Materiały źródłowe

• #1 Current management of coarctation of the aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710863/

  Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. […] Despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. […] Untreated coarctation carries a poor prognosis with average survival age of 35 years of age; with 75% mortality by 46 years of age. […] Long term complications are the consequence of long-term hypertension including premature coronary artery disease, stroke, endocarditis, aortic dissection and heart failure. […] Correction of coarctation should be performed in infancy or early childhood to prevent the development of chronic systemic hypertension as delayed repair after early childhood does not prevent persistence or late recurrence of systemic hypertension.

• #2 (PDF) Noninvasive hemodynamic assessment, treatment outcome prediction and follow-up of aortic coarctation from MR imaging

  https://www.academia.edu/100966977/Noninvasive_hemodynamic_assessment_treatment_outcome_prediction_and_follow_up_of_aortic_coarctation_from_MR_imaging?uc-sb-sw=113129828

  Coarctation of the aorta (CoA) is a congenital heart disease characterized by an abnormal narrowing of the proximal descending aorta. […] The severity of CoA is quantified by the blood pressure drop (P) across the stenotic coarctation lesion. […] The complete workflow is realized in a fast, mostly-automated system that is integrable in the clinical setting. […] To the best of our knowledge, this is the first time that three different settings (preoperative-severity assessment, poststenting-follow-up, and virtual stenting-treatment outcome prediction) of CoA are investigated on multiple subjects. […] Long-term results, however, have revealed decreased life expectancy associated with abnormal hemodynamics. […] The hemodynamic severity and clinical manifestations of COA vary from asymptomatic mild narrowing of the aortic isthmus to severe obstruction associated with cardiac defects, congestive heart failure and shock in the neonatal period, persistent hypertension and aortic dissection. […] Despite advancements in interventional/surgical techniques, the long-term morbidity and subsequent mortality of patients with COA remain high in comparison with the general population.

• #3 Coarctation of the Aorta (CoA)

  https://my.clevelandclinic.org/health/diseases/16876-aortic-coarctation

  CoA is most dangerous when its undiagnosed and untreated. Ideally, diagnosis happens early in life so providers can offer early treatment and monitoring. […] Thanks to improvements in diagnosis and repair, people with coarctation of the aorta can live to at least age 60. In the past, the average life expectancy for people with coarctation of the aorta was just 35 years old. […] If your baby has coarctation of the aorta, you might be wondering why. We cant always know the exact cause of congenital heart disease. But we do know that early diagnosis and treatment can lessen its impact on your childs life.

• #4 Coarctation of the Aorta: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/895502-overview

  The survival curve, while not approaching that in the healthy population, is significantly improved compared with Campbell’s natural history data. […] Death appears to be secondary to recoarctation repair, aneurysms at site of coarctation repair or at a remote site, congestive heart failure, bacterial endocarditis, and hypertension. […] Attempts to define factors that affect long-term survival have been made; age at operation and degree and duration of hypertension prior to surgery appear to affect the long-term survival. […] A study by Oliver et al indicated that in young adults who underwent aortic coarctation repair in childhood, the greatest risk factor for heart failure or cardiovascular death is pulmonary hypertension related to restrictive LV physiology. […] The study did not find heart failure or death to be statistically associated with recoarctation, systemic hypertension, intracardiac lesions, or aortic aneurysm or with treatment with beta blockers or ACE inhibitors/angiotensin receptor blockers.

• #5 Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2791247/

  The long-term clinical course was studied in 646 patients, who underwent isolated operative repair of coarctation of the aorta at the Mayo Clinic from 1946 to 1981. […] Estimated survival analysis revealed 91% of patients alive at 10, 84% at 20, and 72% at 30 years after operative repair. […] Age, sex, and postoperative systolic blood pressure were found to be independently predictive of survival. […] For patients less than 14 years of age at the time of initial coarctectomy, survival to 20 years was 91%, and for patients 14 years or older at the time of operation, survival was 79%. […] The higher the postoperative systolic pressure, the higher the probability of death. […] Four main points emerged. 1) Age at the time of initial repair is the most important predictor of long-term survival. Surgery should be offered to patients after age 1 year or sooner if hypertension is severe. 2) Coronary artery disease is the most common cause of late death.

• #6 Current management of coarctation of the aorta

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710863/

  Long term problems may occur after all forms of treatment. The most important complications are arterial hypertension, recoarctation and aneurysms of the ascending aorta or at the site of intervention. […] Recoarctation at the site of coarctation is an important cause of morbidity after an initially successful repair. […] The reported prevalence of recoarctation ranges between 3% and 41% in a survey of 11 major studies. […] Hypertension is among the factors that contribute to premature death from coronary and cerebrovascular disease following repair of coarctation of the aorta. […] Although the blood pressure typically falls after successful repair, persistent or recurrent hypertension and disproportionate systolic hypertension with exercise are observed. […] All coarctation patients, whether repaired or not, should be monitored with life-long congenital cardiology follow-up because of the potential long-term complications.

• #7 Aortic geometry and long-term outcome in patients with a repaired coarctation | Open Heart

  https://openheart.bmj.com/content/11/1/e002642

  Patients with repaired coarctation of the aorta have a lifetime increased risk of developing cardiovascular events and hypertension, even without residual stenosis or re-coarctation. […] Previous studies have shown that the distinct aortic geometry of coarctation patients may be associated with the increased risk of cardiovascular events; however, prospective studies evaluating the prognostic consequences of aortic geometry in this population are missing. […] Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. […] Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients. […] Findings of this study suggest that aortic geometry deserves more attention in the follow-up of repaired coarctation patients, and especially patients with more aortic tortuosity might require closer surveillance.

• #8 Aortic geometry and long-term outcome in patients with a repaired coarctation | Open Heart

  https://openheart.bmj.com/content/11/1/e002642

  Therefore, a large multicentre study is necessary to validate prognostic implications of aortic geometry in repaired coarctation patients. […] After successful coarctation repair, patients have a distinct aortic arch geometry compared with matched controls with a more tortuous course and smaller aortic arch. […] The degree of residual stenosis can only partly explain the presence of hypertension in patients and was not associated with CVE. […] However, to predict CVE, other geometrical features (e.g., tortuosity) might be helpful.

• #9 Fetal doppler predictor of neonatal coarctation of the aorta – MedCrave online

  https://medcraveonline.com/JCCR/fetal-doppler-predictor-of-neonatal-coarctation-of-the-aorta.html

  Coarctation of the aorta (CoAo) is one of the most common congenital heart defects (CHD), accounting for approximately 7% of all live births with CHD. Correct prenatal diagnosis of CoAo improves survival and reduces morbidity by allowing planned delivery in an appropriate left and early prevention of ductal constriction. Currently prenatal diagnosis of this condition lacks sensitivity at screening and specificity even when performed by experts in tertiary lefts. This leads to increased morbidity and mortality in affected neonates without correct prenatal diagnosis, who often collapse and require resuscitation before surgery and unjustified costs of cardiac lefts due to false-positive cases. Despite advances in fetal echocardiography and the description of antenatal findings associated with neonatal CoAo, this lesion remains the most challenging diagnosis to be made in fetal and early neonatal life. To the best of our knowledge quantitative fetal Doppler criteria of neonatal CoAo have not been described in the literature.

• #10 Fetal doppler predictor of neonatal coarctation of the aorta – MedCrave online

  https://medcraveonline.com/JCCR/fetal-doppler-predictor-of-neonatal-coarctation-of-the-aorta.html

  We have described fetal quantitative Doppler criterion which is a step to objectivization of assessment of aortic isthmus flow disturbance and improvement of the accuracy of fetal echocardiography for prediction of neonatal CoAo. The IDDFID after 32 weeks of gestation is sensitive and specific parameter for prediction of neonatal CoAo. Using of such parameter may be the step to objectivization of assessment of aortic isthmus flow disturbance. The IDDFID could be incorporated as a part of multiparametric scoring system together with fetal morphological criteria of CoAo that needs further research. […] The mean post-test probabilities of CoAo were higher in fetuses with confirmed CoAo than in fetuses with false suspicion (85 vs 30%; P0.0001).

• #11 Coarctation of the Aorta: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/895502-overview

  Coarctation of the aorta is a lifelong disease with a guarded prognosis. Relief of obstruction, control of hypertension, follow-up monitoring for recurrent obstruction, and follow-up care of associated anomalies are imperative. […] Patients without residual obstruction who are normotensive both at rest and with exercise should lead normally active lives without restriction. They should be able to obtain health and life insurance. […] Patients with persistent hypertension, untreated residual obstruction, or other complications have a variable prognosis related to the severity of these problems. […] Data regarding long-term follow-up are limited. Available studies indicate that significant mortality rates are found at long-term follow-up after surgical correction of aortic coarctation.

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