Doppler echocardiographic indices in aortic coarctation : a comparison of profiles before and after stenting : cardiovascular topic

Hajsadeghi, Shokoufeh; Fereshtehnejad, Seyed‐Mohammad; Ojaghi, M; Bassiri, Hossein Ali; Keramati, Mohammad Reza; Chitsazan, Mitra; Gholami, Somayeh

doi:10.5830/cvja-2012-044

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…Considering the retrospective nature of this study and the difficulties in routine measurements of upper and lower body blood pressures, we opt to use the echocardiographic data instead which has been shown to provide a reliable index of re-coarctation. 22 At 1 year follow-up 75.8% of our patients had gradients below 30 mmHg which is an acceptable gradient 11 . Few studies have used echocardiographic measurements for follow-up gradients.…”

Section: Discussionmentioning

confidence: 63%

Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A single center study

Kojuri

Mokhtaryan

et al. 2014

Journal of Cardiovascular and Thoracic Research; ISSN 2008-5117

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Section: Discussionmentioning

confidence: 63%

Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A single center study

Kojuri

Mokhtaryan

et al. 2014

Journal of Cardiovascular and Thoracic Research; ISSN 2008-5117

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“…Subcutaneous furosemide injections were administered (1-5 mg/kg, BID weekdays, OD weekends) as needed for up to 14 days post-surgery to limit and/or treat edema. Weekly Doppler ultrasound imaging was performed by a trained sonographer using protocols similar to human echocardiography 14 until estimates of the BP gradient across the CoA calculated using the simplified Bernoulli Equation no longer changed with body weight. For dissolvable CoA groups, BPGpp was expected to recover back to normal as the suture dissolved.…”

Section: Methodsmentioning

confidence: 99%

Coarctation duration and severity predict risk of hypertension precursors in a preclinical model and hypertensive status among patients

Ghorbannia,

Jurkiewicz,

Nasif

et al. 2023

Preprint

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Coarctation of the aorta (CoA) often leads to hypertension (HTN) post-treatment. There is limited evidence for the current ≥20 mmHg peak-to-peak blood pressure gradient (BPGpp) guideline, which can cause aortic thickening, stiffening and dysfunction. This study sought to find the BPGpp severity and duration that avoids persistent dysfunction in a preclinical model, and test if predictors identified translate to HTN status in CoA patients.Rabbits (N=75; 5-11/group; 10 weeks-old) were exposed to mild, intermediate or severe CoA (≤12, 13-19 & ≥20 mmHg BPGpp) for ∼1, 3 or 22 weeks using dissolvable and permanent sutures with thickening, stiffening, contraction and endothelial function evaluated via multivariate regression analysis. The relevance of findings to CoA patients (N=239; age=0.01-46 years; mean 3.44 years) was similarly tested by retrospective review of predictors (pre-operative BPGpp, age at surgery, etc) vs follow-up HTN status.CoA duration and severity were predictive of remodeling and dysfunction in rabbits and HTN likelihood in CoA patients. Interaction between patient age and BPGpp at surgery were significant contributors to HTN, suggesting preclinical findings translate to human. Machine-learning decision tree analysis uncovered duration and severity values for precursors of HTN in the preclinical model, and HTN at follow-up in CoA patients.These findings suggest the current BPGpp threshold is likely too high to limit activation of processes leading to persistent aortic changes associated with HTN. The resulting decision tree provides a foundation for revising CoA treatment guidelines by considering the interaction between CoA severity and duration to limit the chance of HTN.

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Echocardiogram reveals unexpected finding in the investigation of murmur in a hypertensive postpartum patient

Williamson

2019

Sonography

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A transthoracic echocardiogram (echo) was requested for a 19-year-old female who required hospital admission for ongoing fevers, tachycardia, and hypertension. She was 10 days postpartum having delivered a healthy baby boy. A new murmur was noted, and she was found to have Escherichia coli bacteraemia prompting the referral for cardiac investigation. The echo was performed less than 24 hours after the referral was received, and the patient was well enough to attend the cardiology department being transported from the ward via wheelchair.The patient had a long history of systemic hypertension and attended a renal clinic regularly for review and management. Previous investigations included renal angiography and echo along with physical examination, which revealed no significant abnormalities.Blood testing showed an elevated aldosterone level for which she was being treated and systolic blood pressure averaged 155 mmHg.The patient was previously asymptomatic, and it was noted that her father was also treated for hypertension from the age of 33. The underlying cause of hypertension was deemed to be familial as no primary cause was identified.Because of longstanding systemic hypertension, the patient was classified as high risk for preeclampsia during her pregnancy. She was monitored closely, and at 37 +4 weeks gestation, the baby was induced and delivered without complication. | CASE DESCRIPTIONFollowing three tachycardic episodes, requiring admission to the Intensive Care Unit, an echo was performed to look for the source of murmur.The departmental routine echo protocol was followed with images obtained from parasternal, apical, subcostal, and suprasternal windows.Cardiac structure and function appeared normal with no evidence of significant valvular abnormality (Figure 1). Colour Doppler using a subcostal window demonstrated continuous flow within the abdominal aorta (Figure 2A). This was confirmed using colour M-mode (Figure 2B). Suprasternal imaging showed only the proximal portion of the upper descending aorta with no abnormality detected on 2D (Figure 3A) or using colour or spectral Doppler as demonstrated in Figure 3B. Nonpulsatile flow in the abdominal aorta is suggestive of coarctation of the aorta and, while there was no evidence of this in the suprasternal images, a CT aortogram was requested to provide more comprehensive imaging of the aorta. 1 The CT aortogram demonstrates clearly the presence of a severe narrowing just distal to the left subclavian artery, which is the typical location for coarctation 2 (Figure 4). The CT report also noted prominent collateral circulation including enlargement of the internal mammary and intercostal arteries. The CT image also demonstrates enlargement of the left subclavian artery.The coarctation site was unable to be crossed during coronary angiography when approached via the femoral artery and, instead, the coronaries were accessed from the right brachial artery.Aortogram demonstrated a failure of contrast to cross the narrowing, and the coarctation was deemed to be e...

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Doppler echocardiographic indices in aortic coarctation : a comparison of profiles before and after stenting : cardiovascular topic

Cited by 6 publications

References 33 publications

Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A single center study

Procedural Outcome and One Year Follow up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A single center study

Coarctation duration and severity predict risk of hypertension precursors in a preclinical model and hypertensive status among patients

Echocardiogram reveals unexpected finding in the investigation of murmur in a hypertensive postpartum patient

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