ABSTRACT
INTRODUCCIÓN: La coartación de aorta es una cardiopatía congénita con una incidencia de 4 por cada 10 000 nacidos vivos y puede asociarse o no a ductus arterioso persistente u otras malformaciones. Suele ser asintomático, normalmente se diagnostica mediante los signos clásicos; con gradiente de presión arterial entre extremidades, pulsos reducidos en extremidades inferiores, hipertensión arterial en miembros superiores o, en casos graves, fallo cardiaco izquierdo. Su resolución puede ser percutánea o quirúrgica, dependiendo de la edad y sus características. CASO CLÍNICO: Paciente masculino de 6 años, asintomático, con sospecha de coartación aórtica, por presentar una diferencia entre presiones arteriales de miembros superiores e inferiores, extremidades inferiores con pulsos reducidos y soplo sistólico en foco aórtico. Se solicitó ecocardiograma que informó válvula aórtica bicúspide con rafe, insuficiencia ligera y coartación de aorta; angiotomografía evidenció coartación de aorta yuxtaductal; cateterismo cardiaco objetivó casi nulo paso de contraste a través del defecto, por lo que se programó tratamiento quirúrgico. EVOLUCIÓN: La corrección quirúrgica se realizó mediante coartectomía con anastomosis termino-terminal más cierre del conducto arterioso. Posterior a la intervención se logró objetivar una mejora relevante en el gradiente de presión entre las extremidades. En el postquirúrgico el paciente presentó hipertensión que logró ser controlada, evolucionó favorablemente y recibió el alta a los 4 días sin tratamiento antihipertensivo ambulatorio. CONCLUSIÓN: La expectativa de vida en pacientes intervenidos para corregir su cardiopatía congénita es superior en relación a aquellos que no son intervenidos, por lo que el diagnóstico oportuno supone una herramienta importante para mejorar la calidad y esperanza de vida.
BACKGROUND: Coarctation of the aorta is a congenital heart disease with an incidence of 4 per 10 000 live births, it may or may not be associated with patent ductus arteriosus as well as other malformations. It is usually asymptomatic and diagnosed by its classic signs such as; arterial pressure gradient between extremities, reduced pulses in the lower extremities, arterial hypertension in the upper extremities or, in severe cases, left heart failure. Its resolution can be percutaneous or surgical, depending on the patient's age and the characteristics of the defect. CASE REPORTS: A 6-year-old male patient, asymptomatic, with suspected aortic coarctation, due to a difference between arterial pressures in the upper and lower limbs, lower limbs with reduced pulses, and a systolic murmur in the aortic focus. An echocardiogram was requested, which reported a bicuspid aortic valve with raphe, mild regurgitation, and coarctation of the aorta; CT angiography showed coarctation of the juxtaductal aorta; cardiac catheterization showed almost no passage of contrast through the defect, so surgical treatment was scheduled. EVOLUTION: Surgical correction was performed by coartectomy with end-to-end anastomosis and closure of the ductus arteriosus. After the intervention, a relevant improvement in the pressure gradient between the extremities was observed. In the postoperative period the patient presented hypertension, that we managed to control, the patient progressed favorably and was discharged after 4 days without antihypertensive treatment. CONCLUSION: Life expectancy in patients who underwent surgery to correct a congenital heart disease is higher than in those who don't, so timely diagnosis is an important tool to improve life quality and life expectancy.
Subject(s)
Humans , Male , Child , Aortic Coarctation/complications , Thoracic Surgery/methods , Ductus Arteriosus, Patent , Heart Defects, Congenital/diagnostic imagingABSTRACT
Objective To evaluate the diagnostic value of the diameter ratio of left subclavian artery to aortic isthmus(LSA/AoIS)in fetuses with aortic coarctation(COA).Methods A retrospective study of 79 fetal echocardiographic data was undergone on 49 COA fetuses.The COA cases were divided into four groups according to different gestational week (cases in each group including follow-up review of different gestational weeks):group 1 ,24-27+6 W;group 2,28 -31+6 W;group 3,32 -35+6 W;group 4,36 -39+6 W.The normal fetuses with gestational age matched were also divided into four control groups.The diameter of left subclavian artery(LSA) and aortic isthmus (AoIS) were measured,the ratio of LSA/AoIS of each group were calculated,and the data between the COA and control groups were compared.ROC curve analysis was used for LSA/AoIS to predict the demarcation point of postnatal COA.Results ①There was no statistic difference in the LSA diameter between COA groups and control groups (P >0.05):group 1 (1 .87±0.42)mm vs (1 .75 ±0.25)mm;group 2 (2.25 ±0.36)mm vs (2.21 ±0.22)mm;group 3 (2.74±0.32)mm vs (2.90 ±0.29)mm;group 4 (2.83 ±0.28)mm vs (3.06 ±0.30)mm;②The ratio of LSA/AoIS was significantly increased in COA groups than those in control groups:group 1 (0.88± 0.15) vs (0.66±0.06),group 2 (0.85±0.13)vs(0.64±0.05),group 3 (0.94±0.17)vs(0.73±0.07), group 4 (0.94±0.18)vs(0.70±0.07),the difference was statistically significant(P <0.05);③The cut-off value of LSA/AoIS ratio were 0.78,0.73,0.83,0.78 in each group,respectively.Conclusions The ratio of LSA/AoIS can be used as a useful echocardiographic parameter which suggest the presence of aortic coarctation.This ratio≥0.8 may have a certain diagnostic significance.
ABSTRACT
Se comunican los casos de dos pacientes con síndrome de Bonnet, Wyburn-Mason en quienes existía un aneurisma cirsoide de la retina de diferente grado de desarrollo. En uno, el cuadro oftalmoscópico era obvio; en tanto que en el otro la manisfestación fundamental era una tortuosidad vascular acentuada y en quien solo la angiografía fluoresceínica del fondo ocular mostró sutiles cambios compatibles con una malformación arteriovenosa localizada. Otro elemento inusual en el comportamiento de este tipo de malformaciones fue la asociación a una coartación de la aorta torácica y multiples anomalías esqueléticas sencillas, así como la obstrucción de un segmento muy desarrollado de la malformación arteriovenosa con infarto hemorrágico retiniano e involución posterior de parte de ella
We communicate the cases of two patients with syndrome of Bonnet, Wyburn-Mason who had cirsoide aneurysms of the retina of differnt degrees of development. In one, the ophthalmoscopic picture was obvious, while on the other, The primary manifestation was a marked vascular tortuosity and in which only the ocular fundus fluorescein angiography showed subtle changes consistent with a located arteriovenous malformation. Another unusual element in the behavior of this type of malformations was a coarctation of the thoracic aorta and multiple skeletal anomalies simple associated, as well as the obstruction of a highly developed portion of the retinal arteriovenous malformation with hemorrhagic infarction and consecutive involution of part of it