Imaging adult patients with coarctation of the aorta

Thakkar, Akanksha; Chinnadurai, Ponraj; Lin, Chien‐Jung

doi:10.1097/hco.0000000000000430

Cited by 14 publications

(21 citation statements)

References 34 publications

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“…En caso de realizar un esofagograma con bario es posible visualizar el signo de la E, correspondiente a la curvatura del esófago alrededor de los segmentos preestenóticos y postestenóticos de la aorta. Actualmente la radiografía simple de tórax está incluida dentro de la valoración inicial de los pacientes, aunque su utilidad posterior es escasa (1) .…”

Section: Radiografía Simple De Tóraxunclassified

“…La coartación de aorta (CoAo) es una malformación congénita consistente en un estrechamiento localizado de la luz del vaso. La constricción de la aorta se localiza a cualquier nivel, aunque es más frecuente en la región yuxtaductal (1) (Figura 1). Corresponde aproximadamente al 5-8% de todas las cardiopatías congénitas y se presenta en el 85% de los casos junto a lesiones asociadas, o formando parte de un síndrome establecido.…”

Section: Introductionunclassified

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Técnicas de imagen en la coartación de aorta

Wals-Rodriguez

Rodríguez-Puras

Gallego

2020

Rev Ecocar Pract (RETIC)

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La coartación aórtica es una malformación congénita relativamente frecuente. Sus manifestaciones abarcan un amplio espectro de presentación, pudiendo mostrar síntomas desde el nacimiento, o bien diagnosticarse en la edad adulta. Para su manejo se dispone de una amplia gama de técnicas de imagen que permiten valorar la anatomía de la estenosis, las repercusiones estructurales en el ventrículo izquierdo, las alteraciones hemodinámicas y las complicaciones asociadas. La ecocardiografía transtorácica es la técnica de primera línea. Para la valoración quirúrgica en la coartación nativa y el seguimiento de la coartación reparada, la tomografía computarizada y la resonancia magnética son las técnicas de elección.

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Section: Radiografía Simple De Tóraxunclassified

Section: Introductionunclassified

Técnicas de imagen en la coartación de aorta

Wals-Rodriguez

Rodríguez-Puras

Gallego

2020

Rev Ecocar Pract (RETIC)

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“…Nonpulsatile flow in the abdominal aorta is suggestive of coarctation of the aorta and, while there was no evidence of this in the suprasternal images, a CT aortogram was requested to provide more comprehensive imaging of the aorta . The CT aortogram demonstrates clearly the presence of a severe narrowing just distal to the left subclavian artery, which is the typical location for coarctation (Figure ).…”

Section: Case Descriptionmentioning

confidence: 99%

Echocardiogram reveals unexpected finding in the investigation of murmur in a hypertensive postpartum patient

Williamson

2019

Sonography

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A transthoracic echocardiogram (echo) was requested for a 19-year-old female who required hospital admission for ongoing fevers, tachycardia, and hypertension. She was 10 days postpartum having delivered a healthy baby boy. A new murmur was noted, and she was found to have Escherichia coli bacteraemia prompting the referral for cardiac investigation. The echo was performed less than 24 hours after the referral was received, and the patient was well enough to attend the cardiology department being transported from the ward via wheelchair.The patient had a long history of systemic hypertension and attended a renal clinic regularly for review and management. Previous investigations included renal angiography and echo along with physical examination, which revealed no significant abnormalities.Blood testing showed an elevated aldosterone level for which she was being treated and systolic blood pressure averaged 155 mmHg.The patient was previously asymptomatic, and it was noted that her father was also treated for hypertension from the age of 33. The underlying cause of hypertension was deemed to be familial as no primary cause was identified.Because of longstanding systemic hypertension, the patient was classified as high risk for preeclampsia during her pregnancy. She was monitored closely, and at 37 +4 weeks gestation, the baby was induced and delivered without complication. | CASE DESCRIPTIONFollowing three tachycardic episodes, requiring admission to the Intensive Care Unit, an echo was performed to look for the source of murmur.The departmental routine echo protocol was followed with images obtained from parasternal, apical, subcostal, and suprasternal windows.Cardiac structure and function appeared normal with no evidence of significant valvular abnormality (Figure 1). Colour Doppler using a subcostal window demonstrated continuous flow within the abdominal aorta (Figure 2A). This was confirmed using colour M-mode (Figure 2B). Suprasternal imaging showed only the proximal portion of the upper descending aorta with no abnormality detected on 2D (Figure 3A) or using colour or spectral Doppler as demonstrated in Figure 3B. Nonpulsatile flow in the abdominal aorta is suggestive of coarctation of the aorta and, while there was no evidence of this in the suprasternal images, a CT aortogram was requested to provide more comprehensive imaging of the aorta. 1 The CT aortogram demonstrates clearly the presence of a severe narrowing just distal to the left subclavian artery, which is the typical location for coarctation 2 (Figure 4). The CT report also noted prominent collateral circulation including enlargement of the internal mammary and intercostal arteries. The CT image also demonstrates enlargement of the left subclavian artery.The coarctation site was unable to be crossed during coronary angiography when approached via the femoral artery and, instead, the coronaries were accessed from the right brachial artery.Aortogram demonstrated a failure of contrast to cross the narrowing, and the coarctation was deemed to be e...

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“…Uncorrected CoA has a poor prognosis, as 90% of patients without intervention die by the age of 60 years (9) due to congestive heart failure, aortic dissection, coronary artery disease, or intracranial hemorrhage (10). Thus, in patients with suspected or known CoA, imaging is crucial in the diagnosis, as well as pre- and post-intervention evaluation (11). According to guidelines (12), an adult with CoA should undergo thoracic aorta magnetic resonance imaging (MRI) or computed tomography (CT) every five years, regardless of intervention.…”

Section: Introductionmentioning

confidence: 99%

Morphometric evaluation of aortic coarctation and collateral circulation using computed tomography in the adult population

et al. 2019

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Background Analysis of morphometric details of aortic coarctation and collateral circulation using computed tomography (CT) and its impact on clinical symptoms is a perspective which is missing in the published literature. Purpose To perform CT-based qualitative and quantitative evaluation of aortic coarctation and collateral circulation with reference to clinical symptoms. Material and Methods The study comprised 2022 patients who underwent CT angiography. If aortic coarctation was seen, the patients underwent evaluation of its anatomy and associated clinical symptoms. Results Aortic coarctation was found in 33 patients. Follow-up (median 2476 days; range 1692–3543) was performed in 31 (94%) individuals. In this group (median age 42 years; range 30–52.5 years), median stenosis at the site of coarctation was 70% (range 58–85%) of the lumen area, with 17 (55%) patients presenting with significant (≥70%) stenosis. Patients with significant stenosis had a greater right and left internal mammary artery diameter ( P = 0.0070 and P = 0.0114, respectively) than those with mild stenosis. Patients with significant coarctation stenosis revealed hypertension and headache more commonly than those with mild stenosis (17 vs. 9, P = 0.01 and 10 vs. 2, P = 0.02), respectively. In patients who underwent intervention, a decrease in prevalence of hypertension (19 vs. 0, P = 0.008) and headache (12 vs. 3, P = 0.010) were observed in the follow-up. Conclusion CT enables quantitative and qualitative evaluation of aortic coarctation anatomy, including stenosis at the site of coarctation, and collateral circulation. In adult patients with aortic coarctation, the prevalence of hypertension and headache is related to the degree of stenosis at the site of coarctation and decreases after intervention.

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Imaging adult patients with coarctation of the aorta

Abstract: Although echocardiography is an important first line means to establish the diagnosis of aortic coarctations, CT and MRI-based techniques enable the provision of patient-specific management options, can guide transcatheter interventions and detect long-term post-intervention complications.

Cited by 14 publications

References 34 publications

Técnicas de imagen en la coartación de aorta

Técnicas de imagen en la coartación de aorta

Echocardiogram reveals unexpected finding in the investigation of murmur in a hypertensive postpartum patient

Morphometric evaluation of aortic coarctation and collateral circulation using computed tomography in the adult population

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