Aortic coarctation: Difference between revisions

	Aortic coarctation Microchapters
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Revision as of 17:14, 24 June 2011

For patient information click here'

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Diagnosis

Symptoms | Physical examination | Electrocardiogram | Chest x-ray | Echocardiography

Useful in determining associated abnormalities.

Weyman et al were able to visualize this area and make the diagnosis on 2D echo in 16/18 patients.

Confirmation by cardiac catheterization is unnecessary. Only done when the diagnosis is unclear, which is rare. It is mandatory in the infant to determine preoperative anatomy.

Angiography

MRI

Magnetic resonance imaging (MRI) can define the location and severity of a coarctation. MRI can also detect associated cardiac abnormalities and is used for serial follow-up after surgical repair or balloon angioplasty. MR angiography has almost completely replaced invasive catheter based techniques for evaluating re coarctation. In adults with untreated coarctation blood often reaches the lower body through collaterals, eg. internal thoracic arteries via. the subclavian arteries. Those can be seen on MR or angiography.

Schematic drawing of alternative locations of a coarctation of the aorta, relative to the ductus arteriosus. A: ductal coarctation, B: preductal coarctation, C: postductal coarctation. 1: Aorta ascendens, 2: Arteria pulmonalis, 3: Ductus arteriosus, 4: Aorta descendens, 5: Trunchus brachiocephalicus, 6: Arteria carotis communis sinister, 7: Arteria subclavia sinister

[Courtesy of RadsWiki and copylefted]
[Courtesy of RadsWiki and copylefted]
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

CT

CT images shown below are courtesy of Cafer Zorkun and copylefted

Aortic Coarctation
Aortic Coarctation
Aortic Coarctation
Aortic Coarctation

Therapy

Therapy is conservative if the patient is asymptomatic. If symptoms or hypertension are present, treatment for coarctation may be surgical or catheter based. The treatment choice depends on the patients age, the location of the coarctation and other associated anomalies. Recoartctaion after previous surgery is treated percutaneously with either balloon dilation and/or stenting.

References

External links

A case of coarctation of the aorta was published in the New England Journal of Medicine in 2007 showing chest X-Rays and MRT Images.^[1]
Aortic Coarctation information from Seattle Children's Hospital Heart Center
Overview and diagram at childrenscentralcal.org
Diagram at kumc.edu
Overview and diagram at umich.edu
[3]

Template:SIB

Template:Link FA de:Aortenisthmusstenose it:Coartazione dell'aorta no:Koarktasjon av aorta nn:Koarktasjon sr:Коарктација аорте uk:Коарктація аорти

Template:WikiDoc Sources

↑ Quiros-Lopez R, Garcia-Alegria J (2007). "A medical mystery -- high blood pressure". N Engl J Med. 356 (25): 2630. PMID 17582073.

[1] Quiros-Lopez R, Garcia-Alegria J (2007). "A medical mystery -- high blood pressure". N Engl J Med. 356 (25): 2630. PMID 17582073.

[1]

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-Irregularities or notching of the inferior margins of the posterior ribs results from collateral flow through dilated and pulsatile intercostal arteries. These collaterals appear after 6 years of age if the coarctation is significant.
-Post-stenotic dilation of the aorta results in a classic 'reverse 3 sign' on [[x-ray]]. The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the [[aorta|aortic wall]] at the site of [[cervical]] [[rib]] obstruction, with consequent post-stenotic dilation. This physiology results in the reversed '3' image for which the sign is named.<ref name="medstudy">{{cite book|last=Sabatine|first=Marc|title = Pocket Medicine|publisher=Lippincott Williams & Wilkins|date=February 15, 2000|pages=256 pages|isbn=0781716497}}</ref><ref>{{cite web|url=http://www.amazon.com/dp/007146431X/|title=General Surgery ABSITE and Board Review (Pearls of Wisdom)|author=Blecha, Matthew J.|date=August 30, 2005|publisher=McGraw-Hill|isbn=978-0071464314}}</ref><ref>{{cite web|url=http://www.amazon.com/dp/0976155273/|title=Quick Essentials: Emergency Medicine, 2nd Edition|author=Brady Pregerson|date=October 1, 2006|publisher=ED Insight Books|isbn=0976155273}}</ref>
-Chest X-ray below showing 3 sign and arrows pointing to notching of ribs.
-[[Image:COA_x-ray.jpg]] [[Image:COA x-ray labeled.jpg]]

v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)

Aortic coarctation: Difference between revisions

Revision as of 17:14, 24 June 2011

Contents

Overview

History

Epidemiology and demographics

Classification

Anatomy

Pathophysiology

Natural History

Genetics

Complications

Associated conditions

Diagnosis

Angiography

MRI

CT

Therapy

References

External links

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