Aortic coarctation: Difference between revisions

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''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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  Name          = {{PAGENAME}} |
{{Template:Aortic Coarctation}}
  Image          = Coarctation-of-the-aorta-MRI-003.jpg|
 
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  ICD10          = {{ICD10|Q|25|1|q|20}} |
  ICD9          = {{ICD9|747.10}} |
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  eMedicineSubj  = med |
  eMedicineTopic = 154 |
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[[Image:Coarctation.png|thumb|right|Sketch showing heart with coarctation of the aorta. A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:pulmonary artery, 10:Aorta
]]
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Revision as of 17:03, 24 June 2011

For patient information click here'

Aortic coarctation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Coarctation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

CT

MRI

Angiography

Echocardiography

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic coarctation On the Web

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American Roentgen Ray Society Images of Aortic coarctation

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

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CDC on Aortic coarctation

Aortic coarctation in the news

Blogs on Aortic coarctation

Directions to Hospitals Treating Aortic coarctation

Risk calculators and risk factors for Aortic coarctation

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

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

Overview

History

Epidemiology and demographics

Classification

Anatomy

Pathophysiology

Natural History

Genetics

Complications

Associated conditions

Diagnosis

Symptoms | Physical examination | Electrocardiogram

With severe coarctation, left ventricular hypertrophy LVH may be present.

Chest X Ray

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 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.[1][2][3]

Chest X-ray below showing 3 sign and arrows pointing to notching of ribs.

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.

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Angiography

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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

CT

CT images shown below are courtesy of Cafer Zorkun and copylefted

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

  1. Sabatine, Marc (February 15, 2000). Pocket Medicine. Lippincott Williams & Wilkins. pp. 256 pages. ISBN 0781716497.
  2. Blecha, Matthew J. (August 30, 2005). "General Surgery ABSITE and Board Review (Pearls of Wisdom)". McGraw-Hill. ISBN 978-0071464314.
  3. Brady Pregerson (October 1, 2006). "Quick Essentials: Emergency Medicine, 2nd Edition". ED Insight Books. ISBN 0976155273.

External links

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


Template:WikiDoc Sources

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