Coarctation of the aorta

Rao, P. Syamasundar

doi:10.1007/s11886-005-0060-0

Cited by 123 publications

(114 citation statements)

References 65 publications

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“…Rarely, the coarcted segment is present in the lower thoracic or abdominal aorta, long and fusiform with irregular lumen and may be considered as a variant of Takayasu arteritis. Coarctation can occur in isolation, in association with bicuspid aortic valve or with major cardiac malformations [1]. CoA accounts for 5-8% of children born with congenital heart disease [2,3].…”

Section: Introductionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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Coarctation of the Aorta (CoA) is a congenital cardiac anomaly consisting of a constricted aortic segment with a prevalence of 5 to 8% of all Congenital Heart Defects (CHD). The classic CoA is located in the thoracic aorta distal to the origin of the left subclavian artery, at about the level of the ductal structure. Significant hypertension and/or congestive heart failure are indications of intervention. If hypertension (rather that heart failure) is the clinical problem, it is better to relieve the aortic obstruction promptly rather that attempting to "treat" hypertension with antihypertensive medications. Surgical relief of the aortic obstruction and catheter interventional techniques (balloon angioplasty and stents) are available alternatives. Since the introduction of surgical correction by Crafoord and Nylin and Gross and Hufnagel in early 1940s, surgical therapy has been the treatment of choice for aortic coarctation. Gruntzig's technique of balloon angioplasty was adopted by Singer and Sperling and their associates to enlarge coarcted aortic segments in post-surgical recoarctation and native coarctation, respectively in early 1980s. This is followed by the application of the technique by other cardiologists to treat native CoA. The procedure consists of inserting a balloon angioplasty catheter across the site of coarctation and inflating the balloon with diluted contrast material. Both immediate and followup results are reasonably good. Residual and recurrent obstructions following surgery and prior balloon angioplasty are also amenable for balloon angioplasty. Despite reasonably good short-term and long-term results of balloon angioplasty, some problems remain and include restenosis, probability of aortic rupture, formation of aneurysms and inability to effectively treat long-segment tubular narrowing. Because of these and other reasons, endovascular stenting of aortic coarctation has gained acceptance over the last decade. The balloon catheter, with the stent mounted on it, is advanced over a stiff guide wire and positioned across the coarctation segment and the balloon inflated, thus implanting the stent. Most cardiologists use stents in adolescents and adults and restrict their use in younger children because of issues related to growth. Stent therapy appears to be an attractive method for treatment of native or recurrent coarctation, aneurysm formation following prior surgical or balloon intervention and for long segment hypoplasia. Role of covered stents to manage aortic coarctation is limited and are used when the assessed risk for development of aneurysm or dissection is high. A comparison of all available treatment modalities was made and while it is difficult to make a definitive statement, the overall data seem to indicate that transcatheter methods may be better than surgery. Selection of the method of therapy is largely based on the age at presentation and anatomy of the coarcted segment and surrounding structures; surgery for infants and long segment coarctations, balloon angioplast...

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Section: Introductionmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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“…It is characterized by the narrowing of the isthmus of aortic arch, which is most commonly pre-ductal (juxta-ductal) and very rarely post-ductal. Coarctations of the aorta increase the load on the right ventricle resulting in right ventricular hypertrophy and dilation, as seen in antenatal and early neonatal echocardiographic, which is similar to neonates with VGAM [5].…”

Section: Introductionmentioning

confidence: 72%

“…Informed consent All procedures followed were in accordance with the ethical standards of the responsible committee on humannexperimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to inclusion in this article of information that could potentially lead to their identification Ethics standards The authors confirm that all human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments.…”

Section: Resultsmentioning

confidence: 99%

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Vein of Galen arteriovenous malformation mimicking coarctation of the aorta

2014

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Arteriovenous malformation of the vein of Galen is a rare congenital intracranial anomaly lacking a capillary bed and subsequent aneurysmal enlargement of the arterial and venous system, warranting careful management due to associated morbidity and mortality. Coarctations of aorta demonstrate similar neonatal echocardiographic signs to the vein of Galen arterial malformation (VGAM). We present a boy at 37 weeks of gestation whose initial ultrasound and echocardiographic investigations showed a dominant right ventricle and isthmal hypoplasia, suggestive of coarctation of aorta. Followup ultrasound and echocardiography revealed an arteriovenous malformation involving middle and posterior cerebral artery branches, eliminating coarctation of aorta. VGAM was confirmed by further ultrasound and angiographic investigation, which demonstrated a tangle of cerebral and choroidal arterial branches centrally feeding into an enlarged vein of Galen. The boy's hemodynamic and neurological statuses were confirmed to be stable despite increased venous pressure. Elective embolization at 7 months of age was complicated by a cerebrovascular accident, resulting in right hemiparesis despite no residual cardiac issues. This case demonstrates that rarely, arteriovenous malformations such as the vein of Galen malformations may be the primary cause of patients presenting with coarctation of aorta. The rarity of this condition and its guarded prognosis make our case of special interest to cardiologists and the perinatal care team.Keywords Vein of Galen Á Cerebral arteriovenous malformation Á Coarctation of aorta Á Isthmal hypoplasia Riassunto Le malformazioni artero-venose della vena di Galeno sono rare anomalie intracraniche congenite caratterizzate da assenza del letto capillare e successiva dilatazione aneurismatica dei sistemi arterioso e venoso, che richiedono un'attenta gestione, per le associate morbilità e mortalità. La coartazioni dell'aorta presenta segni ecocardiografici neonatali simili alla malformazione artero-venosa della vena di Galeno (VGAM). Presentiamo il caso di un ragazzo che, alla 37 settimana di gestazione, mostrava all'esame ecocardiografico un ventricolo destro dominante e un'ipoplasia dell'istmo, suggestivi per coartazione dell'aorta. Il follow-up ecografico ed ecocardiografico hanno rivelato una malformazione artero-venosa che coinvolgeva rami delle arterie cerebrale media e posteriore, eliminando l'ipotesi di coartazione dell'aorta. La diagnosi di VGAM è stata confermata da ulteriori indagini ecografiche e angiografiche, che hanno dimostrato un groviglio di rami arteriosi cerebrali e dei plessi corioidei alimentato da Ultrasound (2014) 17:297-301 DOI 10.1007 una vena di Galeno ingrandita. I parametri emodinamici e neurologici del ragazzo erano stabili nonostante l'aumento della pressione venosa. A 7 mesi di età l'embolizzazione elettiva è stata complicato da un incidente cerebrovascolare, con conseguente emiparesi destra, nonostante non vi siano state complicanza cardiache. Questo caso dimostra che r...

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“…Ductal-dependent cardiac malformations require drug therapy for keeping the permeability of the ductus arteriosus until the time of corrective surgery [10,11].…”

Section: Introductionmentioning

confidence: 99%

Drug Closure of a Patent Ductus Arteriosus in An Extremely Low Birth Weight Premature Newborn. A Case Report

Moldovan

Cucerea

2015

The Journal of Critical Care Medicine

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Introduction: Patent ductus arteriosus involves maintaining the permeability of the vascular ductus located between the pulmonary artery and the descending aorta, due to the failure of transition from foetal to adult type circulation. This malformation is characteristic to premature newborns with extremely low birth weight. The main pathophysiological factors identified in this pathology are immaturity of the smooth muscles, presence of vasodilator mediators and persistent hypoxaemia. Ductal-dependent cardiac malformations require drug therapy for keeping the permeability of the ductus arteriosus until the time of corrective surgery. Case presentation: We present the case of an extremely low birth weight premature newborn, derived from twin pregnancy with suspected specific pathology, respectively feto-fetal transfusion syndrome, admitted to the Regional Centre of Neonatal Intensive Care Unit Tîrgu-Mureş.

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Coarctation of the aorta

Cited by 123 publications

References 65 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Vein of Galen arteriovenous malformation mimicking coarctation of the aorta

Drug Closure of a Patent Ductus Arteriosus in An Extremely Low Birth Weight Premature Newborn. A Case Report

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