Particularities of neonatal isthmic aortic coarctation ( Tunisian study).
##plugins.themes.academic_pro.article.main##
Abstract
Introduction
Coarctation of the aorta(CoA) in new born is a diagnosticand therapeutic emergency.
The purpose of the work was to identify the clinical, echocardiographic and therapeutic features of CoA in neonates and to determine echocardiographic signs in favor of its constitution in the fetus.
METHODS:
a retrospective study including 47 patients with isthmic Co A diagnosed in ante et postnatal périod hospitalized in pediatric cardiology departement of la Rabta Hospital 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.
Keywords:
coarctation of the aorta, neonate, fetus, echocardiography##plugins.themes.academic_pro.article.details##
References
- Anderson R, Baker Ej, Macartney Fj, Rigby Ml, ShinebourneEa, Tynan M et al. PaediatricCardiology. 2nd Ed. Churchill Livingstone, London 2002.
- Marçon F, Bosser G, Worms AM. Coarctation de l'aorte. Encycl Med Chir, cardiologie. 1996 ;11-41
- Kovasikova L, Dakkak K, Skrak P, Zahorec M, Holan M. Neonates with left-sided obstructive heart disease: clinical manifestation and management at primary care hospitals. BratislLekListy. 2007;108:316-319
- Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or lifelong disease process? Heart .2005;91:1495-502.
- Head CE, Jowett VC, Sharland GK, Simpson JM. Timing of presentation and postnatal outcome of infants suspected of having coarctation of the aorta during fetal life. Heart. 2005;91:1070-4.
- Marcon F, Bosser G, Worms Am. Service de cardiologie infantile, hôpital d'enfants, Vandoeuvre France Cardiologie (11-014Q-10) 1996 Elsevier Masson SAMar;141(3): 223-6
- Jagdeep G. Coarctation of the aorta: Anaesthesia tutorial of the zeek 265. Westmead Children's Hospital, Sydney. 23 July 2012 la chirurgie de l'aortethoraciquethèse n° 029/1621
- Allan LD, Chita SK, Anderson RH et al. Coarctation of the aorta in prenatal life: an echocardiographic, anatomical, and functional study. Br Heart J. 1988;59:356-60.
- Pasquini L, Fichera A, Tan T, Ho SY, Gardiner H. Left superior caval vein: a powerful indicator of fetal coarctation. Heart .2005;91:539-40.
- Mivelaz Y, Bernardo SD, Meijboom EJ, Sekarski N. Validation of two echocardiographic indexes to improve the diagnosis of complex coarctations.Eur J CardiothoracSurg. 2008;34:1051-1056.
- R. El Yahyaoui Coarctation de l'aorte chez le nouveau-né et le nourrisson, thèse de Médecine, n° 157/ 2008, Fès
- Quarello E, Stos B, FermontL.Diagnostic prénatal des coarctations de l'aorte. Gynécologie Obstétrique et Fertilité. 2011;39:442-53.
- Cobanoglu A, Teply JF, Grunkemeier GL, Sunderland CO, Starr A .Coarctation of the aorta in patients younger than three months. J ThoracCardiovascSurg .1985 ; 89: 128-135
- Moulton AL, Bowman FO Jr. Primary definitive repair of type B interrupted aortic arch, ventricular septal defect, and patent ductus arteriosus.J ThoracCardiovasc Surg. 1981 Oct;82(4):501-10
- Chessa M, Carrozza M, Butera G, Piazza L, Negura Dg, Bussadori C et al. Results And Mid-Long-Term Follow-Up Of Stent Implantation For Native And Recurrent Coarctation Of The Aorta. Eur Heart J. 2005;26:2728-2732.
- Worms Am, Marcon F, Michalski H, Chehab G. Percutaneous Angioplasty Of Aortic Recoarctation: short- and mid-term results in 18 cases]. arch mal coeurvaiss .1993;86:573-57
- Cobanoglu A, Thyagarajan GK, Dobbs JL. Surgery for coarctation of the aorta in infants younger than 3 months: end-to-end repair versus subclavian flap angioplasty: is either operation better? Eur J CardiothoracSurg .1998;14:19-25.
- Conte S, Lacour-Gayet F, Serraf A et al. Surgical management of neonatal coarctation. J ThoracCardiovascSurg 1995;109:663-74
- Beekman RH, Rocchini AP, Behrendt DM, Rosenthal A .Reoperationfor coarctation of the aorta. Am J Cardiol. 1981;48:1108-14.
- Khory GH, Hawes CR. Recurrent coarctation of the aorta in infancy and childhood. J Pediat. 1968;72:801-06
- Zehr KJ, Gillinov AM, Redmond JM, Reene PS, Kan JS, Gardner T et al. Repair of coarctation of the aorta in neonates and infants: a thirty-year experience. Ann Thorac Surg. 1995;59:33-41. 22- Zias EA, Amin Z, Weigel TJ. Repair of coarctation with resection and extended end-to-end anastomosis. Ann ThoracSurg .1998;66:1365-70.
- Puchalski MD, Williams RV, John A. Hawkins JA, Minich LL. Follow-Up of Aortic Coarctation Repair in Neonates. J Am CollCardiol .2004;44:188-91.
- F.Roubertie, E Le Bret, R. Roussin, M. Ly, N.Bensari, A. Serraf .Coarctations Aortiques et Hypoplasies de L'arche. 2010 Elsevier Masson Sas (42-761).