成人复杂主动脉缩窄

IF 18 Q4 Medicine
A. Boutaleb , Y. Mekouar , A. Drighil , A. Boutaleb
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引用次数: 0

摘要

主动脉缩窄(CoA)常与双尖瓣主动脉瓣(BAV)相关。这两种疾病都是最常见的先天性心脏病,易导致进行性瓣膜和主动脉损伤,导致未确诊患者的死亡率更高。成人主动脉缩窄导致严重左心室功能损害的病例极少,早期诊断对改善预后至关重要。目的本病例报告的目的是强调一种罕见的晚期诊断形式的主动脉缩窄发现心力衰竭与降低射血分数(HFrEF)评估。结果/预期结果一名60岁男性向我们报告纽约心脏协会功能性III级呼吸困难和非典型胸痛。体格检查发现患者下肢脉搏延迟,并伴有上肢和下肢血压测量不对称。超声心动图显示严重心力衰竭伴射血分数降低(HFrEF), 1型左右双尖瓣主动脉瓣(BaV)伴中度主动脉狭窄(图1),主动脉峡处主动脉严重缩窄。诊断被证实使用计算机断层血管造影,允许一个精确的评估位置和解剖主动脉。术前冠状动脉造影显示一个平滑的心外膜冠状动脉树。长期高负荷后继发的HFrEF被诊断并接受最佳药物治疗,并计划经皮球囊血管成形术治疗主动脉瓣狭窄。结论/观点尽管主动脉缩窄在成人先天性心脏病患者中的患病率较低,但在出现难治性心力衰竭症状或经最佳药物治疗后仍存在持续性高血压的患者中应进行筛查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adult complex aortic coarctation

Introduction

Coarctation of the aorta (CoA) is often associated with bicuspid aortic valve (BAV). Both count as the most frequent congenital heart diseases and predispose to progressive valvular and aortic damage, leading to a higher morbimortality in undiagnosed patients. Rare cases of adult aortic coarctation lead to severely left ventricular impairment function so early diagnosis is crucial for prognosis improvement.

Objective

The objective of this case report is to highlight a rare form of late diagnosis of aortic coarctation discovered during heart failure with reduced ejection fraction (HFrEF) assessment.

Results/Expected results

A 60-year-old male presented to us with New York Heart Association functional class III dyspnea and atypical chest pain. On physical examination, he was found to have lower limbs pulse delay associated with asymmetrical blood pressure measurement between the upper and lower limbs. The echocardiography revealed severe heart failure with reduced ejection fraction (HFrEF), a type 1 left right bicuspid aortic valve (BaV) with moderate aortic stenosis (Figure 1), and severe coarctation of the aorta located in the aortic isthmus. The diagnosis was confirmed using computed tomography angiography, which allowed for a precise evaluation of the location and anatomy of the aorta. A pre-operative coronary angiography revealed a smooth epicardial coronary artery tree. HFrEF secondary to long-term high afterload was diagnosed and treated with optimal medical therapy, and scheduled for percutaneous balloon angioplasty of the aortic stenosis.

Conclusion/Perspectives

Despite the low prevalence of aortic coarctation among patients with adult congenital heart diseases, it should be screened in patients presenting with refractory heart failure symptoms or persistent high blood pressure despite optimal medical treatment.

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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