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Coarctation of the aorta 总被引:2,自引:0,他引:2
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Rao PS 《Current cardiology reports》2005,7(6):425-434
Coarctation of the aorta is an important, treatable cause of secondary hypertension. Its prevalence varies from 5% to 8% of
all congenital heart defects. This condition is most often detected because of a murmur or hypertension found on routine examination.
Delayed or absent femoral pulses and an arm/leg systolic blood pressure difference of 20 mm Hg or more in favor of the arms
may be considered as evidence for aortic coarctation. The coarctation may be demonstrated on a suprasternal notch two-dimensional
echocardiographic view along with increased Doppler flow velocities across the coarctation site. Cardiac catheterization reveals
significant systolic pressure gradient (> 20 mm Hg) across the coarctation and angiography demonstrates the degree and type
of aortic narrowing. Aortic obstruction may be relieved by surgery or by transcatheter techniques; the latter include balloon
angioplasty and stent implantation. In the past, surgery has been used exclusively, but because of morbidity and complications
associated with surgery, catheter techniques are increasingly used in the management of aortic coarctation. Balloon angioplasty
in children and stents in adolescents and adults are becoming initial therapeutic options for management of coarctation. Studies
evaluating long-term follow-up results of the interventional techniques are needed. 相似文献
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Opinion statement
相似文献
– | Balloon angioplasty or early surgical correction is recommended once coarctation of the aorta has been diagnosed. Medical management is not a long-term option. |
– | The rate of restenosis is higher in infants and children than in adults, but the incidence of residual or late hypertension increases with age at initial intervention. |
– | Current angioplasty and stent placement techniques have reduced the rate of aneurysm formation and expanded the types of complex anatomic configurations amenable to nonsurgical intervention. |
– | Patients require long-term follow-up for restenosis and late or residual hypertension. |
– | Coarctation treatment is straightforward in patients with simple isolated coarctation. In neonates with associated lesions and diffuse arch hypoplasia, aggressive (albeit higher-risk) arch-enlargement procedures can be done at the time of open-heart correction of intracardiac defects. |
– | Changes in aortic compliance, vascular reactivity, and vascular homeostasis mechanisms in patients who have late surgery are associated with a higher incidence of residual hypertension. |
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D E Fixler 《Cardiology Clinics》1988,6(4):561-571
This article discusses the clinical and laboratory findings of isolated coarctation of the aorta, with emphasis on the newer methods of diagnosis and treatment, as well as the long term natural history following surgical repair. 相似文献
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Coarctation of the aorta 总被引:1,自引:0,他引:1
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Calhoun TR Thumwood RG Tennyson KB Wright RM Kitten CM Windham PA 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》1983,10(3):269-273
Coarctation of the abdominal aorta represents an unusual but surgically treatable form of hypertension. The cause is somewhat controversial but generally can be traced to congenital or acquired origins. A case is presented in which the anomaly appears to be congenital. The variability in anatomy and subsequent treatment are discussed along with appropriate evaluation of the problem. 相似文献
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B W McCrindle 《Current opinion in cardiology》1999,14(5):448-452
Coarctation of the aorta may seem to be a relatively simple lesion, but controversy persists about the optimal management strategy for this condition. A plethora of options are available, and strong evidence to guide clinical decision making is lacking. The age of the patient at presentation and anatomic variations have a significant effect on the type of therapy chosen and the outcome of intervention, which can include death, recurrence of obstruction, and persistent or late hypertension. The current trend in practice is to favor surgical repair in neonates and infants and transcatheter balloon dilation in older children and adults. 相似文献
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Coarctation of the aorta in infancy 总被引:9,自引:0,他引:9
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Coarctation of the aorta and pregnancy 总被引:2,自引:0,他引:2
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Levy MJ Levinsky L Deviri E Hauptman E Blieden LC 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》1983,10(1):57-62
Twenty-five infants under 1 year of age (mean weight 3.4 kg) underwent repair of coarctation of the aorta between the years 1965 and 1982. Three patients had coarctation only, three had coarctation with patent ductus arteriosus (PDA), and 19 had associated intracardiac anomalies. Eleven patients underwent resection of the aorta and end-to-end anastomosis. Eight had subclavian flap arterioplasty, five had patch graft arterioplasty, and one had subclavian-to-aortic anastomosis. Additional procedures were performed on seven patients: banding of the pulmonary artery on one, repair of total anomalous pulmonary venous drainage on one, mitral valve replacement on one, aortic valvotomy on one, and aortic valvotomy plus pulmonary artery banding on one. Twenty-one survived the operation. All patients who died had associated intracardiac anomalies. The 21 survivors have been followed from 3 months to 13 years, with three late deaths that were associated with intracardiac anomalies. Five of the survivors underwent additional second operations: one had repair of the re-coarctation, one had replacement of the prosthetic mitral valve, one had aortic valvotomy, and two had pulmonary artery debanding and closure of a ventricular septal defect. Two of the 18 surviving patients have mild hypertension associated with a residual gradient. The others are in good health. 相似文献
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The incidence of congenital heart disease is higher in monozygotic than dizygotic twins, with a higher concordance rate. Although coarctation of the aorta has previously been reported in monozygotic twins, to the best of our knowledge it has not been described in dizygotic twins. We report here such a concurrence in dizygotic twins conceived by in-vitro fertilisation. The finding provides support for both genetic and environmental factors in the aetiology of congenital heart disease. Furthermore, it highlights our lack of data regarding the outcome of in-vitro fertilisation. 相似文献
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