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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
Complications associated with uncorrected coarctation of the aorta include hypertension, HF, and aortic dissection. The mainstay of therapy is control of hypertension and avoidance of hypovolemia during the peripartum period. In cases of aortic dissection or severe HF unresponsive to medical therapy, surgical repair has been successfully attempted during pregnancy (60,61). Fetal morbidity and mortality are high because of decreased placental blood flow from hypertension or reduced cardiac output and increased incidence of fetal cardiac anomalies (34).
Rheumatology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Clarissa Pilkington, Kiran Nistala, Helen Lachman, Paul Brogan
Non-inflammatory large-vessel vasculopathy of congenital cause: fibromuscular dysplasia.Williams syndrome.Coarctation of the aorta.Midaortic syndrome.Ehlers–Danlos type IV.Marfan syndrome.Neurofibromatosis type 1.
Interventions for congenital heart disease
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Another relatively common congenital anomaly (5%–7% of congenital heart disease) that can present for the first time in adulthood is coarctation of the aorta. This most commonly results in a focal stricture of the descending thoracic aorta, adjacent to the ductus arteriosus or its remnant, the ligamentum arteriosum. It can also be associated with hypoplasia of the aortic arch or descending aorta or narrowing of the abdominal aorta. Coarctation has an incidence of approximately 3 per 10,000 births and may be associated with other congenital cardiac disorders including bicuspid aortic valve and dilatation of the ascending aorta, VSD, PDA, atrioventricular cushion defects and left heart hypoplasia. It may also be associated with intracranial aneurysms. It is most commonly first recognised in young adults with hypertension but may also cause lower limb claudication. Treatment is recommended if there is a >20 mmHg peak-to-peak gradient across the coarctation.24
Covered stent placement for treatment of coarctation of the aorta: immediate and long-term results
Published in Acta Cardiologica, 2021
Jan Stassen, Pieter De Meester, Els Troost, Leen Roggen, Philip Moons, Marc Gewillig, Alexander Van De Bruaene, Werner Budts
Coarctation of the aorta (CoA) is a congenital cardiovascular malformation, characterised by a restriction of the lumen of the thoracic aorta. This restriction is often just distal to the left subclavian artery and described as the adult type of CoA, whereas other patients have a more diffuse hypoplastic aortic arch or the combination of both. It occurs in approximately 4 of 10.000 live births and comprises 5% to 8% of congenital heart disease [1]. Mostly, CoA is detected in childhood and repaired surgically or by endovascular therapy. Occasionally it is diagnosed in adolescence or adulthood by investigations done for systemic hypertension. Exact numbers of late diagnosis of CoA are not reported in literature, but in a high-volume centre of adult congenital heart disease, it ranges between 2 and 4 diagnoses per year (data from the University Hospitals Leuven). The natural history of CoA carries a poor prognosis due to complications such as left ventricular failure, intracranial haemorrhage, aortic rupture or dissection, premature coronary artery disease and sudden death [2–6].
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
Coarctation of the aorta (CoA) is a congenital condition of the cardiovascular system which consists in narrowing of the descending aorta at the level of subclavian artery. Currently, most of the patients undergo interventional treatment in early childhood. Such treatment improves prognosis and prolongs life. However, removing a mechanical obstacle does not lead to a full recovery. Long-term observations of patients after aortic coarctation repair indicate that they suffer from arterial hypertension, ischaemic heart disease, atherosclerosis and chronic heart failure, a low percentage of subjects (3–9%) develop aortic root aneurysms [1–4]. Even if residual or recurrent aorta stenosis does not occur, surgical treatment does not mean a full recovery. Data from literature expose that coarctation of the aorta is not a simple mechanical obstacle but a generalised vascular disease [4–7]. Coarctation of the aorta frequently coexists with bicuspid aortic valve (around 60–85% of patients with CoA) [8–11]. Bicuspid aortic valve (BAV) is not only an anatomic defect of the valve due to the fusion of its cusps. It is also associated with thoracic aorta abnormalities including dilatation, aneurysm formation and dissection [12]. Even if aortic valve function does not deteriorate, dilatation of the Valsalva sinuses and the ascending aorta occurs [13]. The above observations allow for a presumption that there is a similarity at the molecular level of the aorta structure in subjects with bicuspid aortic valve and coarctation of the aorta.
The effect of including increased arterial stiffness in the upper body when modelling Coarctation of the Aorta
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Dilan Pathirana, Barbara Johnston, Peter Johnston
Coarctation of the Aorta (CoA) is a congenital heart disease, involving a narrowing in the aorta, which results in increased blood flow to regions of the body that are supplied by arteries upstream of the coarctation (generally the upper body) and decreased blood flow to downstream regions (generally the lower body) (Rao 2005). It is considered a serious disease with a mean age of mortality of 34 years if left untreated (Campbell 1970), and it affects 3–4 in every 10,000 live births (van der Linde et al. 2011). Although several treatments are available that resolve the coarctation, treated patients still experience decreased life expectancies compared to healthy populations, for treatments where data is available (Vriend and Mulder 2005; Nguyen and Cook 2015). Long-term or mortality data for patients treated with some treatments, such as stents, are unavailable as these treatments have only been applied in CoA patients in recent decades; hence, reviews of the treatments for CoA often are unable to recommend a particular treatment as being superior (Pádua et al. 2012).