with aortic coarctation are prone to develop arterial hypertension at various stages throughout life. There are at least three different pathophysiologic... (Comparative Study)
Comparative Study Review
Patients with aortic coarctation are prone to develop arterial hypertension at various stages throughout life. There are at least three different pathophysiologic pathways: re-stenosis at the aortic isthmus, paradoxical hypertension, and late hypertension at long-term follow-up. As the most common causes of death reported for coarctation patients are linked to hypertension, it is important to differentiate these pathways of hypertension carefully to provide optimal treatment for hypertensive coarctation patients. This review summarizes the actual data about those different pathologic pathways, about how to differentiate them from each other, and how to treat them adequately.
Topics: Adolescent; Adult; Age Factors; Aged; Antihypertensive Agents; Aortic Coarctation; Aortic Valve Stenosis; Baroreflex; Cardiovascular Diseases; Diuretics; Echocardiography, Doppler; Female; Follow-Up Studies; Humans; Hypertension; Infant; Life Style; Magnetic Resonance Imaging; Male; Sex Factors; Time Factors; Tomography, Spiral Computed
PubMed: 19942845
DOI: No ID Found -
Cardiovascular Journal of AfricaCritical coarctation of the aorta in neonates is a common cause of shock and death. It may be the most difficult of all forms of critical congenital heart disease to... (Review)
Review
Critical coarctation of the aorta in neonates is a common cause of shock and death. It may be the most difficult of all forms of critical congenital heart disease to diagnose because the obstruction from the coarctation does not appear until several days after birth (and after discharge from the hospital), and because there are no characteristic murmurs. Some of these patients may be detected by neonatal screening by pulse oximetry, but only a minority is so diagnosed. Older patients are usually asymptomatic but, although clinical diagnosis is easy, they are frequently undiagnosed.
Topics: Age Factors; Angioplasty, Balloon; Aortic Coarctation; Cardiac Imaging Techniques; Diagnostic Techniques, Cardiovascular; Early Diagnosis; Hemodynamics; Humans; Infant, Newborn; Neonatal Screening; Oximetry; Predictive Value of Tests; Prognosis; Stents; Vascular Surgical Procedures
PubMed: 29293259
DOI: 10.5830/CVJA-2017-053 -
Journal of Vascular Surgery Oct 2021
Topics: Aortic Coarctation; Asymptomatic Diseases; Collateral Circulation; Humans; Male; Middle Aged; Regional Blood Flow; Vascular Surgical Procedures
PubMed: 34598758
DOI: 10.1016/j.jvs.2020.10.079 -
Journal of Cardiac Surgery Jul 2014Aortic coarctation can be repaired surgically or percutaneously. The decision should be made according to the anatomy and location of the coarctation, age of the... (Review)
Review
Aortic coarctation can be repaired surgically or percutaneously. The decision should be made according to the anatomy and location of the coarctation, age of the patient, presence of other cardiac lesions, and other anatomic determinants (extensive collaterals or aortic calcification). This article reviews the different therapeutic options available, explaining the differences between children and adults, describing different approaches to the same disease, exemplified by three cases of nonclassic surgical approach and one percutaneous treatment.
Topics: Adolescent; Adult; Aortic Coarctation; Cardiovascular Surgical Procedures; Endovascular Procedures; Female; Humans; Male; Middle Aged; Stents; Treatment Outcome
PubMed: 24894975
DOI: 10.1111/jocs.12367 -
Romanian Journal of Morphology and... 2017Stenting of aortic coarctation became the method of choice. In severe aortic coarctation, when retrograde crossing of the coarctation is impossible, a secondary approach... (Review)
Review
Stenting of aortic coarctation became the method of choice. In severe aortic coarctation, when retrograde crossing of the coarctation is impossible, a secondary approach with antegrade arterial crossing proved to be the solution in many cases. Here we report two cases of severe aortic coarctation in males aged 12 and 14, respectively, in which we used a secondary transradial approach (right and left) followed by guidewire snaring. For the first case, a right radial-right femoral arterio-arterial circuit was created, which offered a stable position during stent implantation. In both cases, we predilated the lesion and then implanted a 45 mm Cheatham-platinum (CP) covered stent. The final result was very good in both patients; only the first one required post-dilatation of both ends of the stent. Asymptomatic post-procedural absence of left radial pulse was noticed in the second case. In conclusion, even in the case of children, secondary transradial approach is suitable for antegrade crossing of the coarctation in extremely severe cases and possibly in stabilization of the circuit for stent implantation.
Topics: Adolescent; Aortic Coarctation; Child; Humans; Male; Treatment Outcome
PubMed: 29250685
DOI: No ID Found -
La Radiologia Medica Jun 2009Aortic coarctation accounts for 5%-10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging... (Review)
Review
Aortic coarctation accounts for 5%-10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging allows the study of this disease with several advantages in comparison with conventional angiography, transesophageal echocardiography, and computed tomography. The MR protocol applied at our institution for both diagnosis and follow-up after surgical or endovascular treatment consists of four steps: morphologic study, cine MR study, flow analysis, and MR angiography (MRA). The first three sequences are acquired during breath-hold and with electrocardiographic gating. Anatomy is well depicted with dark-blood half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. Cine true-fast imaging with steady-state precession (true-FISP) sequences show not only morphologic features but also blood-flow changes inside the aorta. Gradient-echo sequences for phase-velocity mapping allow flow analysis. Application of Bernoulli's equation--here briefly presented and discussed--allows for calculation of the pressure gradient caused by the coarctation. MRA, acquired with a breath-hold three-dimensional T1-weighted gradient-echo sequence and intravenous administration of paramagnetic contrast material, allows for optimal depiction of the aortic lumen, with a panoramic view of the whole aorta, its main branches and possible collateral circulation.
Topics: Algorithms; Aortic Coarctation; Blood Flow Velocity; Contrast Media; Echo-Planar Imaging; Follow-Up Studies; Humans; Italy; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Predictive Value of Tests; Pulsatile Flow; Sensitivity and Specificity; Treatment Outcome
PubMed: 19444591
DOI: 10.1007/s11547-009-0386-6