Aortic coarctation natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
Line 23: Line 23:
==Complications==
==Complications==
About 50% of patients with coarctation of the aorta die within the first three decades of life, and more than 75% are dead by age 50 due to:
About 50% of patients with coarctation of the aorta die within the first three decades of life, and more than 75% are dead by age 50 due to:
===Rupture of the aorta or aortic dissection===
*Rupture of the aorta or aortic dissection
*Most frequently in the third or fourth decade.
** Most frequently in the third or fourth decade.
*Dissections originate either proximally (secondary to hypertension and local stress)or distally (where the jet erodes the intima).
** Dissections originate either proximally (secondary to hypertension and local stress)or distally (where the jet erodes the intima).
*Ruptures may bleed into the esophagus, and [[hematemesis]] or [[melena]] may portend disaster.
** Ruptures may bleed into the esophagus, and [[hematemesis]] or [[melena]] may portend disaster.


===Infective endocarditis or endarteritis===
* Infective endocarditis or endarteritis
*Most frequently in the second to fourth decade of life.
** Most frequently in the second to fourth decade of life.


===Rupture of the circle of Willis===
* Rupture of the circle of Willis
*Most frequently in the second or third decade of life.
** Most frequently in the second or third decade of life.
*Secondary to the increased incidence of aneurysms in this population and the presence of proximal hypertension.
** Secondary to the increased incidence of aneurysms in this population and the presence of proximal hypertension.


===Congestive Heart Failure===
* Congestive Heart Failure
*Common in infants, often occurs with associated abnormalities such as [[VSD]] or mitral valve disease.
** Common in infants, often occurs with associated abnormalities such as [[VSD]] or mitral valve disease.
*In the adult is secondary to [[hypertension]] associated with [[coronary artery disease]] or aortic valve disease.
** In the adult is secondary to [[hypertension]] associated with [[coronary artery disease]] or aortic valve disease.


===Calcification aortic stenosis===
* Calcification aortic stenosis
*Result of associated [[bicuspid aortic valve]] disease that over time becomes calcified.
** Result of associated [[bicuspid aortic valve]] disease that over time becomes calcified.
===Premature death occurs due to===
 
* Coronary artery disease
* Premature death occurs due to
* Heart failure
** [[Coronary artery disease]]
* Stroke
** [[Heart failure]]
* Aortic dissection or rupture
** [[Stroke]]
** [[Aortic dissection]] or rupture


==References==
==References==

Revision as of 16:30, 23 January 2013

Aortic coarctation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Coarctation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

CT

MRI

Angiography

Echocardiography

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic coarctation natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic coarctation natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic coarctation natural history, complications and prognosis

CDC on Aortic coarctation natural history, complications and prognosis

Aortic coarctation natural history, complications and prognosis in the news

Blogs on Aortic coarctation natural history, complications and prognosis

Directions to Hospitals Treating Aortic coarctation

Risk calculators and risk factors for Aortic coarctation natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S.[2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S.[4]

Overview

80% of patients are diagnosed during childhood. In the remaining 20% of cases, the symptoms are often less severe, but the coarctation will ultimately require correction in order to prevent irreversible organ damage. Common complications among patients who go untreated include: aortic rupture, infective endocarditis, congestive heart failure, and calcification of the aorta.

Natural History

In infants with a preductal coarct, the LV output goes to the upper extremities, and the RV output goes to the lower extremities through the patent ductus.

  • Childhood:
  • Adolescence:
  • When first recognized in adolescents, coarctation of the aorta is generally asymptomatic.
  • Adulthood:
  • The postductal form is often less severe and discovered in adulthood.
  • Infrequently coarctation of the aorta is associated with other congenital abnormalities.
  • In patients over the age of 30, major complications leading to death are not uncommon. [1][2]
  • 75% of patients with coarctation will have hypertension at 30 years of their age.
  • If the coarctation is left untreated, arterial hypertension may become permanent due to irreversible changes in some organs (such as the kidney).

Complications

About 50% of patients with coarctation of the aorta die within the first three decades of life, and more than 75% are dead by age 50 due to:

  • Rupture of the aorta or aortic dissection
    • Most frequently in the third or fourth decade.
    • Dissections originate either proximally (secondary to hypertension and local stress)or distally (where the jet erodes the intima).
    • Ruptures may bleed into the esophagus, and hematemesis or melena may portend disaster.
  • Infective endocarditis or endarteritis
    • Most frequently in the second to fourth decade of life.
  • Rupture of the circle of Willis
    • Most frequently in the second or third decade of life.
    • Secondary to the increased incidence of aneurysms in this population and the presence of proximal hypertension.
  • Congestive Heart Failure
    • Common in infants, often occurs with associated abnormalities such as VSD or mitral valve disease.
    • In the adult is secondary to hypertension associated with coronary artery disease or aortic valve disease.
  • Calcification aortic stenosis

References

  1. Giuliani et al, Cardiology: Fundamentals and Practice, Second Edition, Mosby Year Book, Boston, 1991, pp. 1670-1676.
  2. Deal K, Wooley CF. Coarctation of the Aorta and Pregnancy. Annals of Internal Medicine 1973, 78:706-710.

Template:WH Template:WS