Table of Contents
How can coarctation of aorta be treated?
Twenty years ago, surgery was the only treatment available for aortic coarctation. Surgery is still considered the gold standard, but today treatment options for adults with this condition also include balloon angioplasty, stenting, stent grafting, or hybrid repair (a combination of open surgery and stent grafts).
What can be used to repair the coarctation?
Most adults born with aortic coarctation will have been repaired in childhood. This repair may have been surgical or done in the cardiac catheterization laboratory using a balloon or stent. These patients need lifelong monitoring by a congenital heart specialist.
What is correct about coarctation of the aorta?
What is Coarctation of the Aorta? Coarctation of the aorta is a birth defect in which a part of the aorta is narrower than usual. If the narrowing is severe enough and if it is not diagnosed, the baby may have serious problems and may need surgery or other procedures soon after birth.
When should you intervene on coarctation?
Intervention for coarctation is recommended in the following circumstances: (1) Peak-to-peak coarctation gradient of at least 20 mm Hg (level of evidence: C) and (2) peak-to-peak coarctation gradient below 20 mm Hg in the presence of anatomic imaging evidence of significant coarctation with radiologic evidence of …
Which intervention is recommended postoperatively for a child with repair of a coarctation of the aorta?
Surgery is the preferred treatment of infants with coarctation with an overall survival rate of 98 percent at a median follow-up of 4.8 years of age10. Surgical repair is also possible in preterm infants with birth weights less than 2.5 kg, with an overall survival rate of 76 percent one year after initial repair11.
What is coarctation gradient?
Coarctation is classically defined as a catheterization-measured peak systolic gradient > 20 mmHg. Hemodynamic assessment should include coarctation gradient assessment, right and left heart catheterization including assessment of left ventricular end diastolic pressure.
What causes rib notching?
Non-vascular causes of rib notching include neurofibromatosis, intercostal neuromas and pseudo-rib notching where irregular cortical thickening may occur in the presence of tuberous sclerosis and hyperparathyroidism. Degrees of rib notching on chest radiography may also be of no clinical significance.
When do you intervene on aortic coarctation?
The most widely accepted indication for intervention in children and adults is the presence of systemic arterial hypertension, with an upper and lower extremity systolic blood pressure difference ≥ 20 mg.
Why there is radio femoral delay in coarctation of aorta?
The radial and femoral pulses are palpated simultaneously. An appreciable delay in the femoral pulse is suggestive of coarctation of the aorta. Coarctation of the aorta may lead to hypertension in the circulatory system serving the head and upper limbs.
How do you assess coarctation of aorta echo?
Examination by continuous wave Doppler echocardiography is an effective non-invasive method of assessing the severity of coarctation of the aorta, particularly when systolic and diastolic events are considered together. This approach overcomes the relatively low sensitivity of peak systolic gradient alone.
Why do you get rib notching in coarctation?
The notching of the inferior aspect of the ribs as a result of pressure from the tortuous vessels of the collateral circulation in coarctation of the aorta is one of the best known diagnostic signs in medicine.
How is coarctation of the aorta diagnosed?
Coarctation of the aorta is usually diagnosed by echocardiogram (ultrasound pictures of the heart). Cardiac magnetic resonance imaging), cardiac CT (computerized tomography scan), and cardiac catheterization angiography also show aortic narrowing.
Why does coarctation of the aorta cause rib notching?
Bilateral symmetrical rib notching, readily appreciated on the chest image, is diagnostic of aortic coarctation. It is the result of obstruction of blood flow at the narrowed aortic segment, in conjunction with collateral blood flow through the intercostal arteries.
What does Radioradial delay indicate?
Radio-radial delay describes a loss of synchronicity between the radial pulse on each arm, resulting in the pulses occurring at different times. To assess for radio-radial delay: Palpate both radial pulses simultaneously.
Can you see coarctation on an echo?
Which modalities are capable of delineating the coarctation and collateral vessels?
All modalities are capable of delineating the coarctation as well as collateral vessels, most common collateral pathway being subclavian artery to internal mammary artery to intercostal arteries (resulting in inferior rib notching) to post-coarctation part of descending thoracic aorta.
What is the collateral pathway to the thoracic aorta?
if the coarctation is distal to either subclavian artery, then increased flow occurs through the subclavian artery, forming a collateral pathway via the internal thoracic artery, anterior intercostal artery, posterior intercostal artery and then into the descending thoracic aorta
What is the treatment for coarctation of the subclavian artery?
Treatment and prognosis. Treatment can be either primary surgical repair with excision of the coarctation and end-to-end anastomosis, or balloon angioplasty. Subclavian flap repair is a common surgical technique used, where the origin and proximal left subclavian artery is excised, opened up and sutured onto the aorta.
How is coarctation of the aorta treated?
Treatment can be either primary surgical repair with excision of the coarctation and end-to-end anastomosis, or balloon angioplasty. Subclavian flap repair is a common surgical technique used, where the origin and proximal left subclavian artery is excised, opened up and sutured onto the aorta.