Coartacion de la aorta - learn what it is, treatment and more. Coarctation of the aorta. Dr. Rodrigo Javier Oribea raudone.info Generalidades y fisiopatología. La coartación de aorta representa un. La coartación de la aorta fue descrita clásicamente como una simple estrechez del istmo aórtico que podría El Texto completo solo está disponible en PDF.
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Aortic Coarctation: Current Solutions for a Complex Condition. Coartación de aorta: posibles soluciones a un complejo problema. Visits. Download PDF. Abstract | PDF Downloads HTML Downloads Usage. EBSCO . Coartación de aorta e interrupción del arco aórtico. Servicio de Cardiología. Español (pdf) · Artículo en XML; Referencias del artículo; Como citar este La prevalencia de Coartación Aórtica (CoA) es de por cada nacidos vivos. mainly the distal aortic arch and the emergence of the descending aorta.2 It is.
Philadelphia: Saunders; Prediction of recurrent coarctation by early postopera-tive blood pressure gradient. J Thorac Cardiovasc Surg. Am J Cardiol.
Aortoplasty the operation of choice for infant aortic co-arctation? Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach.
Percutaneous interventions on se-vere coarctation of the aorta: a year experience. Pe-diatr Cardiol. Severe aortic coarctation in infants less than 3 months: successful palliation by balloon angioplasty. J Invasive Cardiol. Is extended arch aortoplasty the operation of choice for in-fant aortic coarctation? Results of 15 years' experience in patients.
Or operated? Percutaneous treatment of neonatal aor-tic coarctation presenting with severe left ventricular dysfunction as a bridge to surgery. Cardiol Young. However, the clinical presentation varies and depends on age and the frequently associated malformations.
Coartación de la aorta
In the neonate or infant, it tends to appear with severe congestive heart failure. Interventricular communication, isthmic hypoplasia, aortic stenosis, bicuspid aortic valve, etc can also be present, adding risk, morbidity and mortality to the treatment.
In the adolescent or adult, AHT is the predominant clinical feature that leads to diagnosis.
Thus, its task is to demonstrate that this is feasible and with results comparable to surgical ones. However, it is important to bear in mind that surgery has already been used for 60 years and that its long-term consequences are well known.
The first BA was done by Singer in and the maximum follow-up time for this option is 23 years. This means that the maximum follow-up time of this technique does not exceed years. From a merely anatomical standpoint, the surgical technique, with excision of the diseased wall, should be considered curative and is strongly advised, at least for young patients. This is not always possible and alternatives to end-to-end anastomosis are sometimes required, including patch aortoplasty.
All surgical series have reported variable percentages of recoarctation and aneurysms, although the trend is decreasing. The Dacron patch seems to be associated with a greater incidence of aneurysms or late aortic dissections.
Initial series have already reported serious complications, ranging from restenosis, aneurysms and dissections, up to death, without forgetting "minor" flaps, residual gradients, vascular damage, and need for several redilatations or stenting at follow-up. In recent series other authors have described remodelling in the treated vessel at follow-up, especially regarding localized coarctations, a lower frequency of aneurysms and a greater index of efficacy.
Stenting avoids overdistention of the aortic wall and leaves the pathological vessel wall in situ, with the hope that the scarring mechanisms will strengthen the vessel thus avoiding long-term problems. Both techniques, although having good immediate results BA or very good results stenting , need long follow-up before they can be compared to surgery.
There is abundant medical literature on the treatment of aortic coarctation demonstrating that there is no single and definitive cure. The dilemma lies in choosing the most suitable method, in assessing when it should be applied and finding out how it could change the daily life of the patient. Previous stroke or the presence of severe isthmic stenosis, as shown by angiographic imaging, nuclear magnetic resonance imaging, computerized tomography, etc, are also considered therapeutic indications.
The indication for treatment should be unique for surgery or intervention, since both have a high risk of complications.
In the first year of life surgical indication is undisputable and we currently have a series with excellent results: infants operated on with just 4 recoarctations 2. Thus, it would be advisable to be able to establish, with valid criteria, which patients are good candidates for BA, and thus avoid using this technique in those patients at more risk of presenting complications.
Analysis of international results supports the value of BA in native coarctation, as an alternative to surgery, from the age of 1 year old until adolescence, but we should be aware that a percentage of patients will remain ineffectively treated. Furthermore, we still lack long-term follow-up in redilatated vessels. Balloon angioplasty, however, is considered the technique of choice regarding aortic recoarctation after surgery, due to its lower risk deriving from the greater perivascular scarring response.
From adolescence onwards, or in patients weighing more than 30 kg for some authors, the controversy focuses on 2 areas: surgery versus intervention, and BA versus primary implantation of stent.
All the treatments have their supporters and detractors, showing that a standard treatment is still lacking.
Coarctation of the Aorta (CoA)
In addition, we know that the results can vary considerably depending on experience and that each center should treat patients with the technique they have most experience with. In the case of BA and stenting, given the potential complications of the procedure, it is essential to have anesthesia and thoracic surgery available in the center, as well as a complete stock of material large-caliber sheaths, coated stents, balloons and stents of different lengths and diameters, rigid guidewires and arterial vascular sealants.
When analyzing our own experience, the article by del Cerro et al,6 and other medical literature, the strong impact of technological advances on the results can be appreciated, especially regarding BA.
Thus, the relatively large balloons initially used were associated with the appearance of complications that occasionally were even fatal. In recent years, balloon profile has been considerably reduced thus reducing the size of the arterial introducer sheath , maximum inflation pressure increased, the passage of the balloon greatly improved, and they are now smoother with a shorter cuff.
This fact is especially important in the pediatric population, where vascular complications are more frequent. We consider that the anatomy and the size of the aortic isthmus are essential to indicate, counter-indicate, or predict the effects of BA.
Finally, it is important to recall that BA is contraindicated in aortas with arteriopathy, as in Turner's and Marfan's syndromes, a fact also emphasized in the study by del Cerro et al.
Remarkable advances have been achieved with stenting.
More information for parents of children with CoA
This stent has blunt edges, reasonable flexibility and wide cells, requiring 12 Fr introducers.Also, blood pressure may stay high even when the aorta's narrowing has been repaired. A surgeon doesn't have to open the heart to repair the coarctation. Everyone with a known coarctation of the aorta should be seen annually by a cardiologist with expertise in caring for adults with congenital heart disease even if the coarctation has been successfully repaired.
Philadelphia: Churchill Livingstone; Surgical treatment of coarctation of the aorta in a ten week old infant: report of a case. It's best to plan ahead and have a thorough check-up including an imaging study of the aorta to detect these problems before becoming pregnant, and control the problems before conception.
These results are valid for BA for up to 18 years, as shown in the article by del Cerro et al,6 although, t he future evolution of this group o f patients in the longer term is a question that future studies will have to answer.
The efficacy of the treatment has been traditionally proved by the abolition of the pressure gradient between the upper and lower limbs and pressure normalization. This spectrum is dichotomized by the idea that aortic coarctation occurs in the aortic arch, at or near the ductus arteriosis, whereas aortic stenosis occurs in the aortic root, at or near the aortic valve.
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