Andersons pediatric cardiology 1204
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (128.59 KB, 3 trang )
Abstract
Thischapterprovidesanoverviewoftwoaorticarchanomalies,the
commoncoarctationoftheaortaandtherareinterruptedaorticarch.These
lesionsareoutlined,describingtheirmorphologyonaspectrumfrom
discretecoarctationthroughtubularhypoplasiaandfinallyprogressingto
interruptedaorticarch.Interruptedaorticarchhasastrongassociationwith
DiGeorgesyndrome.Thepresentationanddiagnosticevaluationare
coveredtogether,withemphasisontheuseofechocardiographyboth
prenatallyandpostnatally,aswellascross-sectionalimaging.Theoperative
approachandoutcomesarediscussedindividually,althoughthereissome
overlapintechniqueaswellaslong-termsequelae,suchashypertension.
Percutaneousinterventionisalsoreviewed,asitismostbeneficialin
recurrentobstructionandolderpopulations.
Keywords
Aorticarchanomalies;aorticcoarctation;interruptedaorticarch;aortic
isthmus;end-to-endanastomosis;end-to-sideanastomosis;balloonstent
angioplasty;aorticarchadvancement;DiGeorgesyndrome
Introduction
CoarctationderivesfromtheLatintermcoartatio,whichtranslatedliterally
means“adrawingtogether.”Aorticcoarctation,therefore,indicatesanarrowing
atsomepointalongthecourseoftheaorta.Whenusedinthecontextofthe
congenitallymalformedheart,coarctationmostusuallydescribedanareaof
narrowingofthethoracicaortaintheregionoftheinsertionofthearterialduct,
withorwithoutadditionalabnormalitiesoftheaorticarch.Obstructivelesions
canbefoundmoreproximally,involvingtheascendingaorta.Theseare
considered,alongwithlesionsoftheaorticvalve,inChapter45.Thosedistalto
thethoracicaorta,togetherwithacquiredlesions,arebeyondthescopeofthis
chapter.Withinthischapter,however,interruptionoftheaorticarchis
considered.Thisinvolvesdiscontinuitybetweentwoadjacentsegmentsofthe
aorticarch.Inhemodynamicterms,itincludescaseswithafibrouscordbetween
thediscontinuoussegments.Inthisrespect,interruptioncanbeinterpretedasthe
extremeendofthespectrumofobstructionoftheaorta(Fig.45.1).
FIG.45.1 Morphologicspectrumofobstructionintheaorticarch,
extendingfromtheshelflesionproducingcoarctationinthemiddlepanel
andmovingincounterclockwisefashiontointerruptionoftheaorticarchat
theisthmus.
