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Chapter 19 - Coarctation of the Aorta

from Section 3 - Left-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Coarctation of the aorta is any form of narrowing of the aorta; it is often a discrete narrowing of the aorta distal to the left subclavian artery, just past the point of insertion of the ductus arteriosus. The hallmark is upper extremity hypertension characterized by a differential systolic blood pressure gradient between the upper and lower extremities of at least 20 mm Hg. If left untreated the natural history involves development of accelerated coronary artery disease, stroke, heart failure, and/or aortic dissection. In neonates the treatment of choice is a surgical repair but in older children the decision to utilize a surgical versus an interventional cardiology approach in the catheterization laboratory is more complex. Craniosynostosis is a condition in which one or more of the sutures in an infant’s skull fuse prematurely and alter the growth pattern of the skull; it is surgically repaired, often during infancy. This chapter discusses the perioperative challenges of caring for an infant with residual coarctation of the aorta undergoing craniosynostosis repair.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 121 - 128
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Fox, E. B., Latham, G. J., Ross, F. J., et al. Perioperative and anesthetic management of coarctation of the aorta. Semin Cardiothorac Vasc Anesth 2019; 23: 221–4.CrossRefGoogle ScholarPubMed
Boris, J. R.. Primary-care management of patients with coarctation of the aorta. Cardiol Young 2016; 26: 1537–42.CrossRefGoogle ScholarPubMed
Padua, L. M. S., Garcia, L. C., Rubira, C. J., et al. Stent placement versus surgery for coarctation of the thoracic aorta (review). Cochrane Database Syst Rev 2012; 5: 118.Google Scholar
Astengo, M., Berntsson, C., Johnsson, A. A., et al. Ability of noninvasive criteria to predict hemodynamically significant aortic obstruction in adults with coarctation of the aorta. Congenit Heart Dis 2017; 12: 174–80.CrossRefGoogle ScholarPubMed
Stout, K. K., Daniels, C. J., Aboulhosn, J. A., et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease. J Am Coll Cardiol 2019; 73: e81192.CrossRefGoogle ScholarPubMed
Fiore, A. C., Fischer, L. K., Schwartz, T., et al. Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg 2005; 80: 1659–65.CrossRefGoogle ScholarPubMed
Koh, J. L. and Gries, H.. Perioperative management of pediatric patients with craniosynostosis. Anesthesiol Clin 2007; 25: 465–81.CrossRefGoogle ScholarPubMed
Pearson, A. and Matava, C. T.. Anaesthetic management for craniosynostosis repair in children. BJA Educ 2016; 16: 410–16.CrossRefGoogle Scholar

Suggested Reading

Fox, E. B., Latham, G. J., Ross, F. J., et al. Perioperative and anesthetic management of coarctation of the aorta. Semin Cardiothorac Vasc Anesth 2019; 23: 221–4.CrossRefGoogle ScholarPubMed
Koh, J. L. and Gries, H. Perioperative management of pediatric patients with craniosynostosis. Anesthesiol Clin 2007; 25: 465–81.CrossRefGoogle ScholarPubMed
Pearson, A. and Matava, C. T. Anaesthetic management for craniosynostosis repair in children. BJA Educ 2016; 16: 410–16.CrossRefGoogle Scholar

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