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1.
Coarctation of the aorta: collateral flow assessment with phase-contrast MR angiography 总被引:1,自引:0,他引:1
PR Julsrud JF Breen JP Felmlee CA Warnes HM Connolly HV Schaff 《Canadian Metallurgical Quarterly》1997,169(6):1735-1742
OBJECTIVE: The purpose of this report is to describe a new use of MR imaging in coarctation of the aorta. The specific question addressed was how well collateral blood flow in intercostal arteries, as determined by phase-contrast MR angiography, correlated with findings during surgery or catheterization in patients with coarctation of the aorta. CONCLUSION: Phase-contrast MR angiography is an excellent technique for detecting the presence or absence of collateral blood flow in the intercostal arteries of patients with coarctation of the aorta. Knowing whether collateral blood flow is present in patients with narrowing of the juxtaductal aorta should help assess the clinical hemodynamic significance of the coarctation. 相似文献
2.
F Amaral LC Peres JA Granzotti OC Almeida Filho C Monteiro 《Canadian Metallurgical Quarterly》1997,68(6):451-452
The case of a neonate in heart failure with the classical signs of coarctation of the aorta is described. Two dimension and Doppler echocardiography ruled out coarctation of the aorta and an abdominal ultrasonography detected a large thrombotic formation in the abdominal aorta, confirmed at necropsy. 相似文献
3.
W Hański 《Canadian Metallurgical Quarterly》1980,31(4):583-589
The effect of experimental coarctation of the aorta at a site above the coeliac bifurcation (site of occurance of spontaneous atherosclerotic lesions) in White Carneau pigeons was examined. Cholesterol content of the aorta in the site where spontaneous atherosclerosis usually occurs (coeliac bifurcation = lesion site) was decreased in pigeons with aortic coarctation. On the other hand, in the region proximal to the site of coarctation which is usually free of atherosclerotic events cholesterol accumulation was increased. A decrease in percent composition of oleic acid (the major fatty acid which increases during atherosclerosis) was noted in the lesion site. These studies have shown regional differences in response of aorta to experimental coarctation in spontaneously atherosclerotic-susceptible pigeons and suggest that lowering of blood pressure at lesion site might decrease cholesterol accumulation and perhaps might retard subsequent atherogenic process. 相似文献
4.
T Vicente E Pinar A García A Gómez J López D Pascual JM Felices M Valdés 《Canadian Metallurgical Quarterly》1997,50(11):802-805
We report the case of a 20-year-old woman with severe hypertension diagnosed two months previously. The symptoms and physical examination suggested the diagnosis of coarctation of the aorta, but a transthoracic echocardiogram and a thoracic CT scan were normal. Nevertheless, a severe stenosis of the thoracoabdominal aorta was demonstrated by transesophageal echocardiography. The usefulness of transesophageal echocardiography for the diagnosis of atypical coarctation of the aorta is discussed. 相似文献
5.
CL Backer C Mavroudis EA Zias Z Amin TJ Weigel 《Canadian Metallurgical Quarterly》1998,66(4):1365-70; discussion 1370-1
BACKGROUND: Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy. METHODS: From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20+/-0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture. RESULTS: There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on extracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8+/-17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%. CONCLUSIONS: Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta. 相似文献
6.
During the five years 1990 through 1994, 70 neonates and infants had surgery for coarctation of the aorta. 30 patients with complex coarctation of the aorta underwent a first stage correction with supplementary ductus ligation and pulmonary artery banding as needed. The mode of surgical repair of coarctation was end-to-end anastomosis in ten patients and patch graft in 20 patient. Mean follow-up was 766 (range 3-1812) days. Mortality after primary procedure was 16.6% (5/30) and after secondary procedure 11.1% (2/18). Three surviving patient developed recoarctation, but only one patients needed re-operation. In spite of improvement in neonatal cardiac surgery, we conclude that a staged approach is still the current treatment in most cases of complex coarctation of the aorta. 相似文献
7.
R Maffeo 《Canadian Metallurgical Quarterly》1998,24(5):418-419
We describe the first successful balloon angioplasty of a coarctation in a 460-g newborn infant with coarctation of the aorta and heart failure. A coronary angioplasty catheter was positioned across the coarctation via a transumbilical approach. The waist of the balloon disappeared on maximal inflation and there was an increase in blood pressure distal to the coarctation and the clinical status improved. A ductus arteriosus was ligated 4 days after angioplasty. 相似文献
8.
We report on the case of a 45-year-old man with recurrent syncope and angina with shortness of breath on exertion. Invasive and noninvasive diagnostic methods revealed severely stenosed bicuspid aortic valve, postductal coarctation of the aorta, and a coronary artery-descending aorta fistula. After surgical correction of the coarctation, ligation of the fistula, and aortic valve replacement, the patient's symptoms resolved. 相似文献
9.
A Cabrera A Gutiérrez E Pastor J Alcíbar P Martínez 《Canadian Metallurgical Quarterly》1996,49(8):615-617
The coarctation of the aorta can be acquired or secondary to the surgical correction of congenital anomalies of the great vessels. We report the cases of two newborns operated for patency of the ductus arteriosus (normal aortic arch and a great left-to-right-shunt). During the postoperative period the patients were asymptomatic and the echocardiogram showed no abnormalities. Later, both patients developed coarctation of the aorta. This is the first report of this condition during the neonatal period. 相似文献
10.
A 23-year-old female with Turner syndrome and horse-shoe kidney underwent the operation of the coarctation of the aorta associated with the thoracic aortic aneurysm. The aortic aneurysm was located between the left carotid artery and the coarctation of the aorta, and the subclavian artery which was branched away from the aortic aneurysm was also aneurysmal. Aneurysmectomies and the reconstruction of the descending thoracic aorta and the left subclavian artery were performed with knitted Dacron grafts under assisting of the left atriodescending thoracic aortic bypass with Bio-pump. The disease was rare and such a case was not reported previously. 相似文献
11.
Y Taniguchi N Yorioka K Yamashita Y Xue-Feng T Nishiki T Ogawa H Oda M Yamakido 《Canadian Metallurgical Quarterly》1997,17(5):413-416
We report a 59-year-old male with abdominal aortic coarctation presented as paraplegia due to spinal hemorrhage caused by the rupture of abnormally dilated spinal artery. In coarctation of aorta, coarctation is usually located in the aortic isthmus which could be the cause of cervical and upper thoracic myelopathy. However, there has been no report of abdominal aortic coarctation with hemorrhagic transverse myelopathy. In this case hemorrhage occurred after surgical treatment and prescribed warfarin may have exaggerated the outcome. 相似文献
12.
Assessment of the hemodynamic and anatomic results following balloon angioplasty of discrete native coarctation of the aorta, with particular attention to "remodeling," has required repeat cardiac catheterization and angiography, which is invasive and has limited resolution. Eight patients with hypertension and discrete native coarctation with an otherwise normally developed aortic arch underwent angioplasty at 5.0 +/- 6.8 years of age. Angiographic cross-sectional areas of the aorta indexed to body surface area at the isthmus (I), coarctation site (C), and 1 cm distal to the coarctation site (Cd) pre- and postangioplasty were compared with MRI-indexed cross-sectional areas 18 +/- 10 months (MRI-1) and 35 +/- 11 months (MRI-2) postangioplasty. From preangioplasty to MRI-2, the isthmus was smaller (149 +/- 22 versus 127 +/- 27 mm2/m2; p < 0. 05). The coarctation site was larger postangioplasty (25 +/- 9 versus 116 +/- 40 mm2/m2; p < 0.001) with continued growth at latest follow-up (116 +/- 40 versus 164 +/- 36 mm2/m2; p < 0.01). The segment 1 cm distal to the coarctation site continued to decrease in area at latest follow-up (267 +/- 78 versus 163 +/- 38 mm2/m2; p < 0. 001). I versus C versus Cd at MRI-2 were similar, whereas postangioplasty and MRI-1 cross-sectional area measurements were significantly different. Following angioplasty of discrete native coarctation, the aorta becomes more uniform or undergoes "remodeling." Noninvasive MRI is an effective means of evaluating the anatomic result following balloon angioplasty, obviating the need for repeated invasive cardiac catheterizations. 相似文献
13.
Subclavian flap aortoplasty is one of the best procedures for coarctation repair, but recoarctation still remains a problem in neonates and infants. We employed subclavian flap aortoplasty with resection of the whole layer of aortic ductal tissue in 9 patients less than 3 months of age with coarctation of the aorta and obtained satisfactory results. 相似文献
14.
J Engvall L Sj?qvist E Nylander KA Thuomas B Wranne 《Canadian Metallurgical Quarterly》1995,16(10):1399-1409
This study compared flow-sensitive magnetic resonance imaging with biplane transoesophageal echocardiography in combination with continuous wave Doppler from the suprasternal notch in patients with native coarctation or after surgical repair. Twenty patients (mean age 33 years, range 17-60) were investigated, of whom 15 had undergone surgery at mean age 13 years, range 5-43. Peak and mean flow in the ascending and descending aorta as well as coarctation peak velocity were determined with the magnetic resonance imaging phase contrast technique. Coarctation peak velocity was also measured by Doppler from the jugulum. Magnetic resonance imaging axial sections as well as biplane transoesophageal echocardiography were used to measure the smallest diameter of the constricted segment. Sixteen healthy volunteers, mean age 36 years, range 22-63, provided reference values for magnetic resonance imaging determined volume of flow in the aorta. Peak flow in the descending aorta was 9.2 +/- 3.7 l. min-1 (reference 13.0 +/- 2.5, P < 0.01) and mean flow 3.1 +/- 0.9 l. min-1 (reference 3.4 +/- 0.8, P > 0.05). The ratio of descending-to-ascending peak flow was 0.54 +/- 0.17 (reference 0.69 +/- 0.10, P < 0.01) and mean flow 0.68 +/- 0.15 (reference 0.69 +/- 0.08, P > 0.05). The coarctation velocity was slightly higher with Doppler than with magnetic resonance imaging (+0.24 +/- 0.44 m. s-1, 95% confidence interval +0.45 to +0.02 m. s-1, P = 0.05). The coarctation diameter was slightly larger with magnetic resonance imaging than with transoesophageal echocardiography (1.4 +/- 3.5 mm, 95% confidence interval +3.1 to -0.3 mm, P = 0.11). Both methods are suitable for the assessment and follow-up of coarctation of the aorta. Flow assessment with magnetic resonance imaging provides a hitherto unavailable measure with which to assess the severity of obstruction. 相似文献
15.
RS Fraser J Stobey RE Rossall J Dvorkin RF Taylor 《Canadian Metallurgical Quarterly》1976,115(5):415-7,434
Thirty-six patients, 19 men and 17 women, presented at age 18 or older between 1952 and 1974 with coarctation of the aorta. Of the 14 (39%) who had associated cardiovascular disease, 12 had aortic stenosis or insufficiency or both. Three patients had infections-two, endocarditis (aortic valve) and one, endarteritis. Three of the seven patients who did not undergo an operation are alive, two at more than 50 years of age. Five patients had myocardial infarctions, two at 35 years of age. Twenty-nine (80%) had operations; in eight instances the patient was over age 40. All 18 patients undergoing repair of isolated coarctation survived, while only 7 of the 11 patients with associated cardiovascular lesions who underwent repair recovered. Aortic valvular disease and myocardial infarction are serious complicating factors in coarctation of the aorta. 相似文献
16.
We report the case of a young woman in whom endaortitis developed at the site of a coarctation of the aorta after the invasive investigation of right fossa iliac pain. The organism responsible suggests a causal relationship to the investigations without antibiotic prophylaxis, and we emphasize the need for antibiotic prophylaxis in these cases. Invasive investigation of isolated coarctation in a young adult or adolescent is probably superfluous. 相似文献
17.
S Brili J Dernellis C Aggeli C Pitsavos C Hatzos C Stefanadis P Toutouzas 《Canadian Metallurgical Quarterly》1998,82(9):1140-3, A10
Patients with successfully repaired coarctation of the aorta have impaired distensibility. Age at surgery as well as left ventricular mass index are factors that are related to the distensibility index. 相似文献
18.
PA Seirafi KG Warner RL Geggel DD Payne RJ Cleveland 《Canadian Metallurgical Quarterly》1998,66(4):1378-1382
BACKGROUND: Recent surgical reports on coarctation of the aorta have primarily focused on the relative merits of various operative techniques. However, appropriate timing for elective repair remains unclear. METHODS: In a retrospective analysis we examined the surgical outcomes in 176 consecutive patients undergoing repair of coarctation of the aorta in our institution over a 25-year period. Ninety-nine percent of the patients had follow-up for a median of 7.5 years. RESULTS: A total of 13 patients have died (7.4% overall mortality). Nine of these patients had associated complex intracardiac anomalies. There was no mortality in the 113 patients with isolated coarctation. Residual or recurrent coarctation occurred in 27 patients (15.3%). The age at operation and the type of surgical repair did not have an effect on the incidence of recurrence. Persistent or late hypertension was identified in 18 of the 107 patients who have been followed up for more than 5 years (16.8%). A total of 48 patients operated on during infancy have been followed up for more than 5 years. Only 2 have developed late hypertension (4.2%). Both of these patients had recurrence. In contrast, 16 of the 59 patients operated on after a year of age had late hypertension (27.1%). CONCLUSIONS: To minimize the risk of persistent hypertension, elective repair of coarctation should be performed within the first year of life. 相似文献
19.
We report a case of right aortic arch with mirror-image branching and coarctation of the aorta and left ductus arteriosus in a 6-year-old boy. He was referred to Chang Gung Children's Hospital with suspected left ventricular failure. Physical examination revealed hypertension and a pulse discrepancy between the upper and lower extremities. Echocardiography and magnetic resonance imaging revealed a right aortic arch, a long segmental aortic coarctation, and a patent ductus arteriosus. In addition, mirror-image branching of the brachiocephalic vessels was found. The coarctation was resected and the ductus arteriosus was ligated. The postoperative recovery was uneventful and the blood pressure returned to normal. He remained normotensive and had no symptoms of heart failure within the 2 years of follow-up. 相似文献
20.
Hemoptysis secondary to an aortobronchial fistula is rare and uniformly fatal when left untreated. The authors describe a case of massive hemoptysis caused by an aortopulmonary fistula in an infected Dacron graft used successfully to repair a coarctation of the aorta. 相似文献