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The risk of having additional obstructive lesions in neonatal coarctation of the aorta

Published online by Cambridge University Press:  01 July 2011

Jami C. Levine ,
Stephen P. Sanders ,
Steven D. Colan ,
Richard A. Jonas  and
Philip J. Spevak
Jami C. Levine*
Affiliation:
Department of Cardiology and the Division of Cardiovascular Surgery, Children's Hospital and the Departments of Pediatrics and Surgery, Harvard Medical School, Boston, MA
Stephen P. Sanders
Affiliation:
Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC
Steven D. Colan
Affiliation:
Department of Cardiology and the Division of Cardiovascular Surgery, Children's Hospital and the Departments of Pediatrics and Surgery, Harvard Medical School, Boston, MA
Richard A. Jonas
Affiliation:
Department of Cardiology and the Division of Cardiovascular Surgery, Children's Hospital and the Departments of Pediatrics and Surgery, Harvard Medical School, Boston, MA
Philip J. Spevak
Affiliation:
Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
*
Correspondence to: Jami C. Levine, MD, Children's Hospital, Department of Cardiology, 300 Longwood Avenue, Boston MA 02115, USA. Tel: 617-355-4902; Fax: 617-739-6282
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Abstract

Infants with coarctation of the aorta may have obstructions at other sites within the left heart which are not always apparent on the initial echocardiogram. The magnitude of the risk of having the additional obstructions is not well described, with few reliable quantitative criterions for identifying patients at the highest risk. We determined the frequency of additional, late appearing, stenotic lesions within the left heart, and the predictive morphologic features on the initial cross-sectional echocardiogram.

We identified all patients with coarctation of the aorta diagnosed by 3 months of age, excluding those with complex cardiac disease or definite additional stenotic lesions at presentation, leaving 101 patients for study. At follow-up, 31 stenotic lesions were diagnosed in 23 patients, 15 of whom had at least 1 intervention. Mitral stenosis was diagnosed in 11 patients, aortic stenosis in 10, subaortic stenosis in 8, and supravalvar aortic stenosis in 2. The probability for freedom from obstructive lesions was 81% at 1 year, 74% at 3 years, and 70% at 5 years. Echocardiographic predictors of mitral stenosis included smaller mitral valvar annuluses, presence of a mean transmitral gradient between 2.5 and 5.0 mmHg, and elongation of the area of intervalvar fibrous continuity. Predictors of aortic stenosis were smaller mitral valvar annuluses, an initial aortic valvar gradient between 15 and 20 mmHg, and obliteration of the commissure between the right and non-coronary leaflets of the aortic valve. Predictors of subaortic stenosis were smaller mitral valvar annuluses and elongation of the area of intervalvar fibrous continuity. Patients with Z-scores for the diameter of the mitral valve of less than −1 were at the highest risk for manifesting obstructive lesions at any level.

Associated stenoses in the left heart are common in the setting of aortic coarctation. When Doppler data is equivocal, features of the cross-sectional echocardiogram can identify the sub-group of infants at increased risk.

Keywords

CoarctationShone'sechocardiographypediatric
Type
Original Articles
Information
Cardiology in the Young , Volume 11 , Issue 1 , January 2001 , pp. 44 - 53
Copyright
Copyright © Cambridge University Press 2001

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