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Aortic Disease
Published in Paul Schoenhagen, Frank Dong, Cardiac CT Made Easy, 2023
An incidental finding of an intra-aortic balloon pump in the aorta is shown in Figure 10.55. Aortic coarctation is further described in Chapter 13 (Section 13.6, ‘Aortic Disease‘) on congenital disease (Chapter 11).
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The patient has typical radiographic features of aortic coarctation. The most common association (75–80%) is with a bicuspid aortic valve. A bicuspid aortic valve is predisposed to stenosis and over time can cause aortic root dilatation due to the high pressure jet of blood through the stenotic valve. A congenital bicuspid aortic valve is one of the most common causes of aortic valve disease in young adults.
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Aortic coarctation (CoA) is a focal narrowing of the aorta, almost always at the junction of the distal aortic arch and descending aorta, just below the origin of the left subclavian artery. It is associated with a generalized arteriopathy and hypertension. CoA accounts for 5%–8% of congenital cardiac disease and is associated with bicuspid aortic valves in approximately 70% of patients, ventricular septal defects, and mitral valve abnormalities. Intracranial aneurysms, typically berry aneurysms of the circle of Willis, are seen in 3%–5% of patients with CoA. Treatment of CoA in childhood in infants and small children is typically surgical; in older children, adolescents, and adults, angioplasty and stent implantation is preferred in patients with suitable anatomy. Residua and sequelae include hypertension due the underlying arteriopathy, residual focal narrowing after stenting or surgical repair, or saccular aneurysms at suture lines after surgical repair.
Current controversies in pre-participation cardiovascular screening for young competitive athletes
Published in Expert Review of Cardiovascular Therapy, 2020
Bradley J. Petek, Aaron L. Baggish
The H&P is a core competency for clinicians in all fields. Thus, it’s use as a tool during PPCS can be performed by physicians and allied health specialists with minimal additional training. The fundamental rationale for the ascertainment of a focused medical history is that diseases associated with SCD often produce exertional symptoms. Thus, the focused questions contained in the AHA-14 and PPE-5 monograph are design to query for the presence of symptoms during exercise, which may help practitioners correctly identify previously unrecognized diseases. In a similar fashion, a focused medical examination may reveal signs of pathology. Recommendations pertaining to the physical examination recognize its utility in identifying conditions that produce murmurs (valvular heart disease and the obstructive HCM), asymmetric hypertension (i.e. aortic coarctation), or signs of connective tissue diseases (i.e. Marfan syndrome).
Arterial stiffness in adult patients after coarctation of aorta repair and with bicuspid aortic valve
Published in Acta Cardiologica, 2019
Beata Róg, Magdalena Okólska, Hanna Dziedzic-Oleksy, Kinga Sałapa, Paweł Rubiś, Grzegorz Kopeć, Piotr Podolec, Lidia Tomkiewicz-Pająk
In the present study, we conducted observation if concomitance of bicuspid aortic valve with aortic coarctation has impact on vascular function. To our best knowledge, it is the first research in this area. Increased aortic wall stiffness in BAV patients has been already reported [31–34], even in subjects without significant valve dysfunction or aortic dilatation, suggesting an intrinsic aortic tissue abnormality in this group. Data from our study confirm this thesis; we find in BAV subjects higher central arterial stiffness parameters than in controls. In comparison between normotensive group of patients with CoA and BAV to group CoA without BAV and BAV patients separately, we did not reveal any statistically significant differences. Concomitance of coarctation of the aorta and bicuspid aortic valve did not influence arterial stiffness augmentation. Both diseases are related to generalised vascular abnormality.
College students with congenital heart disease: A critical time for transition
Published in Journal of American College Health, 2018
Rose Y. Hardy, Michelle Gurvitz, Jamie L. Jackson, Susan May, Paula Miller, Rachel Daskalov, Elyse Foster
With the history that suggested prior repair of aortic coarctation and the presentation of headache in a patient with hypertension, there are several important considerations. Upper extremity hypertension could signify the presence of recurrent coarctation. In this case it is important to examine for a delay between the radial and femoral pulses and to obtain blood pressures in the upper and lower extremities. A lower extremity blood pressure that is more than 20 mmHg lower than that of the upper extremity suggests residual narrowing that may need to be addressed. Patients with coarctation also have higher than normal incidence of intracranial berry aneurysms (∼10%). While most of these are small, the presence of a severe headache should raise the suspicion for larger aneurysm or hemorrhage. Coarctation of the aorta is also often associated with bicuspid aortic valve that may function well in childhood but can deteriorate over time resulting in aortic valve stenosis, regurgitation or both. It is also important to evaluate this in the setting of the patient's symptoms and murmurs on exam. Recurrent coarctation can often be treated with a catheter-based procedure but evaluation by a congenital cardiologist is crucial to determine the best imaging or invasive diagnostic approach.