Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children

2019 ◽  
Vol 23 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Madhusudan Ganigara ◽  
Arpan Doshi ◽  
Iman Naimi ◽  
Guru Prasad Mahadevaiah ◽  
Sujatha Buddhe ◽  
...  
Keyword(s):  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Systemic Hypertension ◽  
Coarctation Of Aorta ◽  
Older Children ◽  
Management Options ◽  
Percutaneous Balloon ◽  
The One ◽  
Aortic Obstruction ◽  
Angioplasty And Stenting

Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. While it is a simple lesion to understand, considerable variation exists in the anatomy and pathophysiology, leading to varied clinical presentation, management options, and prognosis. On the one hand critical CoA manifests in the neonatal period as a duct-dependent lesion, while less severe forms of obstruction present later in childhood or adulthood as hypertension or incidentally noted precordial murmurs. While transthoracic echocardiography is usually adequate, older children and adults may need more advanced imaging modalities like computed tomography and magnetic resonance imaging prior to intervention. Depending on the type of lesion, management options currently available include surgery and percutaneous balloon angioplasty and stenting. Even after successful interventions, these patients need life-long surveillance for residual aortic obstruction and systemic hypertension with variable long-term clinical outcomes.

scholarly journals Successful Surgical Outcome of Coarctation of Aorta in an adult male

2012 ◽  
Vol 8 (1) ◽  
pp. 62-64
Author(s):  
Md Mostafizur Rahman ◽  
M A Hossain ◽  
MAQ Chowdhury ◽  
OS Khan ◽  
SR Sarker ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Uncontrolled Hypertension ◽  
Coarctation Of Aorta ◽  
Older Children ◽  
Exertional Dyspnea ◽  
High Index Of Suspicion ◽  
Patent Ductus

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects. Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most  commonly patent ductus arteriosus, bicuspid aortic valve and ventricular septal defect. The diagnosis of coarctation of the aorta may be missed or delayed unless there is a high index of suspicion and the presentation may be congestive heart failure in infant or hypertension in older children and adult. A case of coarctation of the aorta associated with patent ductus arteriosus having features of headache, exertional dyspnea and  uncontrolled hypertension is being presented here. PTFE patch aortoplasty and ligation with transfixation of  PDA was done. Post-operative period was uneventful and patient was discharged on 7th post-operative day. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11671 University Heart Journal Vol. 8, No. 1, January 2012

Postnatal Development of Obstruction in Coarctation of the Aorta: Role of the Ductus Arteriosus

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 562-569
Author(s):  
Norman S. Talner ◽  
Michael A. Berman
Keyword(s):  
Ductus Arteriosus ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Descending Aorta ◽  
Aortic Isthmus ◽  
Sequence Of Events ◽  
Hypoplastic Right Ventricle ◽  
Discrete Area ◽  
Aortic Obstruction

The sequence of events leading to the development of acute obstruction in two infants with coarctation has been defined by clinical, hemodynamic, and angiographic studies. One infant had normally related great arteries and an isolated coarctation, while the other infant had transposition with a hypoplastic right ventricle, a ventricular septal defect, narrowing of the aortic isthmus, and a localized site of coarctation. In each instance, a posterior aortic shelf-the basic pathologic lesion in coarctation-could be observed angiographically. Signs of aortic obstruction were absent, however, as long as the ductus arteriosus was widely patent. Following ductal obliteration, femoral pulsations diminished, a peak systolic pressure difference was recorded between the ascending and descending aorta, and a discrete area of juxtaductal coarctation was seen. The basic malformation (posterior aortic curtain) would appear to exist in utero, possibly as an aortic branch point. This lesion is nonobstructive as long as blood can traverse the aortic isthmus through the aortic end of the ductus into the descending aorta. Postnatally, as the ductus arteriosus undergoes goes constriction at its aortic insertion, signs of acute aortic obstruction may become apparent. Normal femoral arterial pulsations during the newborn examination do not definitively exclude coarctation. Pediatricians should recheck at 2 weeks of age if the infant is asymptomatic or sooner if there are signs of cardiac failure to establish the presence or absence of this defect.

scholarly journals The immediate and late results for balloon angioplasty of native coarctation of aorta in pediatrics age group

2020 ◽  
Vol 16 (2) ◽  
pp. 16-20
Author(s):  
Maitham Qasim Mohammed ◽  
Husam Thaaban Al-Zuhairi ◽  
Ameer Adnan Muhsen ◽  
Sadiq M. Al Hamash
Keyword(s):  
Balloon Angioplasty ◽  
Balloon Dilation ◽  
Coarctation Of The Aorta ◽  
Late Result ◽  
Heart Catheterization ◽  
Coarctation Of Aorta ◽  
Transverse Arch ◽  
Associated Lesions ◽  
Percutaneous Balloon

Background: percutaneous balloon dilation of corotation of aorta is a less invasive and alternative to surgical repair for patients with discrete coaction of aorta and although the used of balloon angioplasty in patients with recurrent postoperative coarctation gained a wide consensus, the use this technique for native coarctation is still controversial in children less one years.  Objective: to evaluate the immediate and late result of balloon dilation of native coarctation of aorta in infant and children. Type of the study: A prospective study.  Subjects & Methods: The study was done on forty-five patients who were referred for cardiac catheterization and balloon angioplasty of native coarctation of the aorta at Ibn-AL-Bitar center for cardiac surgery between January 2015 to May 2016.Left heart catheterization was performed with evaluation of the morphology and pressure gradient across the stenotic segment of aorta. Follow up evaluations were done between 1 week and 18 months after discharge (mean 6 months) with transthoracic echocardiography.   Results: The age of patients range from 1month to 4 years (median age at time of procedure was12.3month).  Associated lesions in 11 patients (24.4%).  Immediate results were reduction in gradient from 42.5± 17.3 to 10.3± 8.2 mm Hg in forty-two patients (93.3%). Late result during follow up period, 29 patients (69%) had maintain gradient less than 20mmHg. Complications were reported in 6 patients (13.3%). there was one procedure related death (2.2%).    Conclusions: Balloon angioplasty for treatment of native coarctation of the aorta is effective with sustained benefit on long-term follow-up in infants and children >6 months. Transverse arch hypoplasia and children <6 months old has major effect on late outcome of recurrent coarctation of aorta.

scholarly journals Hypertension Associated with Coarctation of the Aorta Revisited: Case-Based Update from Experience of Three Children

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ali Baykan ◽  
Mustafa Argun ◽  
Abdullah Özyurt ◽  
Özge Pamukçu ◽  
Kazım Üzüm ◽  
...  
Keyword(s):  
Physical Examination ◽  
Coarctation Of The Aorta ◽  
Secondary Hypertension ◽  
Diagnostic Approach ◽  
Systemic Hypertension ◽  
Cerebellar Infarction ◽  
Clinical Pictures ◽  
Age Range ◽  
Hypertension In Children ◽  
Case Based

Coarctation of the aorta (CoA) can present with different clinical pictures depending on the severity of the narrowness in the coarcted aortic segment in an age range between newborn and adolescence. Sometimes, it can cause intracranial hemorrhage or infarction when diagnosis and treatment are delayed. The aim of this report is taking attention to CoA as a cause of systemic hypertension and is also emphasizing the differences of diagnostic approach for hypertension in children from adults. Two cases of hypertensive cerebral hemorrhage and one case of hypertensive cerebellar infarction associated with CoA are reported. These cases help us to pay attention to the possibility of CoA in adolescents with hypertensive stroke. We want to emphasize the importance of physical examination for evaluation of hypertension and to impress the diagnostic approach for secondary hypertension in children.

Increased Prevalence of Ventricular Septal Defect: Epidemic or Improved Diagnosis

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. 200-203
Author(s):  
Gerard R. Martin ◽  
Lowell W. Perry ◽  
Charlotte Ferencz
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Cardiovascular Malformations ◽  
Ventricular Septal Defects ◽  
Live Births ◽  
Septal Defects ◽  
Clinical Diagnoses ◽  
Control Study

The Baltimore-Washington Infant Study is an ongoing case-control study of congenital cardiovascular malformations in infants in whom the clinical diagnoses have been confirmed by echocardiography, catheterization, surgery, or autopsy. An increase in the prevalence of ventricular septal defects was detected in 1,494 infants with congenital cardiovascular malformations between 1981 and 1984. The prevalence of congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P&lt;.025) and the prevalence of ventricular septal defect increased from 1.0 to 1.6 per 1,000 live births (P&lt; .001). The increase in ventricular septal defects accounted for the total increase in congenital cardiovascular malformations. The prevalence of isolated ventricular septal defect increased from 0.67 to 1.17 per 1,000 live births (P&lt;.001). The prevalence of ventricular septal defect with associated coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and pulmonic stenosis did not change. The prevalence of ventricular septal defect diagnosed by catheterization, surgery, and autopsy did not change; however, defects diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P&lt;.001). It is concluded that the reported increase in prevalence of ventricular septal defect is due to improved detection of small, isolated ventricular septal defects and that there is no evidence of an "epidemic."

scholarly journals Genetic testing for coarctation of aorta

2018 ◽  
Vol 2 (s1) ◽  
pp. 64-66
Author(s):  
Yeltay Rakhmanov ◽  
Paolo Enrico Maltese ◽  
Alessandra Zulian ◽  
Tommaso Beccari ◽  
Munis Dundar ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Neonatal Period ◽  
Heart Defects ◽  
Coarctation Of The Aorta ◽  
Coarctation Of Aorta ◽  
Descending Thoracic Aorta ◽  
Routine Examination ◽  
Live Births ◽  
Gene Test ◽  
Medial Thickening

Abstract Coarctation of the aorta (CoA) is an inherited narrowing of the proximal descending thoracic aorta. Histological features include localized medial thickening and infolding with superimposed neointimal tissue. CoA is diagnosed by detection of a murmur or hypertension during routine examination. Typical clinical features are delayed or absent femoral pulses and difference in blood pressure between the arm and legs. These symptoms may appear in the first weeks of life or after the neonatal period. CoA accounts for 4-6% of all congenital heart defects and has a reported prevalence of about 4 per 10,000 live births. It is more common in males than females (59% vs 41%). This Utility Gene Test was developed on the basis of an analysis of the literature and existing diagnostic protocols. It is useful for confirming diagnosis, as well as for differential diagnosis, couple risk assessment and access to clinical trials.

scholarly journals Selective trust in young children and distracted adults: halo-effects outweigh rational choices

2020 ◽  
Author(s):  
Jonas Hermes ◽  
Franziska Brugger ◽  
hannes rakoczy ◽  
Tanya Behne
Keyword(s):  
Young Children ◽  
Cognitive Strategies ◽  
Dual Process ◽  
Cognitive Resources ◽  
Older Children ◽  
Selective Trust ◽  
Rational Choices ◽  
Cognitive Foundations ◽  
The One ◽  
The Individual

Research has shown that young children are selective in whom they trust, for example, learning selectively from the previously more reliable sources. To explain what cognitive foundations this capacity may build upon, is has recently been proposed that children recruit different kinds of cognitive strategies. These may include, on the one hand, simple heuristics such as favoring the overall better protagonist or those who score high on a salient, accessible characteristic, and, on the other hand, more systematic and cognitively effortful strategies, e.g., taking into account the individual properties of a protagonist. Based on such dual-process account, the present studies investigated the prediction that the more systematic processes require cognitive resources and develop with age. Children and adults were familiarized with two protagonists: The strong-and-shy protagonist scored high on a highly accessible trait (strength), whereas the weak-and-extraverted protagonist scored high on a less accessible trait (extraversion). In test trials, participants chose between these two protagonists for strength- and extraversion-related tasks. The results were consistent with the prediction of the dual-process account: Older children, and adults under normal conditions, showed a pattern of systematic reasoning, selecting the protagonists with the relevant trait for a given task. Yet, younger children, and adults whose cognitive capacities were burdened with a secondary task, showed a pattern of heuristic reasoning, selecting the strong-and-shy protagonist not only in the strength tasks but often also in the extraversion tasks. This is the first piece of direct evidence for the applicability of a dual-process account on selective trust.

Coarctation-like Physiology with Cerebral Arteriovenous Fistula

PEDIATRICS ◽  
1969 ◽  
Vol 44 (6) ◽  
pp. 1024-1028
Author(s):  
P. B. Deverall ◽  
J. F. N. Taylor ◽  
G. S. Sturrock ◽  
Eoin Aberdeen
Keyword(s):  
Arteriovenous Fistula ◽  
Aortic Arch ◽  
Cardiac Failure ◽  
Ductus Arteriosus ◽  
Coarctation Of The Aorta ◽  
Aortic Isthmus ◽  
Obstructive Lesion ◽  
Cerebral Arteriovenous Fistula ◽  
Flow Through ◽  
Reduced Flow

Hemodynamic signs of coarctation of the aorta were present in a neonate dying in cardiac failure. A cerebral arteriovenous fistula was found at autopsy. No obstructive lesion of the aortic arch was present. Development of the aortic isthmus may be impaired if diminished flow through this segment is present. Reduced flow may be present if most of the systemic output is diverted to a fistula proximal to the isthmus, distal systemic flow being maintained by flow from right-to-left through the ductus arteriosus. Spontaneous duct closure after birth may then be followed by a reduction in distal systemic flow, resulting in signs suggestive of coarctation.

Neonatal Physiology

2018 ◽  
Author(s):  
Brian Frugoni ◽  
Laura Downey
Keyword(s):  
Anesthetic Management ◽  
Ductus Arteriosus ◽  
Respiratory Physiology ◽  
Lung Mechanics ◽  
Older Children ◽  
Anesthetic Care ◽  
Disease States ◽  
Organ Systems ◽  
Neonatal Physiology ◽  
Apnea Of Prematurity

The neonate has many unique physiologic characteristics that set it apart from older children and adults. Many of these differences arise from the requirements for fetal growth and development and the abrupt transition from fetal to extrauterine life. All organ systems are impacted, with critical implications for medical management. Understanding the unique features of the neonate is essential for the safe anesthetic care of these patients. This chapter reviews fetal development of the different organ systems, along with their function during the neonatal period. Placental physiology as it pertains to anesthetic management will be reviewed. Special attention will be paid to transitional cardiac and respiratory physiology as well as neonatal respiratory mechanics. Renal acid–base maintenance, fluid and electrolyte management, hematologic and neurologic systems will be discussed. Emphasis is on the term neonate, although preterm neonatal physiology is also briefly reviewed. Common neonatal disease states are also covered. The goal is for the anesthesia practitioner to gain a greater understanding of the unique aspects of the neonate so that they may better care for this vulnerable subset of patients. This review contains 8 figures, 13 tables, and 52 references. Key Words: apnea of prematurity, chronic lung disease, infant lung mechanics, intraventricular hemorrhage, neonate, patent ductus arteriosus, patent foramen ovale, persistent fetal circulation, transitional circulation, retinopathy of prematurity

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