Depending upon the size of patency this condition can lead to failure to thrive and heart failure. If this communication persists beyond two days, it is called patent ductus arteriosus. It usually closes by the second day after birth in full-term babies. The ductus arteriosus is a communication between the pulmonary artery and the aortic arch in fetal life. Of those who survive the initial event, approximately 80% will die within two weeks. Nearly 40% of patients with acute aortic dissections expire immediately. Aortic dissections are a life-threatening emergency that requires surgical repair to increase the chances of survival. Aortic dissections can then propagate distally or proximally through the aortic wall. It most often occurs at the proximal portion of the ascending aorta, just distal to the aortic valve. Elective repair can reduce the risk of rupture and survival to near normal.Īortic dissection refers to the disruption of the innermost layer of the aorta, allowing blood to tunnel through the central portion of the aortic wall. For this reason, elective repair is often the recommendation once an aneurysm has reached a diameter of 5.5cm or greater. An aortic aneurysm is of concern because dilation of the aorta results in weakening of the aortic wall, increasing risk of aortic rupture or dissection. In young adults, the most common underlying factor is a connective tissue disorder such as Marfan syndrome or Ehler-Danlos syndrome. Management is at the physician's discretion with age at presentation and complexity of coarctation influencing treatment choice.Ī thoracic aortic aneurysm refers to a dilatation of the proximal ascending aorta this is most often the result of chronic hypertension when seen in adults. There is not a standard of care practice or algorithm in treating these patients. Although these options are available, the decision on an optimal treatment strategy can be complicated. Treatment options include surgical repair, balloon angioplasty, and endovascular stent placement. Ĭoarctation of the aorta results in significant morbidity in patients with severe narrowing and poor outcome in patients who survive beyond one year of age. This collateralization most often occurs through the subclavian artery into the internal thoracic artery which goes to the anterior intercostal artery, to the posterior intercostal artery, and finally into the descending thoracic aorta. The dilation of the intercostal arteries may result in the characteristic finding of rib notching on chest x-ray. Collateral vessels may increase in size to aid in the delivery of blood to the descending aorta. This presentation is due to increased blood flow through the aortic arch vessels and decreased blood flow to the descending aorta distal to the stenotic segment. It often presents as hypertension in the upper extremities and weak pulses in the lower extremities. Postductal coarctation occurs distal to the ductus arteriosus, which is the most common form in adults. Preductal coarctation occurs proximal to the ductus arteriosus this most often occurs as a result of a congenital heart anomaly the leads to decreased blood flow to the left side of the heart and aorta, resulting in hypoplastic development.ĭuctal coarctation occurs at the insertion of the ductus arteriosus and most often appears at birth as the ductus arteriosus obliterates. Coarctation of the aorta refers to a congenital condition in which the aorta narrows, obstructing distal blood flow this most commonly occurs in proximity to the ductus arteriosus with classifications of preductal coarctation, ductal coarctation, and postductal coarctation.
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