Imaging Follow-up of Repaired Aortic Coarctation (original) (raw)
Related papers
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...
Late magnetic resonance surveillance of repaired coarctation of the aorta☆☆☆
European Journal of Cardio-Thoracic Surgery, 2009
Objective: Coarctation of the aorta has often been described as a simple form of congenital heart disease. However, rates of re-coarctation reported in the literature vary from 7% to 60%. Re-coarctation of the aorta may lead to worsening systemic hypertension, coronary artery disease and/or congestive cardiac failure. We aimed to describe the rates of re-coarctation in subjects who had undergone early coarctation repair (<2 years of age) and referred for clinically indicated or routine magnetic resonance (MR) surveillance. Methods: We retrospectively identified 50 consecutive subjects (20.2 AE 6.9 years post-repair) imaged between 2004 and 2008. Patient characteristics, rates of re-coarctation and LV/aortic dimensions were examined. Results: Forty percent of subjects had bicuspid aortic valves (BAV). There were 40 cases of end-to-end repair and 10 cases of subclavian flap repair. Re-intervention with balloon angioplasty or repeat surgery had been performed in 32% of subjects. The MRI referrals were clinically indicated in 34% and routine in 66% of patients. Re-coarctation was considered moderate or severe in 34%, mild in 34% and no re-coarctation was identified in 32% of patients. There was no significant difference in the number of cases of re-coarctation identified in the clinically indicated versus routine referrals for MR imaging (p = 0.20). There were no cases of aortic dissection or aneurysm formation identified amongst the subjects. The mean indexed left ventricular mass and ejection fraction was 72 AE 16 g/m 2 and 66 AE 6%, respectively. Amongst those subjects with BAV there were larger aortic sinus (30 AE 1 mm vs 27 AE 1 mm, p = 0.03) and ascending aortic (27 AE 1 mm vs 23 AE 1 mm, p = 0.01) dimensions when compared to subjects with morphologically tricuspid aortic valves. Conclusions: We demonstrate that many years after early repair of coarctation of the aorta, MR surveillance detects significant rates of re-coarctation. These findings were independent of whether or not there was a clinical indication for imaging. Those patients with BAV disease had larger ascending aortic dimensions and may require more frequent non-invasive surveillance.
Coarctation of Aorta in Children
Cureus
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 twodimensional 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.
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.
MRI in adult patients with aortic coarctation: diagnosis and follow-up
Clinical Radiology, 2015
Aortic coarctation is a disease that usually presents in infancy; however, a proportion of patients present for the first time in adulthood. These lesions generally require repair with either surgery or interventional techniques. The success of these techniques means that increasing numbers of patients are presenting for follow-up imaging in adulthood, whether their coarctation was initially repaired in infancy or as adults. Thus, the adult presenting to the radiologist for assessment of possible coarctation or follow-up of coarctation repair is not an uncommon scenario. In this review, we present details of the MRI protocols and MRI findings in these patients so that a confident and accurate assessment can be made.
Early Diagnosis of Coarctation of the Aorta in Children: A Continuing Dilemma
Pediatrics, 1996
Because late repair of coarctation of the aorta (COA) is associated with premature cardiovascular disease in adult life, early detection and treatment is important. Objectives. To determine the timing of referral to see whether early detection of COA has improved in the past decade, to evaluate the pattern of and reasons for medical center referral, and to assess the clinical signs relating to the diagnosis of COA. Methods. The records of 50 consecutive patients older than 1 year who had surgical repair of COA from 1980 to 1990 were reviewed. The age of referral, pattern of referral, and presence of standard clinical signs of COA were analyzed, and data were compared with those from the previous decade. Results. The mean and median ages at referral were 8.4 and 5.8 years, respectively. Pediatricians accounted for 64% of the referrals. A specific diagnosis of COA was made in 2 (4%) of 50 patients before referral to a pediatric cardiologist. The most consistent clinical findings were ...
Coarctation of the Aorta: Management, Indications for Intervention, and Advances in Care
Current Treatment Options in Cardiovascular Medicine, 2014
Congenital heart disease I Coarctation of the aorta I Intervention I Treatment Opinion statement Coarctation of the aorta (CoAo) accounts for 9 % of congenital heart defects. Balloon angioplasty has been the conventional endovascular treatment of choice for both native and recurrent coarctation in adults. Recent advancement in stent technology with the development of the covered stents has enhanced the scope for percutaneous management of both native CoAo and post-surgical CoAo. Stent implantation provides better hemodynamic results with larger acute diameter gain and better long-term hemodynamic benefit. Stenting also decreases the incidence of aneurysm formation. The development of biodegradable stents may revolutionize the percutaneous management of coarctation, as the degradation of the stent scaffold within 6 months of implantation will further decrease the incidence of restenosis. In the future stenting may suffice and obviate the need for open repair. Until then, surgical repair of CoAo is the preferred method in both infants and complicated lesions, leaving stenting to adults with focal and uncomplicated disease.