Coarctation of the Aorta: Diagnosis and Management
Abstract
:1. Introduction
2. History and Anatomical Descriptions
3. Pathophysiology and Genetics
- Extension of ductal tissue into the aorta, causing constriction of the aorta when the ductus arteriosus closes at birth
- Hemodynamic reduction in LV forward flow leading to abnormal development of the aorta, which would be supported by the association of other left-sided obstructive lesions with CoA
- Abnormalities of the migration of neural crest cells which are the origin of parts of the aorta and left ventricular outflow tract and valves [20].
4. Clinical Presentation
5. Diagnosis—Cardiovascular Imaging
6. Fetal Echocardiography
7. Paediatric and Adult Echocardiography
8. Cardiac Computed Tomography
9. Cardiac Magnetic Resonance Imaging
10. Diagnosis—Cardiac Catheterisation
11. Prognosis
12. Treatment
Surgery
13. Transcatheter Interventions
13.1. Balloon Angioplasty
13.2. Stent Implantation
14. Long-Term Complications
14.1. Recoarctation and Reintervention
14.2. Hypertension
14.3. Aortic Aneurysm
14.4. Stroke and Coronary Artery Disease
14.5. LV Remodelling and Failure
15. Pregnancy
16. Conclusions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age Group | Clinical Symptoms | Examination and Investigation Findings |
---|---|---|
Neonates—early presentation | Often asymptomatic prior to ductal closure Tachypnoea Difficulty feeding/failure to thrive | Pulse oximetry-based screening may reveal reduced saturations in the lower limbs compared to the upper limbs, due to left to right shunting through the patent ductus arteriosus Diminished femoral pulses Oliguria, renal failure Left ventricular failure and cardiogenic shock Echo: narrowed aortic segment with pressure gradient across it, ductal patency with left to right shunt Signs of any associated congenital heart lesions, e.g., VSD or aortic stenosis. |
Neonates— late presentation | Tachypnoea Difficult feeding/failure to thrive | Diminished femoral pulses Intrascapular systolic murmur Echo: Left ventricular hypertrophy and left ventricular failure in addition to CoA ECG reveals left ventricular hypertrophy. CXR may show cardiomegaly and signs of interstitial pulmonary oedema |
Children–Adults | Often asymptomatic Headaches, epistaxis Lower limb claudication Reduced exercise capacity May more rarely present with symptoms related to complications due to long-term undiagnosed hypertension including coronary artery disease and heart failure | Uncontrolled hypertension Upper and lower limb BP discrepancy Continuous murmur due to collaterals Echo: left ventricular hypertrophy, left ventricular failure, May more rarely present with catastrophic sequelae such as aortic dissection or intracranial haemorrhage |
Indications for Treatment |
---|
Surgical or catheter-based treatment indicated in hypertensive patients with an increased non-invasive gradient between upper and lower limbs confirmed with invasive measurement (peak to peak > 20 mmHg) with preference for catheter treatment (stenting) |
Catheter treatment should be considered in hypertensive patients with >50% narrowing relative to the aortic diameter at the diaphragm, even if the invasive peak-to-peak gradient is <20 mmHg |
Catheter treatment should be considered in normotensive patients with an increased non-invasive gradient confirmed with invasive measurement (peak-to-peak > 20 mmhg) |
Catheter treatment may be considered in normotensive patients with >50% narrowing relative to the aortic diameter at the diaphragm, even if the invasive peak-to-peak gradient is <20 mmHg |
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Raza, S.; Aggarwal, S.; Jenkins, P.; Kharabish, A.; Anwer, S.; Cullington, D.; Jones, J.; Dua, J.; Papaioannou, V.; Ashrafi, R.; et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics 2023, 13, 2189. https://doi.org/10.3390/diagnostics13132189
Raza S, Aggarwal S, Jenkins P, Kharabish A, Anwer S, Cullington D, Jones J, Dua J, Papaioannou V, Ashrafi R, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics. 2023; 13(13):2189. https://doi.org/10.3390/diagnostics13132189
Chicago/Turabian StyleRaza, Sadaf, Suneil Aggarwal, Petra Jenkins, Ahmed Kharabish, Shehab Anwer, Damien Cullington, Julia Jones, Jaspal Dua, Vasileios Papaioannou, Reza Ashrafi, and et al. 2023. "Coarctation of the Aorta: Diagnosis and Management" Diagnostics 13, no. 13: 2189. https://doi.org/10.3390/diagnostics13132189
APA StyleRaza, S., Aggarwal, S., Jenkins, P., Kharabish, A., Anwer, S., Cullington, D., Jones, J., Dua, J., Papaioannou, V., Ashrafi, R., & Moharem-Elgamal, S. (2023). Coarctation of the Aorta: Diagnosis and Management. Diagnostics, 13(13), 2189. https://doi.org/10.3390/diagnostics13132189