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Diagnosis, imaging and clinical management of aortic coarctation
Elles J Dijkema1, Tim Leiner2, Heynric B Grotenhuis1
1Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands.
Insights
Coarctation of the aorta (CoA) is a congenital heart defect often diagnosed in infancy. Early diagnosis and treatment are crucial for better outcomes, with surgery for infants and transcatheter methods for older patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Coarctation of the aorta (CoA) is a significant congenital heart disease (CHD).
- CoA frequently co-occurs with other cardiac anomalies like bicuspid aortic valve (BAV).
- Prenatal diagnosis of CoA remains challenging despite screening.
Purpose of the Study:
- To provide a comprehensive review of the current clinical diagnosis, imaging, treatment, and follow-up of CoA.
- To highlight the importance of timely diagnosis and management for improved patient prognosis.
- To discuss evolving treatment strategies and long-term management considerations for CoA.
Main Methods:
- Review of current clinical diagnostic criteria and physical examination findings.
- Evaluation of diagnostic imaging modalities, including echocardiography and cardiac MRI.
- Analysis of established and emerging surgical and transcatheter treatment strategies.
- Discussion of essential follow-up protocols for left ventricular function, valvular health, and aortic anatomy.
Main Results:
- CoA diagnosis often relies on clinical signs like pulse discrepancies and blood pressure gradients in infancy.
- Transthoracic echocardiography is the primary diagnostic tool, with cardiac MRI preferred for advanced assessment and follow-up.
- Surgical resection is standard for neonates and young children, while transcatheter interventions are preferred for older children and adults.
- Despite treatment, patients with CoA face reduced life expectancy and increased cardiovascular risks, necessitating lifelong monitoring.
Conclusions:
- Timely and accurate diagnosis of CoA is paramount for reducing long-term morbidity and mortality.
- A multidisciplinary approach involving advanced imaging and tailored treatment strategies is essential for managing CoA.
- Intensive, lifelong follow-up is critical to monitor cardiac and vascular health in CoA patients and prevent late complications.
Abstract:
Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.