Coarctation of the aorta corrected during childhood. Clinical aspects during follow-up

Maia, Margarida; Aiello, Vera Demarchi; Barbero-Marcial, Miguel; Ebaid, Munir

doi:10.1590/s0066-782x2000000200008

Cited by 5 publications

(6 citation statements)

References 70 publications

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“…The results of this study show that reduced proximal COA compliance interacts with COA and amplified P K dP. This could in part explain why some patients who have had a good repair of COA may have residual upper body hypertension at rest or with exercise despite having little evidence of significant recoarctation (Nanton and Olley, 1976; Maia et al, 2000; Gunthard et al, 1996). …”

Section: Discussionmentioning

confidence: 72%

“…Patients with COA have higher incidence of systemic hypertension (up to 68%) even after successful repair of the COA (Clarkson et al, 1983; Maia et al, 2000). Systemic hypertension is associated with elevated systemic resistance and reduced systemic compliance.…”

Section: Discussionmentioning

confidence: 99%

“…Associated structural cardiovascular lesions such as mitral or aortic valve disease, ventricular septal defect and cerebrovascular malformations are responsible for considerable postoperative morbidity and mortality. Hypertension may persist even after a successful correction of COA (Nanton and Olley, 1976; Maia et al, 2000). …”

Section: Introductionmentioning

confidence: 99%

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The role of aortic compliance in determination of coarctation severity: Lumped parameter modeling, in vitro study and clinical evaluation

Keshavarz‐Motamed

Edelman

Motamed

et al. 2015

Journal of Biomechanics

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Early detection and accurate estimation of the extent of coarctation of the aorta (COA) is critical to long-term outcome. Peak-to-peak trans-coarctation pressure gradient (PKdP) higher than 20 mmHg is an indication for interventional/surgical repair. Patients with COA have reduced proximal and distal aortic compliances. A comprehensive study investigating the effects of variations of proximal COA and systemic compliances on PKdP, and consequently on the COA severity evaluation has never been done. This study evaluates the effect of aortic compliance on diagnostic accuracy of PKdP. Lumped parameter modeling and in vitro experiments were performed for COA severities of 50%, 75% and 90% by area. Modeling and in vitro results were validated against retrospective clinical data of PKdP, measured in fifty-four patients with COA. Modeling and in vitro. PKdP increases with reduced proximal COA compliance (+36%, +38% and +53% for COA severities of 50%, 75% and 90%, respectively; p<0.05), but decreases with reduced systemic compliance (−62%, −41% and −36% for COA severities of 50%, 75% and 90%, respectively; p<0.01). Clinical study. PKdP has a modest correlation with COA severity (R=0.29). The main determinants of PKdP are COA severity, stroke volume index and systemic compliance. Systemic compliance was found to be as influential as COA severity in PKdP determination (R=0.30 vs. R=0.34). In conclusion, PKdP is highly influenced by both stroke volume index and arterial compliance. Low values of PKdP cannot be used to exclude the severe COA presence since COA severity may be masked by reduced systemic compliance and/or low flow conditions.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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The role of aortic compliance in determination of coarctation severity: Lumped parameter modeling, in vitro study and clinical evaluation

Keshavarz‐Motamed

Edelman

Motamed

et al. 2015

Journal of Biomechanics

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“…[11][12][13][14] Despite a satisfactory reduction in BP soon after operation, studies with longer follow-up have demonstrated that approximately one-third of patients develop late hypertension, even when surgery is performed in the neonatal period. 15,16,17 Clarkson and colleagues 18 showed that the prevalence of late hypertension increased with the duration of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Repair of Aortic Coarctation in Adults: The Fate of Hypertension

Hashemzadeh

Kakaei

2008

Asian Cardiovasc Thorac Ann

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The benefit of coarctation repair on the resolution of systolic hypertension in adults has been questioned. In this retrospective study, hypertension was assessed in 38 adults (22 men, 16 women; mean age, 25.6 +/- 6.9 years; range, 16-39 years) who underwent coarctation repair between 1996 and 2006. Thirty patients had preoperative hypertension (mean systolic pressure, 158.3+/-18.6; range 140-200 mm Hg). At preoperative catheterization, the peak mean systolic gradient across the coarctation was 70.6 +/- 21.2 mm Hg (range, 38-120 mm Hg). Operative procedures were resection and end-to-end anastomosis (11 patients), patch aortoplasty (24) and resection with interposition of a Dacron tube graft (3). The patients were followed up for 2-90 months (mean, 37 +/- 23 months). Of the 30 patients with preoperative hypertension, 25 (83%) were normotensive at the last follow-up. The mean postoperative systolic blood pressure was significantly lower than the preoperative level. More than half of the patients (58%) were still taking antihypertensive medication. Surgical repair of coarctation of the aorta in adults can lead to regression of systolic hypertension and a decreased requirement for antihypertensive medication.

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“…Correct diagnosis is very important because blood pressure tends to normalize after correction of the aortic defect 10 . In turn, bicuspid aortic valve is the most common cardiac malformation, which may be traditionally associated with coarctation of the aortic arch, but also several other malformations 11 .…”

Section: Commentsmentioning

confidence: 99%

Caso 5: homem de 40 anos de idade, hipertenso, que apresentou dor abdominal e choque

Pereira¹,

Pintón²,

Benvenuti³

2011

Arq. Bras. Cardiol.

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A 40-year-old man sought medical attention because of intense abdominal pain accompanied by profuse sweating (Nov. 2005).He reported hypertension diagnosed at age of 35 and made use of atenolol 100 mg and aspirin 100 mg on a daily basis.The tests taken at the time of diagnosis of hypertension (Oct. 2000) included echocardiogram revealing ascending aortic diameters of 42 mm; left atrium, 19 mm; right ventricle, 26 mm; left ventricle (diastole/systole), 59/33 mm; left ventricular ejection fraction was 75% and septal and left ventricular posterior wall thickness was 7 mm. We made the following echocardiographic diagnoses: dilated ascending aorta, bicuspid aortic valve without signs of stenosis and mild insufficiency. He had been asymptomatic for 10 months had, when short-duration palpitations appeared. There were no complaints of dyspnea, chest pain or syncope. The patient denied rheumatic history.Physical examination (Jul 12) 2005; first visit to the hospital) revealed heart rate of 80 bpm; blood pressure, 160/80 mm Hg; presence of arterial pulsation in the neck; lung semiology revealed no changes; heart examination revealed stroke in the sixth intercostal space out of the left midclavicular line, extending two fingertips; heart sounds were normal and there was systolic murmur +/ 4+ in the aortic area and diastolic murmur aspiration +/ 4+ at the left sternal border. Abdominal examination was normal and there was lower limb edema; neurological examination revealed left hemiparesis.Chest radiography showed cardiomegaly at the expense of increased left ventricle +++/ 4+Laboratory tests revealed 14.3 g/dL hemoglobin; hematocrit 44%; 7700 leukocytes/mm³; creatinine 0.7 mg/dL; potassium 4.4 mEq/L and sodium 139 mEq/L.One month after that visit, he sought medical attention for palpitations that had begun four days before; atrial fibrillation was detected and warfarin and digoxin were added to the medications used. About four months after the first visit, the patient sought emergency medical attention for severe abdominal pain accompanied by profuse sweating. We carried out clinical and laboratory evaluation and the hypothesis of acute cholecystitis was ruled out.Tomography with contrast (Nov. 18 2005) revealed moderate pleural effusion on the right and discrete on the left; enlarged liver, dilated portal and liver veins. The gallbladder was normal. The kidneys were normal and there were no changes in the aorta.Ultrasound examination of the bladder was normal.A CT scan revealed right parietal cortical and subcortical hypoattenuation zone with effacement of adjacent sulci, compatible with old cerebral infarction. Additionally, there was opacification of the ethmoid sinuses.Laboratory tests (Nov. 18 2005) revealed 13.9 g/dL hemoglobin; hematocrit 43%; leukocytes 23.380/mm³ without left deviation; platelets 135 000/mm³; prothrombin time (INR) 3.96; ratio of partial activated thromboplastin time 1,62; urea 74 mg/dL; creatinine 1.2 mg/dL; sodium 144 mEq/L; potassium 4.5 mEq/L; glucose 26 mg/dL; lactate 52 mg/dL; amylase 33 U...

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Coarctation of the aorta corrected during childhood. Clinical aspects during follow-up

Abstract: Maia et al Coarctation of the aorta corrected during childhood Arq Bras Cardiol volume 74, (nº 2), 2000

Cited by 5 publications

References 70 publications

The role of aortic compliance in determination of coarctation severity: Lumped parameter modeling, in vitro study and clinical evaluation

The role of aortic compliance in determination of coarctation severity: Lumped parameter modeling, in vitro study and clinical evaluation

Repair of Aortic Coarctation in Adults: The Fate of Hypertension

Caso 5: homem de 40 anos de idade, hipertenso, que apresentou dor abdominal e choque

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