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1.
Am J Cardiol ; 123(2): 323-328, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30424867

RESUMO

Coronary computed tomography (CT) angiography is often performed in adults with coarctation of the aorta (CoA) for anatomic assessment. As this population ages, assessment of atherosclerotic cardiovascular disease burden is important. Thus, quantitative and qualitative coronary artery calcium (CAC) scores were assessed for patients with CoA ≥16 years of age, who were seen at a referral center. CoA patients had either coronary CT angiography or chest CT with interpretable coronary information performed for clinical indications (follow-up, preoperative, or for symptoms) from 2004 to 2017. Qualitative CAC was determined based on low-dose CT and lung cancer screening protocols. Quantitative CAC scores were compared with an age- and gender-matched control cohort of patients chosen from an emergency department database of patients who received coronary CT angiography for chest pain evaluation. Atherosclerotic cardiovascular disease 10-year predicted risk scores were calculated for both cohorts. Out of 131 patients with CoA (mean age 46.1 ± 15.3 years), 22 patients (17%) had multivessel atherosclerotic disease on qualitative assessment. In the subgroup of patients ≥40 years, those with CoA were more likely to have a quantitative CAC score ≥400 compared with those without CoA (14% vs 4%, p = 0.02). Median atherosclerotic cardiovascular disease risk score was 8% (interquartile range 2% to 12%) for CoA patients ≥40 years, and 5% (interquartile range 2% to 9%) for patient without CoA ≥40 years. In conclusion, we determined that CoA patients have subclinical atherosclerosis identifiable on CT in high rates when compared with patients without CoA. Atherosclerotic cardiovascular disease should be assessed in these patients for prevention and treatment.


Assuntos
Coartação Aórtica/epidemiologia , Vasos Coronários/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Estudos Retrospectivos , Índice de Gravidade de Doença
2.
Eur J Cardiothorac Surg ; 55(2): 323-330, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29933438

RESUMO

OBJECTIVES: Coarctation of the aorta is known to present with hypertension in older patients; we reviewed our experience and assessed the outcome of hypertension following surgical correction. METHODS: From April 2004 to date, 43 patients above the age of 12 underwent coarctation of the aorta repair. The mean age was 20.4 + 9.7 years (maximum 56 years); 21 (48.8%) were older than 18 years and 28 (65.1%) were men. Thirty (69.8%) patients had hypertension. Fourteen (32.6%) had a bicuspid aortic valve; 11 (25.6%) had patent ductus arteriosus; 6 (14%) had myxomatous mitral valve; 4 (9.3%) had ascending aortic aneurysms; and 2 (4.7%) had descending aneurysms. RESULTS: Surgical correction included resection and interposition of a tube graft in 31 (72.1%), an end-to-end anastomosis in 6 (14%) and patch aortoplasty in 3 (7%). Three (7%) patients required an extra-anatomical bypass: 1 had a long segment coarctation of the aorta, and 2 had a Bentall procedure with an ascending-to-descending aortic bypass. Staged procedures were done for concomitant disease in 4 (9.3%). There was 1 death: a 56-year-old woman died of refractory ventricular fibrillation during surgery. Thirty (69.8%) patients were discharged with antihypertensive medication. At a follow-up of 2.8 ± 2.2 years (maximum 9.2 years), the number of hypertensive patients decreased (17/36; 47.2%) (P = 0.042). Univariable predictors for persistence of hypertension revealed the use of an interpositional tube graft for repair (odds ratio 13.855, confidence interval 0.000-0.001; P = 0.001) as an indicator, whereas there were no independent predictors for persistence of hypertension. CONCLUSIONS: Surgical intervention is warranted irrespective of age and helps correct and control hypertension better; however, significant numbers of patients still require antihypertensive medication and regular monitoring. Intervention using an interposition tube graft may affect the prevalence of hypertension.


Assuntos
Coartação Aórtica , Hipertensão , Adolescente , Adulto , Aorta/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/epidemiologia , Coartação Aórtica/cirurgia , Implante de Prótese Vascular , Criança , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Folia Med Cracov ; 58(3): 11-21, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30521508

RESUMO

BACKGROUND: Recoarctation (reCoA) of the aorta is a common complication afer the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to define risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS). METHODS: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSo STATISTICA TM 10 software. RESULTS: ReCoA was noted in 23 patients (33.3%). This complication was diagnosed 95.1 days (49-156 days) on the average a er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). The risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve - OR = 6.22 (p = 0.002). CONCLUSION: Balloon angioplasty seems to be an effective intervention in case of reCoA. A low diameter of the native ascending aorta (<=3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.


Assuntos
Coartação Aórtica/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood , Complicações Pós-Operatórias/epidemiologia , Angioplastia , Aorta/patologia , Coartação Aórtica/terapia , Valva Aórtica/anormalidades , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valva Mitral/anormalidades , Razão de Chances , Tamanho do Órgão , Complicações Pós-Operatórias/terapia , Recidiva , Estudos Retrospectivos , Fatores de Risco
5.
Tunis Med ; 96(8-9): 514-519, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30430531

RESUMO

METHODS: This is a retrospective study including 47 patients with isthmic coarctation (CoA) diagnosed in ante et postnatal périod, hospitalized in pediatric cardiology departement of la Rabta Hospital-Tunisia during the period from 2000 to 2017. RESULTS: They were 36 girls and 11 boys with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod in eight cases. In postnatal period heart failure was observed in (38.5%), abolition of femoral pulse (74%), a tension asymetry was found in all patients. Antenatal echocardiography suspected indicators of fetal coarctation especially ventriculo-arterial asymmetryechocardiography confirmed the diagnosis of CoA ,The ejection fraction was impaired in 31% of the cases.The abnormalities associated with coarctation were dominated by the patent ductus arteriosus (68%), atrial septal defect (55.5%), aortic hypoplasia, bicuspidia in respectively in 34% and 31% coarctation syndrome in (23.4%). Prostaglandin wasneccessary in (89.3%). forty two patients were operated with good immédiaterésults. the early postoperative mortality was 12.5%. In the long term, we deplored two late deaths, six cases of recoarctation with a follow-up of 14 months treated by percutaneous angioplasty with a result considered good in all cases. CONCLUSION: Coarctation of the aorta in neonates is a special form of aorticcoarctaion that differs from the child and adult forms in clinical, echocardiographic, and therapeutic characteristics . His clinical diagnosis must be early, if possible in antenatal , to asssure optimal management.


Assuntos
Coartação Aórtica/diagnóstico , Coartação Aórtica/epidemiologia , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Angioplastia , Coartação Aórtica/terapia , Ecocardiografia , Feminino , Idade Gestacional , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/epidemiologia , Comunicação Interatrial/terapia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Masculino , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Tunísia/epidemiologia
6.
Am J Cardiol ; 122(12): 2120-2124, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30318418

RESUMO

Adults with repaired coarctation of the aorta (CoA) suffer reduced long-term survival compared with the general population, in part due to coronary artery disease (CAD). There is conflicting evidence as to whether or not CoA is an independent risk factor for CAD. The primary aim was to determine if CoA is independently associated with premature myocardial infarction (MI) in the contemporary era. The secondary aim was to determine if CoA is independently associated with early coronary intervention. In a cross-sectional study using the National Inpatient Sample database from 2005 to 2014, we compared the age at MI and the age at coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention, in the absence of MI diagnosis) in patients with and without CoA using weighted linear regression. Among 5,472,416 observations with a primary diagnosis of MI, 174 had a diagnosis of CoA. Patients with CoA had MI 7.2 years younger than those without CoA, after adjusting for potential confounders (95% CI -11.3, -3.1, p = 0.001). Among 3,631,718 patients without a diagnosis of MI who underwent coronary artery bypass grafting or percutaneous coronary intervention, 279 had a diagnosis of CoA. Patients with CoA who underwent coronary intervention were 15.6 years younger than those without CoA, after adjusting for potential confounders (95% CI -18.3, -12.9, p < 0.001). In conclusion, patients with CoA have MI at a slightly younger age and undergo coronary intervention at a significantly younger age than those without CoA in the contemporary era. Our findings support continued close surveillance for and treatment of modifiable risk factors for CAD.


Assuntos
Coartação Aórtica/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Vigilância da População , Medição de Risco/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
7.
Int J Cardiol ; 250: 106-109, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29169748

RESUMO

BACKGROUND: In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). METHODS: Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. RESULTS: CoA with TAV patients (n=27) had smaller aortic root diameters than CoA with BAV (n=41) (32±4.9 vs. 37±5.8mm, p=0.001), despite being older (40 vs. 32years, p=0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28±4.5 vs. 33±6.9mm, p=0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (>37mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. CONCLUSIONS: In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.


Assuntos
Aorta/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/diagnóstico por imagem , Adulto , Coartação Aórtica/epidemiologia , Valva Aórtica/diagnóstico por imagem , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Adulto Jovem
9.
Birth Defects Res ; 109(18): 1442-1450, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28905502

RESUMO

BACKGROUND: We evaluated selected birth defects over a 9-year period to assess prevalence trends by selected maternal and infant factors. METHODS: Data were pooled from 11 population-based birth defects surveillance programs in the United States for children born between 1999 and 2007. Overall prevalence, as well as 3-year interval prevalence, was calculated for 26 specific birth defects, stratified by maternal age, maternal race/ethnicity, and infant sex. Average annual percent change (AAPC) was calculated for each birth defect. Poisson regression was used to determine change in AAPC, and joinpoint regression to identify breakpoints and changes in slope for prevalence of each defect over time. RESULTS: Between 1999 and 2001 and 2005 and 2007, four birth defects increased by 10% or more: coarctation of the aorta (17%), gastroschisis (83%), omphalocele (11%), and Down syndrome (10%). Among mothers <20 years of age, the gastroschisis AAPC increased 10.1% overall and, cross-classified by maternal race/ethnicity, the AAPC for mothers <20 years increased 9.2%, 25.7%, and 7.7% among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic mothers, respectively. A small increase in Down syndrome (AAPC 4.4%) was found for NHB mothers ≥35 years. CONCLUSION: No significant trends in prevalence were identified for most birth defects. Gastroschisis prevalence increased significantly among NHW and NHB mothers <20 years of age, with the greatest increases in NHB mothers. Prevalence of Down syndrome among NHB mothers ≥35 years also increased slightly. Stratified results may suggest avenues of research in birth defect etiology and in evaluating prevention efforts. Birth Defects Research 109:1442-1450, 2017.© 2017 Wiley Periodicals, Inc.


Assuntos
Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/prevenção & controle , Coartação Aórtica/epidemiologia , Coartação Aórtica/prevenção & controle , Síndrome de Down/epidemiologia , Síndrome de Down/prevenção & controle , Grupos Étnicos , Feminino , Gastrosquise/epidemiologia , Gastrosquise/prevenção & controle , Hérnia Umbilical/epidemiologia , Hérnia Umbilical/prevenção & controle , Humanos , Masculino , Idade Materna , Mães , Vigilância da População/métodos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Estados Unidos
11.
Med Clin (Barc) ; 149(9): 391-396, 2017 Nov 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28629660

RESUMO

INTRODUCTION AND OBJECTIVES: Dilatation of the ascending aorta associated with bicuspid aortic valve is a major cause of morbidity and mortality in adults. The main objective was to recognize the aortic involvement in children, its characteristics and risk factors. METHODS: Aortic measures of all pediatric patients with bicuspid aortic valve followed in a tertiary pediatric hospital between 1997 and 2015 were retrospectively taken. Patients with syndromes associated with aortic dilatation were excluded (n=17). RESULTS: Two hundred and six patients were included, 67.9% males. The commonest opening pattern was horizontal: 137 (66.7%). Half of the patients (101) had a history of surgical aortic coarctation, 46 (22.3%) had≥moderate aortic valve stenosis and 13 (6%) had≥moderate aortic insufficiency. Mean follow-up time was 6.1 (4.9) years; diagnosis of aortic dilatation was made during the first year of follow-up. Progression of the dilatation of the ascending aorta was noted in 17.1%, and of the aortic root in 2.5%. More than one-third (80/206) had aortic dilatation (z-score>2). The ascending aorta was exclusively affected in 70/80 patients, with sparing of the aortic root. In the multivariate analysis, patients with dilatation of the ascending aorta were associated with absence of coarctation (P=.001) and vertical opening pattern (P=.007). CONCLUSIONS: Pediatric patients with bicuspid aortic valve warrant medical follow-up for the frequent association with valve impairment and/or dilatation of the ascending aorta.


Assuntos
Aorta/patologia , Valva Aórtica/anormalidades , Valva Aórtica/patologia , Doenças das Valvas Cardíacas/patologia , Coartação Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Pré-Escolar , Comorbidade , Dilatação Patológica , Progressão da Doença , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/patologia , Centros de Atenção Terciária
12.
Int J Cardiol ; 243: 185-190, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28545853

RESUMO

BACKGROUND: There is a high prevalence of late hypertension after coarctation repair. The relative contribution of elevated sympathetic tone and endothelial dysfunction to its development is unknown. This study aims to investigate the neural profile of coarctation patients including muscle sympathetic nerve activity testing to directly measure sympathetic nervous activity. METHODS: Twenty-three patients aged ≥18years with a coarctation repair underwent measurements of clinic and 24-h blood pressures, muscle sympathetic nerve activity, sympathetic and cardiac baroreflex functions, digital endothelial function, and ambulatory arterial stiffness index. Median age at repair was 1.2months (interquartile range: 0-9months). Patients were compared to 17 healthy matched controls. RESULTS: After 26±5years, 6% (1/18) and 44% (8/18) suffered clinic hypertension and prehypertension, respectively. On 24-h blood pressure monitoring, 15% (3/20) and 20% (4/20) had hypertension and prehypertension, respectively. Coarctation patients had elevated muscle sympathetic nerve activity compared with controls (49.6±24.9 vs. 29.9±14.0 bursts/100 heartbeats, p=0.02), dampened sympathetic baroreflex function (-2.2±2.1 vs. -7.0±5.6 bursts/100heartbeats·mm·Hg-1, p=0.007), normal cardiac baroreflex function (41.9±30.4 vs. 35.7±21.1ms·mm·Hg-1, p=0.6), endothelial dysfunction (pulse amplitude tonometry ratio: 0.39±0.32 vs. 0.81±0.50, p=0.004), and increased ambulatory arterial stiffness index (0.46±0.15 vs. 0.29±0.17, p=0.008). CONCLUSION: After coarctation repair patients have increased muscle sympathetic nerve activity, dampened sympathetic baroreflex response, endothelial dysfunction, and increased ambulatory arterial stiffness index, all of which may contribute to the development of late hypertension.


Assuntos
Coartação Aórtica/fisiopatologia , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Endotélio Vascular/fisiopatologia , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Adulto , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Masculino , Sistema Nervoso Simpático/fisiopatologia , Rigidez Vascular/fisiologia , Adulto Jovem
13.
Heart ; 103(15): 1148-1155, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28377475

RESUMO

Coarctation of the aorta (CoA ) is a well-known congenital heart disease (CHD) , which is often associated with several other cardiac and vascular anomalies, such as bicuspid aortic valve (BAV), ventricular septal defect, patent ductus arteriosus and aortic arch hypoplasia. Despite echocardiographic screening, prenatal diagnosis of C o A remains difficult. Most patients with CoA present in infancy with absent, delayed or reduced femoral pulses, a supine arm-leg blood pressure gradient (> 20 mm Hg), or a murmur due to rapid blood flow across the CoA or associated lesions (BAV). Transthoracic echocardiography is the primary imaging modality for suspected CoA. However, cardiac magnetic resonance imaging is the preferred advanced imaging modality for non-invasive diagnosis and follow-up of CoA. Adequate and timely diagnosis of CoA is crucial for good prognosis, as early treatment is associated with lower risks of long-term morbidity and mortality. Numerous surgical and transcatheter treatment strategies have been reported for CoA. Surgical resection is the treatment of choice in neonates, infants and young children. In older children (> 25 kg) and adults, transcatheter treatment is the treatment of choice. In the current era, patients with CoA continue to have a reduced life expectancy and an increased risk of cardiovascular sequelae later in life, despite adequate relief of the aortic stenosis. Intensive and adequate follow-up of the left ventricular function, valvular function, blood pressure and the anatomy of the heart and the aorta are , therefore, critical in the management of CoA. This review provides an overview of the current state-of-the-art clinical diagnosis, diagnostic imaging algori thms, treatment and follow-up of patients with CoA.


Assuntos
Coartação Aórtica , Procedimentos Cirúrgicos Cardíacos/métodos , Gerenciamento Clínico , Imagem Multimodal/métodos , Coartação Aórtica/diagnóstico , Coartação Aórtica/epidemiologia , Coartação Aórtica/cirurgia , Saúde Global , Humanos , Morbidade/tendências
14.
J Am Soc Echocardiogr ; 30(6): 589-594, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28410945

RESUMO

BACKGROUND: Coarctation of the aorta (CoA) is difficult to diagnose by fetal echocardiogram (F-Echo), often requiring multiple F-Echos during gestation and neonatal echocardiograms (N-Echos) after birth. Furthermore, CoA is the most common ductal-dependent lesion missed on routine physical exam. OBJECTIVES: We sought to determine the most cost-effective diagnostic approach in caring for infants in whom an initial F-Echo is concerning for CoA. METHODS: Four paradigms for management after initial F-Echo could not rule out CoA were compared, with a single paradigm involving additional F-Echos: (1) multiple F-Echos for diagnostic clarity and performance of N-Echo on neonates with remaining high suspicion for CoA on F-Echos (prenatal-multiple), (2) no further F-Echo and performance of N-Echo on neonates with high suspicion for CoA on initial F-Echo (postnatal-selective), (3) no further F-Echo and performance of N-Echo on all neonates (postnatal-all), and (4) no further F-Echo or N-Echo with reliance on routine physical exam to identify afflicted infants (postnatal-none). Decision analysis models were constructed. Probabilities dictating clinical course and costs were calculated using our institution's study population. The utility-state values were derived from existing literature. The measure of effectiveness was quality-adjusted life years. To represent societal perspectives, cost was defined as hospital reimbursement payments. RESULTS: From 2007 to 2014 at our institution, 92 patients were diagnosed with CoA and met the inclusion criteria for this study. These patients presented to care either through prenatal diagnosis (n = 31), postnatal examination findings while clinically well (n = 41), or after clinical deterioration in extremis (n = 20), with one patient subsequently dying. Presenting in extremis was associated with a 20% increase in the cost of their subsequent care and with a 51% increase in length of hospital stay. Postnatal-none was the least effective paradigm but also the least costly, thus forming the baseline model. Of the three other diagnostic approaches modeled, Postnatal-all was the cost-effective paradigm, maximizing utility due to avoidance of high-cost/low-utility disease states such as presentation in extremis and death. Prenatal-multiple was the next most effective but was also the most expensive. CONCLUSIONS: Echocardiography is the screening gold standard in avoiding the devastating clinical manifestations of a missed CoA. When a diagnosis of CoA cannot be ruled out on initial F-Echo, the most cost-effective approach is performance of N-Echo on all neonates with no further prenatal evaluation.


Assuntos
Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/economia , Análise Custo-Benefício/economia , Ecocardiografia/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/economia , Ultrassonografia Pré-Natal/economia , Coartação Aórtica/epidemiologia , Ecocardiografia/estatística & dados numéricos , Feminino , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/estatística & dados numéricos , Washington/epidemiologia
15.
Can J Cardiol ; 33(2): 253-259, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27956040

RESUMO

BACKGROUND: Shone complex consists of a constellation of left-sided, usually obstructive, cardiac lesions, including supravalvar mitral ring, parachute mitral valve, subaortic stenosis, and aortic coarctation. Incomplete Shone complex consists of a mitral valve anomaly associated with lesions involving the subaortic region, aortic valve, or thoracic aorta. There is a paucity of data regarding long-term outcomes in adults with Shone complex. METHODS: We reviewed records of adults with complete or incomplete Shone complex followed at the Montreal Heart Institute between 1982 and 2014. RESULTS: Among 4189 adults with congenital heart disease, 28 (0.67%) patients (mean age, 35 ± 11 years; 50% women) had complete or incomplete Shone complex and were followed for a median of 8 years. Only 39% were previously diagnosed as having Shone complex. The most common defects were congenital mitral stenosis (93%), aortic coarctation (75%), and bicuspid aortic valve (71%). Heart transplantation was required in 2 patients (7.1%) at age 22 and 28 years, respectively. Overall, 48% had cardiovascular hospitalizations during adulthood, predominantly for arrhythmias or heart failure. Freedom from cardiovascular intervention was 55%, 18%, and 8% at 10, 20, and 30 years of age, respectively. Although aortic coarctation was the most common indication for initial intervention (61%), adult interventions occurred predominantly for aortic valve/left ventricular outflow tract (60%) and mitral valve (33%) lesions. CONCLUSIONS: Shone complex is an under-recognized entity associated with relatively low mortality in adulthood but substantial morbidity related to arrhythmias, heart failure, and interventions. Increased awareness of this condition and associated complications may allow for more tailored follow-up.


Assuntos
Anormalidades Múltiplas , Coartação Aórtica/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Valva Aórtica/anormalidades , Erros de Diagnóstico/estatística & dados numéricos , Cardiopatias Congênitas/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Estenose da Valva Mitral/diagnóstico , Adulto , Coartação Aórtica/epidemiologia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/epidemiologia , Feminino , Seguimentos , Cardiopatias Congênitas/epidemiologia , Doenças das Valvas Cardíacas/congênito , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Masculino , Estenose da Valva Mitral/congênito , Estenose da Valva Mitral/epidemiologia , Morbidade/tendências , Quebeque/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
16.
Med Princ Pract ; 26(2): 185-188, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27798937

RESUMO

OBJECTIVE: The aim of this case report is to highlight the importance of excluding aortic coarctation in a patient with a bicuspid aortic valve. CLINICAL PRESENTATION AND INTERVENTION: A 56-year-old woman with hypertension was admitted complaining of progressive dyspnea. Transthoracic echocardiography showed a calcified, bicuspid aortic valve with severe stenosis. Aortography revealed the presence of severe narrowing of the aorta between the carotid and subclavian arteries. The patient was referred for cardiovascular surgery in which successful aortic valve replacement and aortic correction were performed. CONCLUSION: This case report shows an uncommon finding of infantile aortic coarctation in an adult patient admitted with heart failure.


Assuntos
Coartação Aórtica/diagnóstico , Insuficiência Cardíaca/diagnóstico , Coartação Aórtica/epidemiologia , Coartação Aórtica/cirurgia , Aortografia , Diagnóstico Diferencial , Dispneia/epidemiologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade
17.
J Clin Hypertens (Greenwich) ; 19(1): 13-22, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27759186

RESUMO

European guidelines recommend that patients with hypertension be assessed for asymptomatic organ damage and secondary causes. The authors propose that a single magnetic resonance imaging (MRI) scan can provide comprehensive first-line imaging of patients assessed via a specialist hypertension clinic. A total of 200 patients (56% male, aged 51±15 years, office BP 168±30/96±16 mm Hg) underwent MRI of the heart, kidneys, renal arteries, adrenals and aorta. Comparisons were made with other imaging modalities where available. A total of 61% had left ventricular hypertrophy (LVH), 14% had reduced ejection fraction, and 15 patients had myocardial infarcts. Echocardiography overdiagnosed LVH in 15% of patients and missed LVH in 14%. Secondary causes were identified in 14.5% of patients: 12 adrenal masses, 10 renal artery stenoses, seven thyroid abnormalities, one aortic coarctation, one enlarged pituitary gland, one polycystic kidney disease, and one renal coloboma syndrome. This comprehensive MRI protocol is an effective method of screening for asymptomatic organ damage and secondary causes of hypertension.


Assuntos
Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Idoso , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/epidemiologia , Coloboma/diagnóstico por imagem , Coloboma/epidemiologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Doenças Renais Policísticas/diagnóstico por imagem , Doenças Renais Policísticas/epidemiologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Insuficiência Renal/diagnóstico por imagem , Insuficiência Renal/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Volume Sistólico , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/epidemiologia
18.
Am Heart J ; 181: 10-15, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27823680

RESUMO

AIMS: In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. METHODS AND RESULTS: In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36.9±14.4years); 344 (52.7%) of them had HTN, defined as either an existing diagnosis or blood pressure (BP) ≥140/90mmHg at the clinical visit. In a multivariable model, age (years) (odds ratio [OR] 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68), and body mass index (kilograms per square meter) (OR 1.09, CI 1.03-1.16) were independently associated with having HTN, and so was systolic arm-leg BP gradient where an association with HTN was found at the ranges of (10, 20] and >20mmHg, in comparison to the interval ≤10mmHg (OR 3.58, CI 1.70-7.55, and OR 11.38, CI 4.03-32.11). This model remained valid when all patients who had increased BP (≥140/90mmHg) without having been diagnosed with HTN were excluded from the analyses. CONCLUSIONS: Hypertension is common in patients with previously repaired CoA and is associated with increasing age, male sex, and elevated body mass index. There is also an association with arm-leg BP gradient, starting at relatively low levels that are usually not considered for intervention.


Assuntos
Coartação Aórtica/cirurgia , Hipertensão/epidemiologia , Sistema de Registros , Adulto , Fatores Etários , Coartação Aórtica/epidemiologia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Fatores Sexuais , Suécia/epidemiologia , Adulto Jovem
19.
Ann Thorac Surg ; 102(6): 2087-2094, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27353483

RESUMO

BACKGROUND: Previous studies have evaluated recurrent coarctation after the Norwood procedure (NP) in patients with single-ventricle (SV) anatomy. Extended patch augmentation of the aorta, a Norwood-type arch reconstruction (NTAR), is also used in patients with 2 ventricles and a diffusely hypoplastic arch; however, outcomes after NTAR in these patients are not well described. METHODS: A retrospective review was performed of neonates with SV and 2-ventricle (2V) anatomy who underwent an NP or NTAR at our institution from 2000 to 2010. The incidence of recurrent coarctation requiring intervention and associated risk factors were evaluated. RESULTS: Overall, 101 patients with 2V anatomy and 361 patients with SV anatomy were included. Eighteen patients with 2V anatomy (17.8%) and 35 patients with SV anatomy (9.7%) required intervention for recurrent coarctation at a median of 0.5 years (interquartile range [IQR], 0.3-1.2 years) after the initial operation. Independent risk factors associated with recurrent coarctation in patients with 2V anatomy included weight less than 2.5 kg (hazard ratio [HR], 6.05; p = 0.001) and peak aortic arch gradient (PAAG) on the discharge echocardiogram greater than 10 mm Hg (HR, 3.07; p = 0.03). In patients with SV anatomy, shunt type (HR, 6.42; p < 0.0001 for right ventricle to pulmonary artery [RV-PA] shunt compared with others) and peak gradient on the discharge echocardiogram greater than 10 mm Hg were found to be significant (HR, 7.40; p < 0.0001). There was no survival difference in patients with and those without recurrent coarctation. CONCLUSIONS: Recurrent coarctation is common after NTAR. Small patient size and shunt type were found to be independent risk factors for recurrent coarctation in the 2V and SV populations, respectively, and discharge aortic arch gradient was a significant risk factor in both populations.


Assuntos
Coartação Aórtica/epidemiologia , Coartação Aórtica/cirurgia , Procedimentos de Norwood , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Int J Gynaecol Obstet ; 135(1): 28-32, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27350224

RESUMO

OBJECTIVE: To evaluate fetal cardiac ventricular disproportion as a marker of cardiac anomalies. METHODS: A retrospective case series included data from all patients who had a fetus diagnosed subjectively with ventricular disproportion by routine obstetric ultrasonography between January 1, 2007 and December 31, 2013 at a single tertiary center in the USA. Fetal and neonatal echocardiography, and neonatal outcome data were retrieved. Outcomes were described for all fetuses with subjective ventricular disproportion. Then, the objective right-to-left ventricular ratio (RLVR) was calculated as a continuous (after transformation to gestational age specific z-scores) or categorical value (>2SD for gestational week), based on previously published reference values. Subsequently, correlations between the objective RLVR and neonatal outcomes were evaluated. RESULTS: Records from 60 fetuses diagnosed with ventricular disproportion at 16-38 weeks of gestation were included. These pregnancies resulted in 54 live deliveries; postnatally, 20 (37%) of these neonates were diagnosed with aortic coarctation and 39 (72%) were diagnosed with other cardiac anomalies, with or without aortic coarctation. No significant differences in objective prenatal diagnostic findings (RLVR) were demonstrated between neonates who were diagnosed postnatally with aortic coarctation or any cardiac anomaly and those not. CONCLUSION: Subjective ventricular disproportion, regardless of objective diagnosis, was associated with cardiac defects. The use of fetal and neonatal echocardiography following diagnosis of fetal ventricular disproportion appears justified.


Assuntos
Coartação Aórtica/epidemiologia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Ventrículos do Coração/anormalidades , Doenças do Recém-Nascido/epidemiologia , Diagnóstico Pré-Natal/métodos , Adolescente , Adulto , Coartação Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico por imagem , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Estados Unidos , Adulto Jovem
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