Coarctation of the abdominal aorta

Inmon, Thomas W.; Pollock, Byron E.

doi:10.1016/0002-8703(56)90269-1

Cited by 25 publications

(3 citation statements)

References 9 publications

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“…Distally decreased blood pressure due to aortic stenosis causes placental hypoperfusion, therefore recurrent abortion is not uncommon in this population [10,11]. …”

Section: Discussionmentioning

confidence: 99%

Usefulness of endovascular stent-graft for combination with a strict aort coarctation and patent ductus arteriosus for an adult patient: a case report

Batur

Koç

Özer

et al. 2009

Cases J

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We reported a 21-year-old patient with strict descending aorta coarctation and small post-ductal patent ductus arteriosus, complicated with abortion and hypertension. The patient was successfully treated by endovascular stent-graft with a single cardiac catheterization. Endovascular stent-graft is an easy, safe, and reliable intervention for the treatment of strict descending aorta coarctation and small post-ductal patent ductus arteriosus.

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“…Distally decreased blood pressure due to aortic stenosis causes placental hypoperfusion, therefore recurrent abortion is not uncommon in this population [10,11]. …”

Section: Discussionmentioning

confidence: 99%

Usefulness of endovascular stent-graft for combination with a strict aort coarctation and patent ductus arteriosus for an adult patient: a case report

Batur

Koç

Özer

et al. 2009

Cases J

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“…Murmurs, pulsations, or thrills in these regions should alert one to the possibility of an atypically located coarctation.2 9 31, 41 In uncomplicated coarctations, intermittent claudication occurs in 8 per cent of the cases,41 but apparently is of greater incidence in abdominal coarctations, occurring in approximately one third of the cases. 29 In typical coarctations, the aortic knob is small and may be absent.42 When the coarctation is in the lower thorax or abdomen, the aortic knob is normal and notching may be present only in the lowest ribs. If any of the above signs or symptoms are found, we consider it is vital to delineate the exact site of the coarctation, with thoracic and abdominal aortograms.…”

Section: Discussionmentioning

confidence: 99%

Multiple and Infraductal Coarctations of the Aorta

et al. 1959

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ITH the recent rapid improvements in methods of diagnosis and treatment of cardiovascular diseases, the surgeon today can attempt to cure the unusual as well as the more common types of defects. Refinements in the technics of cardiac catheterization, angiocardiography, grafting, hypothermia, and extracorporeal circulation have been a great stimulus to the description of the rare lesions in the hope that ultimately a completely corrective procedure can be performed. In this paper, a case of multiple coarctations of the aorta is presented and discussed with a review of the literature. To our knowledge this is the first case report in which there have been 4 distinct coarctations of the aorta. CASE REPORTThe patient was a 32-year-old Puerto Rican woman with a known murmur since the age of 12 and a recent onset of precordial discomfort, dyspnea, and fatigue. No signs or symptoms of congestive heart failure or subacute bacterial endocarditis were evident. Physical examination revealed the following positive physical findings: the blood pressure was, in the right arm 120/90; in the left arm 205/115, and in the right leg 140/100; the right radial pulse was weak, the left was strong, and the femoral pulses were decreased, but palpable. The heart was enlarged to the anterior axillary line in the sixth intercostal space. A grade-II systolic murmur was heard over the entire precordium, loudest along the left sternal border. No collateral pulsations were felt.Laboratory Findings. The electrocardiogram indicated left ventricular hypertrophy. Radiographic and fluoroscopic examination of the chest showed considerable enlargement of the heart to the left, giving an appearance of left ventricular enlargement. The arch of the aorta showed a shallow impression on its superior posterior aspect and the descending aorta was located unusually far toward the left with the esophagus also somewhat deviated to the left. The configuration of the upFrom the Departments of Surgery and Pathology, The Mount Siniai Hospital, New York, N. Y. 910 per portion of the aorta was somewhat suggestive of the so-called atypical coarctation; however, no narrow segment of aortic arch was visualized, nor was there any evidence of rib notching. Because of the x-ray findings, venous angiocardiography was performed, which revealed a narrowing of the descending aorta in the midthoracic region.Hospital Course. A diagnosis was made of a lower thoracic aortic coaretation with separate occlusion of the right subelavian artery. At surgery, a left thoracotomy revealed a marked stenosis approximately 21/2 inches below the origin of the left subelavian artery. No inflammation or adhesions were observed surrounding the aorta; however, peculiar calcification of the wall of the aorta was noted distal to the coaretation. The aorta was cross clamped above and below the area of coaretation, whereupon the blood pressure rose to over 300 mm. Hg. This blood pressure elevation was controlled with a slow intravenous drip of trimethaphan camphorsulfonate (Arfonad) until the r...

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“…Fetal mortality in patients with uncorrected coarctation is said to be 11± 13% 4 . Repeated miscarriages are common, probably related to placental ischaemia 5 .…”

Section: Commentmentioning

confidence: 99%

Not Pre-Eclampsia

2001

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A woman aged 71 had suffered from chronic sinusitis and recurrent nasal polyps for many years. She had been treated with various intranasal corticosteroids including betamethasone nasal drops, beclomethasone nasal spray, mometasone nasal spray and¯uticasone nasal spray. No other topical or systemic corticosteroid treatment had been prescribed. At presentation she reported having been unwell and tired for about twelve months; at this time she had been using betamethasone 0.1% drops for eight months, 1±2 drops in each nostril once daily. Clinically she was not cushingoid. A short tetracosactrin (Synacthen) test was arranged, and she was asked to stop the steroid drops a few days beforehand. After stopping treatment she became unwell and experienced weakness, fatigue, nausea and headache, and was almost unable to get out of bed. The short Synacthen test (250 mg tetracosactrin intramuscularly) showed severe adrenal impairment. The basal cortisol was only 10 nmol/L, rising to 312 nmol/L after 30 minutes. After completing the test she was restarted on the betamethasone drops and felt much better.Over the next two months she was weaned off the betamethasone drops and a repeat short Synacthen test four months later showed a much improved response with basal plasma cortisol 180 nmol/L, rising to 593 nmol/L at 30 minutes. She felt very well, with only minor return of nasal symptoms. COMMENTThis case illustrates the ability of intranasal corticosteroid treatment to cause symptomatic adrenal suppression without cushingoid features. There may be a tendency for patients inadvertently to administer too many drops. In a study by Gallagher and Mackay, doctors were shown how to administer drops correctly but even in this group over a 14-day period overuse was the rule 8 . Excess steroid nasal drops probably trickle down the nasopharynx and are swallowed. The patient is thus effectively on systemic as well as local steroids.Drops do seem more likely than sprays to result in systemic steroid absorption 2±7 . Thus Synacthen tests have given normal results in patients on beclomethasone spray 10 but subnormal results after 6 weeks of betamethasone drops 11 . Long-term use of nasal steroid drops is probably inadvisable. With nasal steroid sprays more accurate doses can be delivered. By far the commonest cause of hypertension in pregnancy is pre-eclampsia, but other causes must not be forgotten. REFERENCES CASE HISTORYOn the second day after a normal delivery a woman aged 16 was referred because of uncontrolled hypertension. 2 years previously she had been found hypertensive when taking the combined oral contraceptive pill. Six months after stopping the pill she had been treated for missed abortion, at which time her blood pressure was 160/95 mmHg. There was no family history of hypertension or congenital heart disease.In the last trimester of her second pregnancy, blood 351

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Coarctation of the abdominal aorta

Cited by 25 publications

References 9 publications

Usefulness of endovascular stent-graft for combination with a strict aort coarctation and patent ductus arteriosus for an adult patient: a case report

Usefulness of endovascular stent-graft for combination with a strict aort coarctation and patent ductus arteriosus for an adult patient: a case report

Multiple and Infraductal Coarctations of the Aorta

Not Pre-Eclampsia

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