We report the case of a 20-year-old female patient presenting with a totally occluded coarctation of the aorta. The patient was admitted for the evaluation of resistant grade III high blood pressure. The physical exam...We report the case of a 20-year-old female patient presenting with a totally occluded coarctation of the aorta. The patient was admitted for the evaluation of resistant grade III high blood pressure. The physical examination revealed a blood pressure gradient between the upper and lower limbs, absent femoral pulses, a diffuse continuous murmur over the chest, and hyperpulsatility of the carotid arteries and sternal notch. A transthoracic echocardiography outlined a narrowing in the caliber of the isthmic aorta without acceleration of flow or gradient. Thoracic CT angiography revealed a complete aortic coarctation with interruption of continuity between segment 3 and the descending aorta.展开更多
Non-isthmic coarctation of the aorta is a rare congenital malformation in adults. Arterial hypertension is a frequent circumstance of discovery. We reported the case of a 22-year-old Guinean man who had been foll...Non-isthmic coarctation of the aorta is a rare congenital malformation in adults. Arterial hypertension is a frequent circumstance of discovery. We reported the case of a 22-year-old Guinean man who had been followed for 5 years for hypertension. Clinically, he presented with hypertension of the upper limbs with a systolic pressure gradient of 100 mmHg. The diagnosis was confirmed by thoracic angioscan, which showed a 65.8% coarctation of the abdominal aorta. He was on triple antihypertensive therapy combining Atenolol 100 mg, Amlodipine 10 mg and Perindopril 10 mg. He is awaiting interventional treatment. His blood pressure is stable at around 140/90 mmHg.展开更多
Background:An isolated bicuspid aortic valve(BAV)is associated with structural and functional abnormalities of the aorta and the left ventricle(LV).Although~50%of patients with aortic coarctation(CoA)have a BAV,less i...Background:An isolated bicuspid aortic valve(BAV)is associated with structural and functional abnormalities of the aorta and the left ventricle(LV).Although~50%of patients with aortic coarctation(CoA)have a BAV,less is known about its impact on LV function and aortic geometry and function in CoA patients.In this cardiovascular magnetic resonance imaging(CMR)study,we analysed markers of LV and aortic function as well as aortic geometry in a large cohort of CoA patients with a BAVand compared them with CoA patients with a tricuspid aortic valve(TAV).Methods:We included 48 patients with a BAV(18.4±9.3 years)and 45 patients with TAV(20.7±9.9 years).LV volumes,mass and ejection fraction as well as aortic distensibilty,pulse wave velocity(PWV)were measured from standard cine CMR and phase-contrast CMR images.2-dimensional CMR feature tracking(2DCMR-FT)was performed to measure longitudinal,circumferential and radial strain and strain rate of the LV.Aortic arch geometry was classified as romanic,gothic and crenel.Results:LV volumes,mass and ejection fraction as well as aortic distensibility and PWV did not significantly differ between the BAV and the TAV group.There was also no significant difference for LV global longitudinal,radial and circumferential strain and strain rate between both groups.Patients with a BAV had more commonly a gothic aortic arch compared to TAV patients,but this difference was not statistically significant(22 vs.14,p=0.2).Ascending and descending aortic distensibility correlated with LV mass in the entire patient group(p<0.001).Global longitudinal,circumferential and radial strain(GLS,GCS,GRS)and global longitudinal and circumferential strain rate(GLSR,GCSR)correlated with LV ejection fraction(p<0.001).Conclusion:Our data suggest that the presence of a BAV does not adversely impact LV and aortic function in children and young adults with CoA.The correlation of global circumferential,longitudinal and radial strain values with LV ejection fraction demonstrates that 2D-CMR-FT might provide additional information related to ventricular function in CoA patients.展开更多
There are very few reports on successful management of young children with coexistence of two congenital heart defects, coarctation of aorta and patent ductus arteriosus. These lesions can be treated either simultaneo...There are very few reports on successful management of young children with coexistence of two congenital heart defects, coarctation of aorta and patent ductus arteriosus. These lesions can be treated either simultaneously or sequentially. Herein, we present the first successful report of simultaneous balloon angioplasty and Amplatzer duct occluder device implantation in a single-sitting in an 8-year-old boy with severe aortic coarctation and patent ductus arteriosus. The coarctation gradient decreased from 70 mmHg to 10 mmHg and a complete closure of the ductus arteriosus was achieved without any complication. Fellow interventional cardiologists may consider single-stage transcatheter treatment in young children with combination of these two lesions.展开更多
BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between the...BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between them is whether arterial lumen exhibits continuity or not,the clinical manifestations are similar and connection exists between them.Adult type A IAA is considered as an extreme form of CoA,which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation.This paper reports two cases(interrupted aortic arch and severe aortic coarctation)to analyze the difference and similarity between them.CASE SUMMARY The two cases of patients presented with hypertension for many years.Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow.The IAA patient refused surgical treatment and blood pressure could be controlled with drugs.While the CoA patient underwent stent implantation because of uncontrollable hypertension,the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.CONCLUSION Adult type A IAA and CoA have difference and similarity,and type A IAA is associated with CoA to a certain extent.The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.展开更多
We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a smal...We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a small intimal tear, a true lumen, a false lumen, a markedly thick mural thrombus and pleural effusion. Open surgical procedure was performed and the aortic coarctation (CoA) and aortic dissection were resected and a 24-mm prosthetic graft was anastomosed. No pseudo aneurysms were present at the anastomosis sites on the follow up CTA.展开更多
We report a 26-year-old man with critical aortic coarctation, severe bicuspid aortic valve stenosis, infective endocarditis and ascending aortic aneurysm. He underwent simultaneously in singlestage a Bentall’s proced...We report a 26-year-old man with critical aortic coarctation, severe bicuspid aortic valve stenosis, infective endocarditis and ascending aortic aneurysm. He underwent simultaneously in singlestage a Bentall’s procedure and an extra-anatomic ascending-descending aortic bypass grafting by 14-mm Dacron tube, through median sternotomy. The immediate postoperative outcome was favourable. The CT scan control for 7 years after surgery showed a good patency of the extra-anatomic bypass.展开更多
In this work, we first investigated the hemodynamic parameters in the case of a normal aortic arch anatomy and in the case of aortic coarctation anatomy, both generated by using CFX-ICEM-ANSYS simulations. Then, we co...In this work, we first investigated the hemodynamic parameters in the case of a normal aortic arch anatomy and in the case of aortic coarctation anatomy, both generated by using CFX-ICEM-ANSYS simulations. Then, we compared these results with those obtained for a proposed model without and with aortic coarctation, while introducing a real tridimensional magnetic resonance imaging geometry in the simulation process. The conclusion is that our proposed model reproduces, with a high agreement, the real case obtained from imaging data.展开更多
Survival to advanced age is exceptional in patients with unrepaired aortic coarctation.We report the case of an 81-year-old man with aortic coarctation and total occlusion who was othersise asymptomatic.Coarctation wa...Survival to advanced age is exceptional in patients with unrepaired aortic coarctation.We report the case of an 81-year-old man with aortic coarctation and total occlusion who was othersise asymptomatic.Coarctation was suspected when a femoral-radial pulse delay was noted during his routine physical examination.A 70-mmHg systolic blood pressure gradient between the upper and lower extremities was detected.展开更多
Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods ...Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with coarctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in展开更多
Coarctation of the aorta(CoA)refers to the congenital coarctation near the isthmus,ductus arteriosus or ligamentum arteriosus,with an incidence of 5%–10%in children with congenital heart defects.[1]It can be isolated...Coarctation of the aorta(CoA)refers to the congenital coarctation near the isthmus,ductus arteriosus or ligamentum arteriosus,with an incidence of 5%–10%in children with congenital heart defects.[1]It can be isolated or coexisted with ventricular septal defects,subaortic stenosis,patent ductus arteriosus,and mitral aortic valve.[2]CoA has a poor prognosis.Without intervention,the median age of death with aortic coarctation is 38 years[3]and 75%death of those patients is at the age of 46 years.[4]Causes of death included congestive heart failure(26%),aortic rupture(21%),bacterial endocarditis(18%),and intracranial hemorrhage(12%).[5]Therefore,early diagnosis and optimal treatment are the key to improve the prognosis of this disease.The aim of this report is underlining the importance of early and accurate diagnose of CoA as a cause of systemic hypertension in young patients and also emphasizing the genetic factors of CoA in twins.展开更多
Type A aortic aneurysm and dissection secondary to bicuspid aortic valve(BAV)with untreated coarctation of the aorta(CoA)in adults is a rare finding because there are almost no“abnormalities”in these patients’medic...Type A aortic aneurysm and dissection secondary to bicuspid aortic valve(BAV)with untreated coarctation of the aorta(CoA)in adults is a rare finding because there are almost no“abnormalities”in these patients’medical histories.Here,we report on a 47-year-old man with unexplained weakness followed by unconsciousness.He was diagnosed with cardiogenic shock and underwent venoarterial extracorporeal membrane oxygenation(VA-ECMO).BAV,ascending aortic aneurysm and dissection(based on bedside echocardiography)and concomitant CoA(based on computed tomography angiography)were confirmed.The patient then underwent emergency surgery including aortic root replacement with a composite mechanical valve conduit,additional ascending-to-descending aortic bypass,and coronary artery bypass grafting with a saphenous vein graft to the right coronary artery.After treatment,he recovered uneventfully.Thus,here we present a case involving a patient in a critical condition with ascending aortic aneurysm and dissection secondary to complex congenital heart defects,who was successfully treated with composite surgical procedures combined with life-saving VA-ECMO.展开更多
A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aort...A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aorta, and extensively enlarged collateral vascular supply to the lower portion of abdominal aorta. The pressures proximal and distal to stenosis were 185/110 and 95/70 mmHg, and the pressure gradient across the stenosis was 90/40 mmHg. After the operation of thoraco-abdominal bypass graft, the pressure difference between the upper and lower extremities eventually disappeared.展开更多
文摘We report the case of a 20-year-old female patient presenting with a totally occluded coarctation of the aorta. The patient was admitted for the evaluation of resistant grade III high blood pressure. The physical examination revealed a blood pressure gradient between the upper and lower limbs, absent femoral pulses, a diffuse continuous murmur over the chest, and hyperpulsatility of the carotid arteries and sternal notch. A transthoracic echocardiography outlined a narrowing in the caliber of the isthmic aorta without acceleration of flow or gradient. Thoracic CT angiography revealed a complete aortic coarctation with interruption of continuity between segment 3 and the descending aorta.
文摘Non-isthmic coarctation of the aorta is a rare congenital malformation in adults. Arterial hypertension is a frequent circumstance of discovery. We reported the case of a 22-year-old Guinean man who had been followed for 5 years for hypertension. Clinically, he presented with hypertension of the upper limbs with a systolic pressure gradient of 100 mmHg. The diagnosis was confirmed by thoracic angioscan, which showed a 65.8% coarctation of the abdominal aorta. He was on triple antihypertensive therapy combining Atenolol 100 mg, Amlodipine 10 mg and Perindopril 10 mg. He is awaiting interventional treatment. His blood pressure is stable at around 140/90 mmHg.
基金This study was supported by Deutsches Zentrum für Herz-Kreislaufforschung e.V.
文摘Background:An isolated bicuspid aortic valve(BAV)is associated with structural and functional abnormalities of the aorta and the left ventricle(LV).Although~50%of patients with aortic coarctation(CoA)have a BAV,less is known about its impact on LV function and aortic geometry and function in CoA patients.In this cardiovascular magnetic resonance imaging(CMR)study,we analysed markers of LV and aortic function as well as aortic geometry in a large cohort of CoA patients with a BAVand compared them with CoA patients with a tricuspid aortic valve(TAV).Methods:We included 48 patients with a BAV(18.4±9.3 years)and 45 patients with TAV(20.7±9.9 years).LV volumes,mass and ejection fraction as well as aortic distensibilty,pulse wave velocity(PWV)were measured from standard cine CMR and phase-contrast CMR images.2-dimensional CMR feature tracking(2DCMR-FT)was performed to measure longitudinal,circumferential and radial strain and strain rate of the LV.Aortic arch geometry was classified as romanic,gothic and crenel.Results:LV volumes,mass and ejection fraction as well as aortic distensibility and PWV did not significantly differ between the BAV and the TAV group.There was also no significant difference for LV global longitudinal,radial and circumferential strain and strain rate between both groups.Patients with a BAV had more commonly a gothic aortic arch compared to TAV patients,but this difference was not statistically significant(22 vs.14,p=0.2).Ascending and descending aortic distensibility correlated with LV mass in the entire patient group(p<0.001).Global longitudinal,circumferential and radial strain(GLS,GCS,GRS)and global longitudinal and circumferential strain rate(GLSR,GCSR)correlated with LV ejection fraction(p<0.001).Conclusion:Our data suggest that the presence of a BAV does not adversely impact LV and aortic function in children and young adults with CoA.The correlation of global circumferential,longitudinal and radial strain values with LV ejection fraction demonstrates that 2D-CMR-FT might provide additional information related to ventricular function in CoA patients.
文摘There are very few reports on successful management of young children with coexistence of two congenital heart defects, coarctation of aorta and patent ductus arteriosus. These lesions can be treated either simultaneously or sequentially. Herein, we present the first successful report of simultaneous balloon angioplasty and Amplatzer duct occluder device implantation in a single-sitting in an 8-year-old boy with severe aortic coarctation and patent ductus arteriosus. The coarctation gradient decreased from 70 mmHg to 10 mmHg and a complete closure of the ductus arteriosus was achieved without any complication. Fellow interventional cardiologists may consider single-stage transcatheter treatment in young children with combination of these two lesions.
文摘BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between them is whether arterial lumen exhibits continuity or not,the clinical manifestations are similar and connection exists between them.Adult type A IAA is considered as an extreme form of CoA,which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation.This paper reports two cases(interrupted aortic arch and severe aortic coarctation)to analyze the difference and similarity between them.CASE SUMMARY The two cases of patients presented with hypertension for many years.Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow.The IAA patient refused surgical treatment and blood pressure could be controlled with drugs.While the CoA patient underwent stent implantation because of uncontrollable hypertension,the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.CONCLUSION Adult type A IAA and CoA have difference and similarity,and type A IAA is associated with CoA to a certain extent.The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.
文摘We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a small intimal tear, a true lumen, a false lumen, a markedly thick mural thrombus and pleural effusion. Open surgical procedure was performed and the aortic coarctation (CoA) and aortic dissection were resected and a 24-mm prosthetic graft was anastomosed. No pseudo aneurysms were present at the anastomosis sites on the follow up CTA.
文摘We report a 26-year-old man with critical aortic coarctation, severe bicuspid aortic valve stenosis, infective endocarditis and ascending aortic aneurysm. He underwent simultaneously in singlestage a Bentall’s procedure and an extra-anatomic ascending-descending aortic bypass grafting by 14-mm Dacron tube, through median sternotomy. The immediate postoperative outcome was favourable. The CT scan control for 7 years after surgery showed a good patency of the extra-anatomic bypass.
文摘In this work, we first investigated the hemodynamic parameters in the case of a normal aortic arch anatomy and in the case of aortic coarctation anatomy, both generated by using CFX-ICEM-ANSYS simulations. Then, we compared these results with those obtained for a proposed model without and with aortic coarctation, while introducing a real tridimensional magnetic resonance imaging geometry in the simulation process. The conclusion is that our proposed model reproduces, with a high agreement, the real case obtained from imaging data.
文摘Survival to advanced age is exceptional in patients with unrepaired aortic coarctation.We report the case of an 81-year-old man with aortic coarctation and total occlusion who was othersise asymptomatic.Coarctation was suspected when a femoral-radial pulse delay was noted during his routine physical examination.A 70-mmHg systolic blood pressure gradient between the upper and lower extremities was detected.
文摘Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with coarctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in
文摘Coarctation of the aorta(CoA)refers to the congenital coarctation near the isthmus,ductus arteriosus or ligamentum arteriosus,with an incidence of 5%–10%in children with congenital heart defects.[1]It can be isolated or coexisted with ventricular septal defects,subaortic stenosis,patent ductus arteriosus,and mitral aortic valve.[2]CoA has a poor prognosis.Without intervention,the median age of death with aortic coarctation is 38 years[3]and 75%death of those patients is at the age of 46 years.[4]Causes of death included congestive heart failure(26%),aortic rupture(21%),bacterial endocarditis(18%),and intracranial hemorrhage(12%).[5]Therefore,early diagnosis and optimal treatment are the key to improve the prognosis of this disease.The aim of this report is underlining the importance of early and accurate diagnose of CoA as a cause of systemic hypertension in young patients and also emphasizing the genetic factors of CoA in twins.
基金supported by the National Natural Science and Technology Foundation of China(81800274 to QJ)Sichuan Science and Technology Program(2021JDJQ0041 to QJ)Grant for Clinical Translation Research of Sichuan Provincial People’s Hospital(2017LY07 to QJ).
文摘Type A aortic aneurysm and dissection secondary to bicuspid aortic valve(BAV)with untreated coarctation of the aorta(CoA)in adults is a rare finding because there are almost no“abnormalities”in these patients’medical histories.Here,we report on a 47-year-old man with unexplained weakness followed by unconsciousness.He was diagnosed with cardiogenic shock and underwent venoarterial extracorporeal membrane oxygenation(VA-ECMO).BAV,ascending aortic aneurysm and dissection(based on bedside echocardiography)and concomitant CoA(based on computed tomography angiography)were confirmed.The patient then underwent emergency surgery including aortic root replacement with a composite mechanical valve conduit,additional ascending-to-descending aortic bypass,and coronary artery bypass grafting with a saphenous vein graft to the right coronary artery.After treatment,he recovered uneventfully.Thus,here we present a case involving a patient in a critical condition with ascending aortic aneurysm and dissection secondary to complex congenital heart defects,who was successfully treated with composite surgical procedures combined with life-saving VA-ECMO.
文摘A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aorta, and extensively enlarged collateral vascular supply to the lower portion of abdominal aorta. The pressures proximal and distal to stenosis were 185/110 and 95/70 mmHg, and the pressure gradient across the stenosis was 90/40 mmHg. After the operation of thoraco-abdominal bypass graft, the pressure difference between the upper and lower extremities eventually disappeared.
