Related Experiment Videos
Coarctation of the aorta
1Department of Pediatrics, University of Wisconsin Medical School, Madison, USA.
Insights
Coarctation of the aorta, a congenital heart defect, causes secondary hypertension and may require surgical or balloon angioplasty. Long-term survival rates after treatment are still being determined.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta is a significant cause of secondary hypertension.
- It accounts for 5-8% of congenital heart defects.
- Infants may present with heart failure, while older children are often diagnosed due to hypertension or murmurs.
Purpose of the Study:
- To review the diagnosis, treatment, and outcomes of coarctation of the aorta.
- To highlight diagnostic methods including physical examination, echocardiography, and cardiac catheterization.
- To discuss surgical and interventional treatment options and their associated complications.
Main Methods:
- Physical examination focusing on pulse deficits (brachial vs. femoral).
- Blood pressure measurement differences between arms and legs.
- Non-invasive imaging: echocardiography with Doppler.
- Invasive imaging: cardiac catheterization and aortography.
Main Results:
- Diagnostic indicators include diminished/delayed femoral pulses and a >20 mm Hg arm-leg blood pressure gradient.
- Echocardiography shows narrowing and increased flow velocity; catheterization reveals pressure gradients.
- Both surgical repair (resection, flap, bypass) and balloon angioplasty can relieve obstruction.
- Potential complications include mortality, recoarctation, aneurysms, and paraplegia.
Conclusions:
- Coarctation of the aorta is treatable, with interventions typically recommended between ages 2-5 for asymptomatic cases.
- While immediate results of surgery and angioplasty are often good, long-term prognosis remains uncertain.
- Long-term survival may be impacted by age at intervention and pre-existing hypertension severity and duration.
Abstract:
Coarctation of the aorta is an important and treatable cause of secondary hypertension. The prevalence of aortic coarctation varies from 5% to 8% of all congenital heart defects. Neonates and infants, especially when they have other associated cardiac defects, may present with signs and symptoms of heart failure. Children beyond infancy are usually asymptomatic and are most often diagnosed because of a murmur or hypertension on a routine examination. Palpation of the brachial and femoral pulses simultaneously will show decreased and delayed or absent femoral pulses. On measurement of blood pressure from arms and legs, a pressure difference of more than 20 mm Hg in favor of the arms may be considered as evidence for coarctation of the aorta. The coarctation can be demonstrated on suprasternal notch two-dimensional echocardiographic views along with increased Doppler flow velocity across the coarctation site. Cardiac catheterization shows significant peak-to-peak systolic pressure gradient across the coarcted segment, and aortography demonstrates the degree and nature of the aortic narrowing. Aortic coarctation may be relieved by surgery or by balloon angioplasty; in asymptomatic patients, therapy during the ages of 2 and 5 years is suggested. Surgical relief of coarctation may be achieved by resection and end-to-end anastomosis or by subclavian flap or prosthetic path angioplasty. Although results of surgery are generally good, there are some problems with the procedure, namely, mortality, morbidity and recoarctation, particularly in neonates and young infants and development of aneurysm, paraplegia, and paradoxical hypertension. Balloon angioplasty has been used by some cardiologists with resultant relief of obstruction, but concern for development of aneurysms and arterial complications remain. Although the immediate results for surgical or balloon therapy for isolated coarctation are good, long-term prognosis is largely undetermined. Limited long-term follow-up studies suggest significantly lower survival rates compared with normal population; age at intervention and the degree and duration of hypertension before intervention may affect long-term survival.