CT and MRI of Aortic Coarctation: Pre- and Postsurgical Findings

Karaosmanoğlu, Ali Devrim; Khawaja, Ranish Deedar Ali; Onur, Mehmet Ruhi; Kalra, Mannudeep K.

doi:10.2214/ajr.14.12529

Cited by 79 publications

(68 citation statements)

References 31 publications

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“…When the PDA closes after birth, severe CoA will lead to aortic obstruction with hypoperfusion of the lower body, renal dysfunction and metabolic acidosis 4. Increased afterload on the left ventricle (LV) may lead to LV failure 4.…”

Section: Neonatal and Infantile Presentationmentioning

confidence: 99%

Diagnosis, imaging and clinical management of aortic coarctation

Dijkema

Leiner

Grotenhuis

2017

Heart

152

129

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Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.

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Section: Neonatal and Infantile Presentationmentioning

confidence: 99%

Diagnosis, imaging and clinical management of aortic coarctation

Dijkema

Leiner

Grotenhuis

2017

Heart

152

129

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“…In older patients, an anteriorposterior film may show indentation of the aorta at the site of coarctation with pre and poststenotic dilation of the aorta, creating the classic "3 sign". Notching of the posterior fourth to eighth ribs due to dilated intercostal arteries may also be seen in older patients [24,25] . Electrocardiogram is typically normal in infants, but in older children and adults, left ventricular hypertrophy is common due to ventricular pressure overload [24] .…”

Section: Discussionmentioning

confidence: 99%

“…MRI has the additional benefit of defining and quantifying collateral vessel flow. Although cardiac catheterization was frequently used for diagnosis of coarctation in the past, it is now typically reserved for therapeutic intervention or in those cases where hemodynamic data is additive to the diagnostic evaluation [24,25] .…”

Section: Discussionmentioning

confidence: 99%

Coarctation of the aorta: Management from infancy to adulthood

Török

Campbell

Fleming

et al. 2015

WJC

235

151

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Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient's anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

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“…Coarctation of the aorta (CoA) is the fifth most common congenital heart disease, accounting for 6-8% of all cases [12]. It is characterized by narrowing of the aorta adjacent to the ductus arteriosus [13]. There are 3 types according to the narrowing site: 1) preductal (proximal to the ductus arteriosus), 2) ductal (at the level of the ductus arteriosus), and 3) postductal (distal to the ductus arteriosus).…”

mentioning

confidence: 99%

“…Other associated anomalies include ventricular septal defect, sinus venosus ASD, hypoplastic left heart syndrome, mitral valve malformation, truncus arteriosus, right aortic arch, supravalvular pulmonary artery stenosis, and left subclavian artery dilatation [17]. Cardiac CT can provide anatomical details of the aorta and the narrowing segment as well as associated cardiovascular anomalies and collateral vessels for initial diagnosis [13].…”

mentioning

confidence: 99%

Non-Coronary Findings on Cardiac Computed Tomography in Adults: What Radiologists Should Know

Lee

Ahn

et al. 2017

Cardiovasc Imaging Asia

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INtroductIoNRecent advances in technology have made cardiac computed tomography (CT) a useful tool for detection of coronary artery disease. Several studies using 64-slice CT demonstrated high sensitivity (96-99%) and a negative predictive value (93-99%) of cardiac CT in excluding significant coronary artery disease [1][2][3]. Therefore, cardiac CT can act as a gatekeeper to invasive coronary angiography. In addition, the appropriateness criteria for cardiac CT published by the American College of Cardiology list various non-coronary applications [4]. These include evaluation of 1) complex congenital heart disease, 2) cardiac masses, 3) pericardial conditions, 4) pulmonary vein anatomy prior to invasive radiofrequency ablation (RFA) in atrial fibrillation, 5) noninvasive coronary vein mapping prior to placement of a biventricular pacemaker, 6) suspected aortic dissection or thoracic aortic aneurysm, and 7) suspected pulmonary embolism. In this article, we will review the non-coronary application of cardiac CT and demonstrate typical CT case findings in adults. Because non-electrocardiogram (ECG)-gated CT is usually sufficient to assess a thoracic aortic aneurysm or pulmonary embolism, we excluded these conditions in this pictorial essay. AssessmeNt of complex coNgeNItAl heArt dIseAseCardiac CT can simultaneously provide information about the great vessels, cardiac chambers, and valve anomalies, with excellent spatial resolution and fast acquisition time in adult congenital heart disease [5].Atrial septal defect (ASD) is the most common congenital heart disease. Among the four subtypes of ASD, ostium secundum ASD is the most common (70-80%), followed by ostium primum ASD (15%), sinus venosus ASD (10%), and coronary sinus ASD (<1%) [6]. Cardiac CT can help to evaluate ASD and its subtypes, measure a defect or rim size, and assess a combined anomaly. In most cases of ostium primum ASD, the anterior leaf of the mitral valve is cleft. Partial anomalous pulmonary venous return (PAPVR) is commonly associated with approximately 85% of sinus venosus and 10% to 15% of ostium secundum ASD cases (Fig. 1) [7].Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease with atrioventricular and ventriculoarterial discordance. Ventriculoarterial discordance indicates that the morphological right ventricle connects to the aorta, and the morphological left ventricle connects to the pulmonary artery (Fig. 2). This double discordance results in physiologically corrected circulation, with the morphological left ventricle supplying the pulmonary circulation, and the cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Cardiac computed tomography (CT) is useful for the assessment of both non-coronary cardiac disease and coronary artery disease...

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CT and MRI of Aortic Coarctation: Pre- and Postsurgical Findings

Cited by 79 publications

References 31 publications

Diagnosis, imaging and clinical management of aortic coarctation

Diagnosis, imaging and clinical management of aortic coarctation

Coarctation of the aorta: Management from infancy to adulthood

Non-Coronary Findings on Cardiac Computed Tomography in Adults: What Radiologists Should Know

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