A multimodality approach to an elderly patient with aortic coarctation, patent ductus arteriosus, and bicuspid aortic valve (original) (raw)
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Coarctation of the Aorta in the Adult
SA Heart, 2017
Coarctation of the Aorta (CoA) is, as part of a generalized arteriopathy, a complex cardiovascular disorder, and not only a circumscript narrowing of the aorta in the area where the ductus arteriosus inserts. (1, 2) In 1760 Morgagni described CoA, seen during the autopsy of a monk, and refers to a similar case reported by the elder Meckel in 1750. (3) More detailed patho-anatomical descriptions followed from Jordan (1827), Reynaud (1828) and others. (4) In 1903 LM Bonnet ordered this lesion into infantile and adult types. The categorization was later revised to preductal and postductal forms. The infantile type was characterized by a long, narrowed aortic segment, located proximal to the ductus, persistence of the ductus and death in early infancy, often due to congestive cardiac failure. The adult type was distinguished by a more circumscript, postductal narrowing of the aorta, accompanied by a closed ductus and clinical manifestation in later life. This classifi cation has been widely replaced and currently, in view of the pathogenesis, all types of CoA are esteemed to be "juxtaductal". In adults CoA is almost always located just below the origin of the left subclavian artery at the conjunction of the distal aortic arch to the descending aorta. In rare cases CoA may be localized ectopically, anywhere in the ascending, descending or abdominal aorta. The pathogenesis of CoA is still not completely understood; the "ductus tissue theory" and the "hemodynamic theory" have recently been proposed. In the ductus tissue theory, postnatal constriction of aberrant ductal tissue and/or intrauterine alterations of blood fl ow through the aortic arch are incriminated as cause. Others have proposed that CoA develops from hemodynamic alteration that reduces the volume of blood fl ow through the fetal aortic arch and isthmus. CoA is often seen in association with a bicuspid aortic valve, a subvalvular, valvular, or supravalvular aortic stenosis, hypoplastic left heart syndrome, mitral valve stenosis or complex congenital heart defects with one of those entities. CoA may occur as either a localized stenosis or as a long and hypoplastic aortic segment. In the localized form, there is a shelf-like infolding of the posterior aortic wall into the aortic lumen, either opposite, proximal or distal to the ductus arteriosus. The shelf consists of thickened aortic media and intima and is always in continuity with the muscular tissue of the ductus arteriosus. At times of ductal closure anomalous fi broductal tissue around the aorta tracks the shelf towards the ductal orifi ce, causing luminal obstruction. Diffuse forms of CoA are characterized by a tubular hypoplasia involving the aortic arch or the aorta distal to the origin of the left subclavian artery and the ductus area. CoA may occur as an isolated defect or combined with other important intracardiac and/or extracardiac lesions. Simple CoA refers to CoA in the absence of other relevant lesions. However, even simple CoA is often accompanied by anomalies, previously thought to be insignifi cant, like bicuspid aortic valve (up to 85%), mitral valve anomalies, and/or intracranial aneurysms. Complex CoA refers to the association with other important lesions, e.g. ventricular septal defects and major mitral or aortic valve abnormalities. Sometimes, CoA complicates complex heart defects, such as transposition of the great arteries, Taussig-Bing anomaly, double-inlet left ventricle, tricuspid atresia with transposition of the great arteries, and hypoplastic left heart syndrome. The association
2021
Contact address: Maria Magdalena Gurzun, 134 Plevnei Avenue, 010825, Bucharest, Romania. E-mail: magdalenagurzun@gmail.com 1 Euroecolab, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 „Prof. Dr. C. C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania 3 Emergency Central Military Hospital, Bucharest, Romania INTRODUCTION Coarctation of the aorta (CoA) is a relatively frequent congenital defect and represents 5-8% of congenital cardiac defects1. Its natural evolution is marked by serious complications including aortic dissection, heart failure, coronary artery disease, infective endocarditis, or cerebral haemorrhages. The estimated mortality in the case of untreated CoA is 90% by the age of 50, with 35 being the mean age of death2. On the other hand, correction of CoA before complications arise is associated with a favourable long-term outcome. Timely diagnosis of CoA is therefore of utmost importance in the prognosis of these patie...
Aortic Coarcatation in Adults : Still a Late Diagnosis
International Journal of Advanced Research
Aortic coarctation is the most common congenital cardiac malformation due to a narrowing of the aorta, most commonly occurring just beyond the left subclavian artery.The diagnosis is mostly neonatal by the systemic palpation of the femoral pulses but can be later discovered at the big childs even at the adult. This fact is illustrated through our observation of a 36-year-old man admitted after a head injury, during his hospitalization the diagnosis of aortic coarctation was made following hypertensive peaks resistant to antihypertensive drugs.
The American Journal of Cardiology, 2009
Children with bicuspid aortic valve (BAV) have aortic dilation that is present and progressive from birth irrespective of the functional state of the valve. There are no published data comparing aortic dilation in children with BAV with and without aortic coarctation (CoA). The objectives of this study were to (1) compare differences in aortic dimensions and rates of dilation between children with isolated BAV with those of children with BAV and CoA and (2) identify risk factors for the development of aortic dilation. Patients with BAV with CoA (group A) and without CoA (group B) were identified from our echocardiographic database (1993 to 2006). Aortic measurements at 4 levels were obtained, and z scores were compared. Criteria for exclusion were severe aortic regurgitation/stenosis, previous aortic valvuloplasty, complex left-sided cardiac disease, ventricular septal defects, and Turner, Noonan, Williams, and Marfan syndromes. There were 600 echocardiograms in 247 patients. Group A had 192 echocardiograms in 53 patients (median age 11.3 years; range 0 to 30; median follow-up 7 years), and group B had 382 in 194 patients (median age 8.7 years; range 0 to 29; median follow-up 4 years). Group B had significantly greater ascending aorta dimensions (p <0.05) and significantly faster rates of aortic dilation (p <0.0001). The ascending aorta in patients with BAV and CoA did not dilate to the same degree as in patients with isolated BAV. In conclusion, valve morphologic characteristics and function and age at CoA repair had none to minimal impact on aortic dimensions.
Echocardiography, 1997
We describe a n unusual case ofperiductal coarctation of the aorta in a 40-year-old patient presenting to the echocardiography laboratory for evaluation of a heart murmur. Subsequent clinical history revealed easy fatigability, dyspnea on exertion, and hypertension. Despite a lack of lefr ventricular hypertrophy, aortic coarctation was suggested by echocardiography. It was later confirmed to be severe by multiple additional imaging modalities, despite a n absence of overt collateral arterial channels.
Aortic Coarctation: Basic Imaging Findings and Management
Coarctation of the aorta (CoA) is a common congenital disease associated with narrowing of the descending aorta. CoA is an arteriopathy that can be associated with other congenital heart and systemic defects and therefore requires vigilant and continuous management and screening even after correction. Advancements in imaging have revolutionized the way CoA is diagnosed and managed. In this article, the authors review CoA and its management, with a focus on the various imaging modalities used for diagnosis and screening of CoA and its associated malformations.
Infantile Aortic Coarctation in an Adult with Heart Failure
Medical Principles and Practice, 2016
Objective: The aim of this case report is to highlight the importance of excluding aortic coarctation in a patient with a bicuspid aortic valve. Clinical Presentation and Intervention: A 56-year-old woman with hypertension was admitted complaining of progressive dyspnea. Transthoracic echocardiography showed a calcified, bicuspid aortic valve with severe stenosis. Aortography revealed the presence of severe narrowing of the aorta between the carotid and subclavian arteries. The patient was referred for cardiovascular surgery in which successful aortic valve replacement and aortic correction were performed. Conclusion: This case report shows an uncommon finding of infantile aortic coarctation in an adult patient admitted with heart failure.