A Rare Presentation of Aortic Coarctation: Distal Thoracic Aortic Coarctation: A Case Report

Abstract

Congenital aortic coarctation is mostly defined as a segmental narrowing that develops in the area where the ductus arteriole is attached to the aorta. Middle aortic syndrome, which is a rare variant is the form of aortic coarctation where the distal thoracic aorta or the abdominal aorta or both. Most cases arise from segmental or diffuse narrowing of the abdominal and / or distal descending thoracic aorta with variable involvement of the renal and visceral branches. Hypertension and claudication usually occur children with distal thoracic aortic coarctation. In case report, a 5-year-old girl presented with leg pain was diagnosed as distal thorasic aortic coarctation. It was presented for rarely seen in literature.

Keywords

• Congenital coarctation of the thoracic aorta
• hypertension
• claudication

Aort Koarktasyonunun Nadir Bir Prezentasyonu: Distal Torasik Aort Koarktasyonu: Olgu Sunumu

Abstract

Aort koarktasyonu çoğunlukla duktus arteriyosuzun aortaya tutunduğu bölgede gelişen segmental bir daralma olarak tanımlanmaktadır. Aort koarkasyonunun nadir rastladığımız bir varyantı olan middle aortik sendrom; aort koarktasyonunun distal torasik aorta veya abdominal aorta veya her ikisinin birlikte bulunduğu şeklidir. Olguların çoğu, renal ve visseral dalların değişken
tutulumu ile birlikte, abdominal ve/veya distal inen torasik aortanın segmental veya yaygın daralmasıyla ortaya çıkmaktadır. Distal torasik aort koarktasyonunda çocuklarda genellikle hipertansiyon ve kladikasyon ortaya çıkar. Bu yazıda bacak ağrısıyla prezente olan 5 yaşında kız hastaya distal torasik aort koarktasyonu tanısı konuldu. Literatürde nadir görüldüğü için sunulmuştur.

Keywords

• Konjenital torasik aort koarktasyonu
• hipertansiyon
• kladikasyon

References

1. Rosenthal E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process Heart. 2005; 91:1495–1502. doi: 10.1136/hrt.2004.057182.
2. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation 2008;118:e714-833.
3. Kenny D, Hijazi ZM. Coarctation ofthe aorta:fromfetallifetoadulthood.Cardiol J 2011;18:487-495.
4. Hiratzka LF, Bakris GL, Beckman JA,et al. 2010ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/ STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Society of Interventiona lRadiology ,Societyof Thoracic Surgeons ,and Society for Vascular Medicine .J Am Coll Cardiol 2010;55:e27-129
5. Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation 1970; 41:1067-1075.
6. Bonnet L. M. Sur la lesion dite stenose congenitale de l’aorte dans la region de l’isthme. Rev Med (Paris)1903; 23: 108.
7. O’Neill JA, Berkowitz H, Fellows K, Harmon C (1995) Midaortic syndrome and hypertension in childhood. J Pediatr Surg 30:164–172
8. Beekman RH. (2001). Coarctation of the aorta. İçinde Allen HG, Gutgessell HP, Clark EB, Driscoll DJ (Editors), Moss and Adams’ Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young Adults. (6th ed.). Philadelphia: Lippincott Williams and Wilkins; 988–1010

9. Crossland DS., Furness JC., Abu-Harb M. Sadagopan SN. ve Wren C. (2004). Variability of four limb blood pressure in normal neonates. Archives of Disease Childhood Fetal Neonatal Ed, 89, 325–327.
10. Kapısız NS., Kapısız HF., Sarıgül A. ve Yücel E. (2006). Aort koarktasyonunun cerrahi tedavisi: Rezidü hipertansiyon Türk Göğüs Kalp Damar Cerrahisi Dergisi, 14(4), 286-289
11. Crafoord C., ve Nylin G. (1945). Congenital coarctation of the aorta and its surgical treatment. Journal thoracic Surgery, 14, 347
12. Erdoğan HB., Ardal H., Ömeroğlu SN., Mansuroğlu D., Polat A., İzgi A. ve ark. (2006). Aort koarktasyonu cerrahi tedavisi: Yirmi yıllık deneyim. Türk Göğüs Kalp Damar Cer Derg, 14(2), 117-121
13. Connolly JE, Wilson SE, Lawrence PL, Fujitani RM (2002) Middle aortic syndrome: distal thoracic and abdominal coarctation, a disorder with multiple etiologies. J Am Coll Surg 194:774–781
14. DeBakey ME, Garrett E, Howell J, Morris G (1967) Coarctation of the abdominal aorta with renal arterial stenosis: surgical considerations. Ann Surg 165:830–843
15. Graham LM, Aelenock GB, Erlandson EE, Coran AG, Lindenauer S, Stanley J (1979) Abdominal aortic coarctation and segmental hypoplaisa. Surgery 86:519–529
16. Hallett JW, Brewster DC, Darling RC, O’Hara PJ. Coarctationof the abdominal aorta. Ann Surg 1980;191:430–443
17. Onat T, Zeren E (1969) Coarctation of the abdominal aorta. Review of 91 cases. Cardiologia 54:140–157
18. Cagneau P, Michel JB, Vuong P. Surgical treatment of Takayasu’sdisease. Ann Surg 1987; 205:157–166
19. Senning A, Johansson L. Coarctation of the abdominal aorta.J Thorac Cardiovasc Surg 1960;40:517–520
20. Stanley JC, Graham LM. Abdominal aortic coarctation and hy-poplasia. In: Gewertz B, Schwartz LB, eds. Surgery of the aortaand its branches. Philadelphia: WB Saunders; 2000:11–16.
21. Maycock WA. Congenital stenosis of the abdominal aorta. AmHeart J 1937; 13:663
22. Scott HW Jr, Dean RH, Boerth R, Sawyers JL, Meacham P, Fisher RD (1979) Coarctation of the abdominal aorta: pathophysiologic and therapeutic considerations. Ann Surg 189:746–757
23. Mendelsohn AM., Lloyd TR., Crowley DC., Sandhu SK., Kocis KC., ve Beekman RH. (1994). Late follw-up of balloon angioplasty in children with a native coarctation of the aorta. American Journal of Cardiology, 74, 696-700
24. O’Laughlin MP., Perry SB., Lock JE., ve Mullins CE. (1991). Use of endovascular stents in congenital heart disease. Circulation, 83(6), 1923-1939
25. Sethna CB, Kaplan BS, Cahill AM, Velazquez OC, Meyers KE. Idiopathic mid-aortic syndrome in children. Pediatr Nephrol 2008; 23:1135–1142.
26. R.K. Rumman, C. Nickel, M. Matsuda-Abedini, et al.Disease beyond the arch: A systematic review of middle aortic syndrome in childhood Am J Hypertens, 28 (2015), pp. 833-846