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PubMedDate not supplied

Coarctation of aorta presenting as acute abdominal pain.

Coarctation of aorta is the most common cardiovascular cause of secondary hypertension. The condition is correctable although early diagnosis is often not made. We report the case of a 9-year-old child who was admitted with severe intractable abdominal pain as the presenting symptom of post-subclavian coarctation of aorta with hypertension. His pain resolved after control of hypertension with parenteral antihypertensives and the narcotic analgesics. He subsequently underwent transcatheter balloon dilation of the coarctation of aorta and remains well with normal blood pressure on follow-up.

Abdominal Pain↗
PubMed1982

Mineralization of human aortas with coarctation: quantitative electron probe microanalysis.

Aortas with coarctation (isthmus stenosis) are obviously an ideal model to investigate pressure dependent changes of the aorta, as one can compare the proximal region (high pressure) with the distal region (low pressure). 7 aortas of patients aged from 2 months to 54 years were investigated. The concentrations of Na, Mg, P, S, C1, K, and Ca were determined by electronprobe microanalysis. Ca and P are constituent parts of the developing mineral and are mainly discussed. The Ca/P ratio (by weight) is about 0.3 in the unmineralized and about 2 in the mineralized tissue. Mineralization is demonstrated by a parallel increase of Ca, P, and the Ca/P ratio. Enrichments of Ca and P are found above all in a subintimal band. Usually they occur proximally and distally, but are much more pronounced proximally. Even in the aorta of a 2 month old infant enrichments were found proximally, but not distally. Thus mineral deposits occur very early in regions of hypertension. The differences between the proximal and distal region may demonstrate the influence of blood pressure on vascular mineralization. The mineralization starts in small compartments, which increase in size and number in the process of mineralization. Mineralized regions could often be localized by cathodoluminescence. But to demonstrate and localize the initial mineral deposits and to quantify element contents, electronprobe microanalysis became indispensable.

Adolescent↗
PubMed2001

Posterior pericardial ascending-to-descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta.

BACKGROUND: Coarctation of the aorta is commonly associated with recoarctation or additional cardiovascular disorders that require intervention. The best surgical approach in such patients is uncertain. Ascending-to-descending aortic bypass graft via the posterior pericardium (CoA bypass) allows simultaneous intracardiac repair or an alternative approach for the patient with complex coarctation. METHODS AND RESULTS: Between 1985 and 2000, 18 patients (13 males and 5 females, mean age 43+/-13 years) with coarctation of the aorta underwent CoA bypass through median sternotomy. Before operation, average New York Heart Association class was II (range I to IV), and 15 patients (83%) had systemic hypertension. One or more previous cardiovascular operations had been performed in 12 patients (67%); 10 patients had >/=1 prior coarctation repair. Two patients had prior noncoarctation cardiovascular surgery. Concomitant procedures performed in 14 patients (78%) included the following: aortic valve replacement in 9; coronary artery bypass surgery in 3; mitral valve repair in 2; and septal myectomy, mitral valve replacement, aortoplasty, subaortic stenosis resection, ventricular septal defect closure, and ascending aorta replacement in 1 patient each. All patients survived the operation and were alive with patent CoA bypass at a mean follow-up of 45 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Systolic blood pressure fell from 159 mm Hg before surgery to 125 mm Hg after surgery. CONCLUSIONS: CoA bypass via median sternotomy can be performed with low morbidity and mortality. Although management must be individualized, extra-anatomic CoA bypass via the posterior pericardium is an excellent single-stage approach for patients with complex coarctation or recoarctation and concomitant cardiovascular disorders.

Adolescent↗
PubMed2001

[Magnetic resonance imaging of dilatation of the ascending aorta after repair of coarctation of the aorta].

The authors studied the risk factors for dilatation of the ascending aorta in patients operated for coarctation of the aorta. A prospective study of the diameters of the ascending aorta by magnetic resonance imaging was undertaken in 46 patients with an average age of 30 months (range 6 days to 11 years) at surgery, and 10 years of age (6 months to 31 years) at the time of the investigation. The diameters were measured at the level of the sinus of Valsalva, at the sino-tubular junction, and compared with reference tables with respect to body surface area. Twenty six per cent of patients had dilatation of the ascending aorta. The predisposing factors were investigated. Age, type of surgery, postoperative hypertension. Doppler gradient in the isthmic region, anatomical appearances of the repair observed by MRI were not predictive of this complication. On the other hand, age of patients at MRI and bicuspid aortic valves (present in 66% of cases) (p < 0.05) were significant risk factors. These results indicate that regular follow-up by echocardiography or MRI of the diameter of the ascending aorta is necessary in patients operated for coarctation of the aorta and with bicuspid aortic valves.

Age Factors↗
PubMed2006

Evidence for cardiovascular autonomic dysfunction in neonates with coarctation of the aorta.

BACKGROUND: Coarctation of the aorta (CoA) is associated with hypertension and abnormalities of blood pressure control, which persist after late repair. Assumptions that neonatal repair would prevent development of blood pressure abnormalities have not been supported by recent data. We hypothesized that early pathological adjustment of autonomic cardiovascular function may already be established in the neonate with coarctation. METHODS AND RESULTS: We studied 8 otherwise well neonates with simple CoA and compared measures of spontaneous baroreflex sensitivity, heart rate variability, and blood pressure variability with 13 healthy newborn babies. Spontaneous baroreflex sensitivity was calculated with sequence methodology from an ECG, and noninvasive blood pressure was recorded with a Portapres. Heart rate variability was determined with time- and frequency-domain measures. Blood pressure variability was measured in the frequency domain. In comparison with normal controls, neonates with CoA had raised blood pressure (78.9+/-3.8 versus 67.1+/-2.1 mm Hg), depressed baroreflex sensitivity (8.7+/-1.5 versus 13.8+/-1.1 ms/mm Hg), reduced heart rate variability (total power 16.5+/-3.1 versus 31.5+/-2.2 ms2), and an increase in the high-frequency component of blood pressure variability (3.1+/-0.3 versus 2.2+/-0. 2 mm Hg2). This is not the pattern expected if neonates with CoA simply had subclinical cardiac failure. CONCLUSIONS: These data suggest that infants with CoA already show signs of pathological adjustment of autonomic cardiovascular homeostasis. Further longitudinal studies are required to determine whether these alterations play a role in the increased risk of late hypertension in these patients.

Aortic Coarctation↗
PubMedDate not supplied

Bicuspid aortic valve and coarctation of aorta.

Bicuspid aortic valve (BAV) and coarctation of aorta (COA) are frequently seen together. It is believed that these malformations result from a single developmental diathesis. A case is presented of COA, aortic stenosis and aneurysm of the ascending aorta corrected by patch aortoplasty and commisurotomy. An aneurysm at the site of the coarctation repair can develop as late as 20 to 25 years after surgery. Almost all of the aneurysms described have occurred in patients undergoing patch aortoplasty. We do not recommend this technique except in special cases.

Aortic Aneurysm↗
PubMed1992

Balloon dilation of postoperative persistent coarctation of aorta and valvular aortic stenosis--a case report.

Coarctation of aorta is frequently associated with severe valvular aortic stenosis. The authors report a case of severe, persistent postoperative coarctation of aorta and severe aortic stenosis who was given successful palliative treatment with percutaneous balloon dilation of both sites of obstruction. This is, to the best of their knowledge, the first report of such an intervention in this group of patients.

Adult↗
PubMed1995

Successful percutaneous transluminal angioplasty in native coarctation of aorta in young adult: a case report.

Coarctation of aorta is a rare cause of secondary hypertension, premature death will occur if no appropriate treatment is given. Before 1980, the only effective treatment was surgery, and recurrent stenosis was frequent. After then several works on percutaneous transluminal angioplasty of this disease were reported, with promising short-term and long-term results, especially in children and young adults. This report concerns a 19-year-old male who had hypertension for four years; the hypertension was caused by coarctation of the aorta, confirmed by cardiac catheterization and angiography. Average blood pressure (BP) of his upper extremities was 200/110 mmHg which dropped to 150/90 mmHg immediately, and still two years, after angioplasty, whereas BP of the lower extremities maintained at about 150/80 mmHg measured by Korotkoff technique. Follow-up transesophageal echocardiography found no coarctation or aneurysm at the dilatation site one year later. Magnetic resonance imaging, performed two years later, showed an almost normal aortic wall at the coaxctation. The postoperative course was uneventful, and patient follow-up at the cardiology clinic has regularly shown an average BP around 150/80 mmHg.

Adult↗
PubMed1989

[A case of aortitis syndrome which presented coarctation of aorta due to intraluminal flap formation in the middle of the thoracic aorta].

We present a rare case of aortitis syndrome associated with dilatation of aorta and coarctation-like effect due to the intraluminal flap formation originated from dissected wall of the aorta. A 31-year-old woman was admitted to our hospital complaining of shortness of breath, palpitation and cough. On admission, her physical status showed congestive heart failure and hypertension of upper extremities and hypotension of lower extremities. Bruits were audible over the neck, the anterior chest and the back. Serological studies showed active inflammation. Chest X-ray film showed upper mediastinal widening, cardiomegaly and pulmonary edema. Aortitis syndrome was strongly suggested by these clinical findings, so that prednisolone therapy was started on 3rd hospital day. Special examinations were performed several days later when inflammatory changes showed a tendency to improve. Chest CT scan, RI angiography and MRI studies showed an aneurysmal dilatation from the ascending aorta to the mid-thoracic aorta. Aortography demonstrated a flap at the terminal portion of this aneurysmal dilatation and grade II (Sellars) aortic regurgitation. There was a pressure difference of 80 mmHg between the parts abutting cranial and caudal sides of the flap. A surgical operation was, then, performed to correct the pressure difference. The dissected wall was extruded toward the aortic lumen creating a flap (2 cm in length). This flap was resected and an artificial graft was inserted. Histologically, the flap consisted of adventitia, media and intima.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Follow-up after patch aortoplasty for coarctation of aorta.

BACKGROUND: Patch aortoplasty (PA) for coarctation of aorta (COA) can lead to aneurysm formation at the repair site. X-ray, echocardiogram and computed tomography are unreliable for diagnosis of this complication. OBJECTIVE: To evaluate prospectively patients with PA for COA by magnetic resonance imaging (MRI) to detect presence of aneurysm at the repair site. DESIGN: All patients who underwent PA at the authors' institution were identified. MRI was performed in transverse and long axis oblique views on all patients except those who had, or were going to have, aortic angiography for other reasons. Details of the surgical procedure were obtained from the hospital records. RESULTS: Of the 18 patients studied, 15 had MRI and three had aortic angiography. Age at PA ranged from one week to 13.3 years (mean 6.3 years). The interval from PA to MRI or angiography was 9.5 years (range four to 12.5). No aneurysm was detected in any patient. Recoarctation was diagnosed in two patients not previously suspected but discovered on MRI. At PA the intimal shelf causing coarctation was either not excised or only minimally trimmed in 14 of 15 instances. CONCLUSIONS: The incidence of late aneurysm formation following PA for COA is low in the authors' patients, possibly due to minimal intimal damage at repair, although these patients should be followed longer. MRI was useful for assessment of aneurysm and restenosis.

Adolescent↗
PubMed2006

Coarctoplasty with self-expandable stent implantation for treatment of coarctation of aorta in adults.

BACKGROUND: Balloon angioplasty for treatment of coarctation of the aorta in adults, though promising, is sometimes limited by significant residual gradient (> 20 mmHg). Few studies have been reported on use of balloon-expandable stents in such a situation. We evaluated the use of self-expandable stents in patients with coarctation of the aorta. METHODS: Eight hypertensive patients (age 15 to 27 years) with coarctation of the aorta (n = 6) or recoarctation (n = 2) and peak systolic gradient of > 40 mmHg underwent stent implantation. Balloon predilatation was done and self-expandable nitinol aortic stents (Optimed) were implanted in all patients. RESULTS: The mean +/- SD peak systolic gradient decreased from a baseline of 55 +/- 15 (range: 40 - 75) to 5 +/- 2 (range: 3 - 7) mm Hg after angioplasty. Nitinol stents were easier to deploy and conformed better to aortic anatomy as compared with balloon-expandable stents. The mean +/- SD diameter of the coarcted segment increased from 3 +/- 1 mm to 16 +/- 2 mm. There were no complications in our series. On 6- to 9-month follow-up, all the implanted stents remained in their original positions and none showed evidence of fracture. Significant improvement in hypertension was seen in 7 out of 8 patients. CONCLUSION: Stent implantation is safe and effective in treating coarctation of the aorta. Self-expandable stents were easy to implant, had good adaptation to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation of the aorta as surgical repair.

Adolescent↗
PubMed1979

Late complications at repair site of operated coarctation of aorta.

Late complications at the repair site of coarctation of the aorta include aneurysms and persistent coarctation. Aneurysms are usually due to failure of the surgical anastomosis and can occur many years after repair. Continued aortic coarctation may be due to either repair failure or failure of the anastomotic site to grow with the patient. Three cases are presented and the literature reviewed.

Aorta, Thoracic↗