Delayed Therapy of Descending Aortic Coarctation Results in Anterior Cerebral Rupture: A Case Report

Background: Coarctation of the aorta (CoA) is the congenital constriction or narrowing of the aortic lumen. These constrictions are primarily located in the descending aorta causing significant discrepancies in systolic blood pressures of the upper and lower extremities. Thus, a delay in diagnosis and treatment may lead to severe and adverse consequences.Case presentation: Herein, we present a 13-year-old boy with anterior cerebral rupture following a delayed diagnosis for descending CoA. Percutaneous transluminal balloon dilatation and endovascular stent implantation were urgently and successfully performed alongside cerebral clipping of the vascular aneurysm.Conclusion: An early diagnosis is crucial for CoA's successful treatment and management to prevent complications, including anterior cerebral rupture.

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Abnormal histology of the aortic arch in coarctation of the aorta

Cardiology in the Young ◽

10.1017/s1047951100001852 ◽

1993 ◽

Vol 3 (4) ◽

pp. 412-416 ◽

Cited By ~ 3

Author(s):

Derk W. Wolterbeek ◽

Arie P. Kappetein ◽

Adriana C. Gittenberger–de Groot

Keyword(s):

Neural Crest ◽

Aortic Arch ◽

Aortic Coarctation ◽

Coarctation Of The Aorta ◽

Lower Number ◽

Descending Aorta ◽

Aortic Isthmus ◽

Cardiac Neural Crest ◽

The Media

SummaryWe examined the number of elastic lamellae in the wall of the proximal aortic arch, aortic isthmus and descending aorta in patients with coarctation of the aorta. In the proximal aortic arch, the number of elastic lamellae was significantly lower in patients with coarctation compared to those with normal hearts without aortic anomalies and those with intracardiac defects but without aortic anomalies. The isthmus also showed a significantly lower number of elastic lamellae in the presence of preductal coarctation. In the descending aorta, the number of elastic lamellae was not significantly different between the different groups. There is doubt about the etiology of coarctation. Recent investigations showed that cells from the cardiac neural crest contribute to the formation of the arch arteries and the media of the arch. A developmental error of the neural crest might be responsible for the abnormal mural structures found in patients with aortic coarctation.

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COARCTATION OF THE AORTA AS A CAUSE OF DEATH IN EARLY INFANCY

PEDIATRICS ◽

10.1542/peds.8.2.192 ◽

1951 ◽

Vol 8 (2) ◽

pp. 192-203

Author(s):

ROBERT C. BAHN ◽

JESSE E. EDWARDS ◽

JAMES W. DUSHANE

Keyword(s):

Cause Of Death ◽

Aortic Coarctation ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Early Infancy ◽

Fetal Life ◽

Descending Aorta ◽

Congestive Failure

This is a report of three cases in each of which an infant exhibited coarctation of the aorta at the level of a closed or closing ductus arteriosus. In all cases the collateral channels were poorly developed. It appears from the available evidence that death resulted from left ventricular congestive failure secondary to an obstructive hypertension. The development of collaterals to by-pass a coarctation of the aorta seems to depend upon the relation of the aortic coarctation to the aortic mouth of the ductus arteriosus. When the coarctation lies distal to the ductus, collaterals develop. When the coarctation lies proximal to the ductus, adequate collaterals do not develop before birth. When the coarctation lies opposite the aortic mouth of the ductus arteriosus, the development of collaterals during fetal life seems to depend upon the direction that the blood flowing in the ductus arteriosus takes. When the flow is into the aorta proximal to the coarctation, collaterals would be expected to develop; while when the ductal flow is into the descending aorta, adequate collaterals would not be expected to develop in the fetus. The three cases reported fall into the latter category.

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Coarctation of the Aorta: A Study in Delayed Detection

PEDIATRICS ◽

10.1542/peds.69.2.159 ◽

1982 ◽

Vol 69 (2) ◽

pp. 159-163

Author(s):

Maureen A. Strafford ◽

Sylvia P. Griffiths ◽

Welton M. Gersony

Keyword(s):

Blood Pressure ◽

Delayed Diagnosis ◽

Coarctation Of The Aorta ◽

Great Majority ◽

Age At Diagnosis ◽

Abnormal Finding ◽

Working Paper ◽

Elevated Systolic Blood Pressure ◽

Upper And Lower Extremities ◽

The Impact

The findings and presentations of 65 consecutive patients in whom uncomplicated coarctation of the aorta was diagnosed after 1 year of age were reviewed. Significant delays in diagnosis occurred in the great majority of patients. The median age at diagnosis was 10 years (range 1 to 36 years). Pediatricians made 75% of the referrals. However, the diagnosis of coarctation of the aorta was made before referral in only 14% of these cases. The remaining referrals were made after the incidental notation of hypertension or a heart murmur out of the context of routine medical care (eg, emergency room, school nurses, working paper and insurance physicals, pregnancy, etc). Cardiac murmurs (median age at diagnosis 6 years) and hypertension (median age at diagnosis 18 years) accounted for referrals in whom the condition was not diagnosed. Prompt referral to a cardiologist after the detection of an abnormal finding did not always occur. Additional delays in referral occurred in 29 patients. All of the patients had cardiac murmurs and differential blood pressure between upper and lower extremities. Elevated systolic blood pressure in the upper extremities was found in 89%; femoral pulses were absent in 40%; and pedal pulses were absent in 77%. It is concluded that coarctation of the aorta is a diagnosis that is often overlooked despite specific physical findings. The importance of upper and lower extremity blood pressure determination as part of an initial routine physical examination is emphasized. The impact of delayed diagnosis has yet to be fully defined, but may well be significant in terms of cardiovascular sequelae of prolonged hypertension.

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Persistent fifth aortic arch associated with aortic coarctation: a case of surgical correction without artificial material

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01664-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chang Hun Kim ◽

Hyungtae Kim ◽

Kwang Ho Choi ◽

Si Chan Sung ◽

Hoon Ko ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Coarctation ◽

Surgical Intervention ◽

Surgical Techniques ◽

Growth Potential ◽

Case Presentation ◽

Descending Aorta ◽

Persistent Fifth Aortic Arch ◽

Additional Surgery ◽

Surgical Methods

Abstract Background Persistent fifth aortic arch (PFAA) is a rare anomaly often associated with aortic coarctation or interruption, and various surgical techniques for this anomaly have been reported. Herein, we show a case of an infant with PFAA and severe aortic coarctation. Case presentation A 41-day-old female infant was admitted for sustained fever. Initially, the patient was diagnosed with bacterial meningitis, and echocardiography showed PFAA with severe aortic coarctation. Because the patient presented progressive oliguria and metabolic acidosis, she was transferred for emergency cardiac surgical intervention. The aortic arch was reconstructed using end-to-side anastomosis between the fifth aortic arch and the descending aorta without any artificial conduit or patching material. Conclusions PFAA with aortic coarctation can be repaired by various surgical methods. Among them, our surgical approach is easy and effective, has growth potential, and an additional surgery is not needed.

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Subclavian flap aortoplasty for infant coarctation of the aorta

10.1510/mmcts.2021.005 ◽

2021 ◽

Keyword(s):

Gold Standard ◽

Aortic Coarctation ◽

Standard Treatment ◽

Coarctation Of The Aorta ◽

Long Term Outcomes ◽

Descending Aorta ◽

Technical Aspects ◽

Video Tutorial ◽

End To End

Aortic resection with an extended end-to-end anastomosis is the surgical gold standard treatment for infant aortic coarctation and has excellent early and long-term outcomes. Subclavian flap aortoplasty is an alternative surgical technique that offers some advantages because there is no need to do extensive dissection and mobilization of the aortic arch and descending aorta as required in an extended end-to-end anastomosis. This video tutorial illustrates the technical aspects of subclavian flap aortoplasty in an infant.

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Persistent Fifth Aortic Arch Associated With Aortic Coarctation: A Case of Surgical Correction Without Artificial Material

10.21203/rs.3.rs-151066/v1 ◽

2021 ◽

Author(s):

Chang Hun Kim ◽

Hyungtae Kim ◽

Kwang Ho Choi ◽

Si Chan Sung ◽

Hoon Ko ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Coarctation ◽

Surgical Intervention ◽

Surgical Techniques ◽

Growth Potential ◽

Case Presentation ◽

Descending Aorta ◽

Persistent Fifth Aortic Arch ◽

Additional Surgery ◽

Surgical Methods

Abstract Background: Persistent fifth aortic arch (PFAA) is a rare anomaly often associated with aortic coarctation or interruption, and various surgical techniques for this anomaly have been reported. Herein, we show a case of an infant with PFAA and severe aortic coarctation. Case presentation: A 41-day-old female infant was admitted for sustained fever. Initially, the patient was diagnosed with bacterial meningitis, and echocardiography showed PFAA with severe aortic coarctation. Because the patient presented progressive oliguria and metabolic acidosis, she was transferred for emergency cardiac surgical intervention. The aortic arch was reconstructed using end-to-side anastomosis between the fifth aortic arch and the descending aorta without any artificial conduit or patching material. Conclusions: PFAA with aortic coarctation can be repaired by various surgical methods. Among them, our surgical approach is easy and effective, has growth potential, and an additional surgery is not needed.

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Late diagnosis of coarctation of the aorta in a 44-year-old male: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01753-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Weijian Luo ◽

Jilin Li ◽

Xiaojun Huang ◽

Xiangna Cai

Keyword(s):

Ventricular Hypertrophy ◽

Good Condition ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Late Diagnosis ◽

Transcatheter Intervention ◽

Case Presentation ◽

Include Blood Pressure ◽

Upper And Lower Extremities

Abstract Background Coarctation of the aorta is a rare congenital disease. In adults, the main manifestations include hypertension, weak or absent femoral pulses, heart failure, and left ventricular hypertrophy. Case presentation We present a case involving a late diagnosis of coarctation of the aorta detected during aortography in a 44-year-old man. The patient underwent stent implantation and aortoplasty. After 2 years of follow-up, the patient was in good condition. Conclusions This case shows that coarctation of the aorta can be cured and that hypertension caused by the condition can be controlled to some extent with medication. Based on our findings, we recommend a detailed physical examination for all patients suspected of having coarctation of the aorta; the examination should include blood pressure measurements of both the upper and lower extremities. The case of coarctation of the aorta is not common or easy to be found in medium-aged population. Better BP control, earlier repair, and transcatheter intervention may result in a good outcome in that case.

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Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽

10.1024/0301-1526/a000176 ◽

2012 ◽

Vol 41 (2) ◽

pp. 132-135 ◽

Cited By ~ 2

Author(s):

Krohn ◽

Gebauer ◽

Hübler ◽

Beck

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Collateral Circulation ◽

Intestinal Ischemia ◽

Clinical Presentation ◽

Lower Limbs ◽

Upper Body ◽

Descending Aorta ◽

Before And After ◽

Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

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