Aortic coarctation natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
In infants with a preductal coarct, the LV output goes to the upper extremities, and the RV output goes to the lower extremities through the patent ductus. | In infants with a preductal coarct, the [[Cardiac output|LV output]] goes to the upper extremities, and the RV output goes to the lower extremities through the [[patent ductus]]. | ||
*'''Childhood:''' | *'''Childhood:''' | ||
:*80% of cases are diagnosed in childhood. | :*80% of cases are diagnosed in childhood. | ||
:*The preductal form is usually discovered in early infancy because it is usually severe. | :*The preductal form is usually discovered in early infancy because it is usually severe. | ||
:*Childhood coarctation is associated with a [[ventricular septal defect]] (VSD), tubular hypoplasia of the [[aortic arch]], [[transposition | :*Childhood coarctation is associated with a [[ventricular septal defect]] (VSD), tubular hypoplasia of the [[aortic arch]], [[TGA|transposition of the great vessels]], and [[mitral valve]] disease. | ||
*'''Adolescence:''' | *'''Adolescence:''' | ||
:*When first recognized in adolescents, coarctation of the aorta is generally asymptomatic. | :*When first recognized in adolescents, coarctation of the aorta is generally asymptomatic. | ||
*'''Adulthood:''' | *'''Adulthood:''' | ||
:*The postductal form is often less severe and discovered in adulthood. | :*The postductal form is often less severe and discovered in adulthood. | ||
:*Infrequently coarctation of the aorta is associated with other congenital abnormalities. | :*Infrequently coarctation of the aorta is associated with other [[congenital abnormalities]]. | ||
:*In patients over the age of 30, major complications leading to death are not uncommon. <ref>Giuliani et al, Cardiology: Fundamentals and Practice, Second Edition, Mosby Year Book, Boston, 1991, pp. 1670-1676.</ref> <ref>Deal K, Wooley CF. Coarctation of the Aorta and Pregnancy. Annals of Internal Medicine 1973, 78:706-710.</ref> | :*In patients over the age of 30, major complications leading to [[death]] are not uncommon. <ref>Giuliani et al, Cardiology: Fundamentals and Practice, Second Edition, Mosby Year Book, Boston, 1991, pp. 1670-1676.</ref> <ref>Deal K, Wooley CF. Coarctation of the Aorta and Pregnancy. Annals of Internal Medicine 1973, 78:706-710.</ref> | ||
* 75% of patients with coarctatin will have hypertension at 30 years of their age. | * 75% of patients with coarctatin will have hypertension at 30 years of their age. | ||
:*If the coarctation is left untreated, [[arterial hypertension]] may become permanent due to irreversible changes in some organs (such as the [[kidney]]). | :*If the coarctation is left untreated, [[arterial hypertension]] may become permanent due to irreversible changes in some organs (such as the [[kidney]]). | ||
Revision as of 15:01, 23 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S.[2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S.[4]
Overview
80% of patients are diagnosed during childhood. In the remaining 20% of cases, the symptoms are often less severe, but the coarctation will ultimately require correction in order to prevent irreversible organ damage. Common complications among patients who go untreated include: aortic rupture, infective endocarditis, congestive heart failure, and calcification of the aorta.
Natural History
In infants with a preductal coarct, the LV output goes to the upper extremities, and the RV output goes to the lower extremities through the patent ductus.
- Childhood:
- 80% of cases are diagnosed in childhood.
- The preductal form is usually discovered in early infancy because it is usually severe.
- Childhood coarctation is associated with a ventricular septal defect (VSD), tubular hypoplasia of the aortic arch, transposition of the great vessels, and mitral valve disease.
- Adolescence:
- When first recognized in adolescents, coarctation of the aorta is generally asymptomatic.
- Adulthood:
- The postductal form is often less severe and discovered in adulthood.
- Infrequently coarctation of the aorta is associated with other congenital abnormalities.
- In patients over the age of 30, major complications leading to death are not uncommon. [1] [2]
- 75% of patients with coarctatin will have hypertension at 30 years of their age.
- If the coarctation is left untreated, arterial hypertension may become permanent due to irreversible changes in some organs (such as the kidney).
Complications
About 50% of patients with coarctation of the aorta die within the first three decades of life, and more than 75% are dead by age 50 due to:
Rupture of the aorta or aortic dissection
- Most frequently in the third or fourth decade.
- Dissections originate either proximally (secondary to hypertension and local stress)or distally (where the jet erodes the intima).
- Ruptures may bleed into the esophagus, and hematemesis or melena may portend disaster.
Infective endocarditis or endarteritis
- Most frequently in the second to fourth decade of life.
Rupture of the circle of Willis
- Most frequently in the second or third decade of life.
- Secondary to the increased incidence of aneurysms in this population and the presence of proximal hypertension.
Congestive Heart Failure
- Common in infants, often occurs with associated abnormalities such as VSD or mitral valve disease.
- In the adult is secondary to hypertension associated with coronary artery disease or aortic valve disease.
Calcification aortic stenosis
- Result of associated bicuspid aortic valve disease that over time becomes calcified.
Premature death occurs due to
- Coronary artery disease
- Heart failure
- Stroke
- Aortic dissection or rupture