Aortic coarctation natural history, complications and prognosis: Difference between revisions
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==Complications== | ==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: | 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 | *[[Rupture of the aorta]] or [[aortic dissection]] | ||
** Most frequently in the third or fourth decade. | ** 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). | ** 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. | ** Ruptures may bleed into the esophagus, and [[hematemesis]] or [[melena]] may portend disaster. | ||
* Infective endocarditis or endarteritis | * [[Infective endocarditis]] or endarteritis | ||
** Most frequently in the second to fourth decade of life. | ** Most frequently in the second to fourth decade of life. | ||
* Rupture of the circle of Willis | * Rupture of the [[circle of Willis]] | ||
** Most frequently in the second or third decade of life. | ** 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. | ** Secondary to the increased incidence of [[aneurysms]] in this population and the presence of proximal [[hypertension]]. | ||
* Congestive | * [[Congestive heart failure]] | ||
** Common in infants, often occurs with associated abnormalities such as [[VSD]] or mitral valve disease. | ** 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. | ** In the adult is secondary to [[hypertension]] associated with [[coronary artery disease]] or [[aortic valve disease]]. | ||
* | * Calcified [[aortic stenosis]] | ||
** Result of associated [[bicuspid aortic valve]] disease that over time becomes calcified. | ** Result of associated [[bicuspid aortic valve]] disease that over time becomes calcified. | ||
Revision as of 16:41, 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 coarctation 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.
- Calcified aortic stenosis
- Result of associated bicuspid aortic valve disease that over time becomes calcified.
- Premature death occurs due to
Prognosis
Prognosis is variable. The prognosis of aortic coarctation depends on whether balloon angioplasty and stenting or the surgery has been done or not.