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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5761_Библиотеки_им_академика_М_И_Перельмана
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499
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_153, © Springer International Publishing Switzerland 2015
A 23-year-old woman presented with hypertension.
Coarctation of the Aorta
Case 153
a
c
b
Fig. 153.1 The suprasternal long-axis view demonstrates the narrowing of the descending aorta ( a ). There is systolic ( arrow ) and diastolic turbu-
lency in the descending aorta ( b ), and systolic velocity is approximately 4 m/s. DAO descending aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_153 ) contains supplementary
material, which is available to authorized users.
500
Diagnosis
The patient was diagnosed with the coarctation of the aorta.
Comment
The patient was referred for magnetic resonance imaging
prior to intervention.
Lesson
Although balloon dilation for coarctation of the aorta and
stenting is the procedure of choice in many centers except if
there is hypoplasia of the descending aorta, there is still some
controversy [ 2 , 159 ].
Case 153 Coarctation of the Aorta
501
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_154, © Springer International Publishing Switzerland 2015
A 25-year-old man presented with hypertension.
Coarctation of the Aorta
Focusing Collaterals
Case 154
ab
Fig. 154.1 The suprasternal long-axis view shows severe descending
aorta narrowing ( a ) and a turbulent fl ow in the descending aorta ( curved
arrow ) ( b ), which is in favor of aortic coarctation. The entrance of the
fl ow ( red fl ow ) to the descending aorta through the collaterals is also
evident in this view ( arrow )
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_154 ) contains supplementary
material, which is available to authorized users.
502
Comment
The patient was referred for intervention.
Lesson
The typical fl ow of coarctation is a systolic–diastolic fl o w .
Fig. 154.2 The continuous fl ow through the descending aorta shows a
systolodiastolic velocity (systolic velocity of 4 m/s)
Case 154 Coarctation of the Aorta Focusing Collaterals
503
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_155, © Springer International Publishing Switzerland 2015
A 22-year-old man presented with newly diagnosed systemic hypertension.
Coarctation of the Aorta
and Bicuspid Aortic Valve
Case 155
Fig. 155.1 The parasternal long-axis view shows the eccentric closure
of the aortic valve ( arrow ) and the dilation of the aortic root and the
ascending aorta, which is in favor of a bicuspid aortic valve. LA left
atrium, LV left ventricle, RV right ventricle, AO aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_155 ) contains supplementary
material, which is available to authorized users.
504
c
a b
Fig. 155.2 The suprasternal long-axis view demonstrates the nearly
total cutoff of the descending aorta ( curved arrow ) ( a ) and turbulency
in the descending aorta ( arrow ) ( b ) with systolic and diastolic gradients
( c ), indicative of the coarctation of the aorta (velocity of 3.85 m/s) ( c ).
The descending aorta is fi lled via the collaterals ( arrow ) ( b ). DAO
descending aorta
Fig. 155.3 A bicuspid aortic valve is evident on transesophageal echo-
cardiography (TEE) (short-axis view) in systole (fi shmouth appearance) ( arrow )
Case 155 Coarctation of the Aorta and Bicuspid Aortic Valve
505
Diagnosis
A diagnosis of the coarctation of the aorta and severe narrowing of the descending aorta was established.
Comment
The patient was referred for coarctoplasty, which proved
successful.
Lesson
The severe narrowing of the descending aorta made us think
that coarctoplasty might not be possible. However, the guidewire passed through the narrowing and coarctoplasty was
performed successfully.
a b
Fig. 155.4 The descending aorta measures 23 × 22 mm, 40 cm from the dental arcade ( a ). Thereafter, about 27 cm from the dental arcade, the
descending aorta becomes narrow ( arrow ) ( b ). The collateral vessels are also evident ( curved arrow ) ( b )
Case 155 Coarctation of the Aorta and Bicuspid Aortic Valve
507
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_156, © Springer International Publishing Switzerland 2015
A 22-year-old woman presented with hypertension. She had
previously undergone coarctoplasty and stenting of the
descending aorta.
Coarctoplasty Plus Stent
Implantation, Ventricular
Septal Defect, and Bicuspid
Aortic Valve
Case 156
ab
Fig. 156.1 The stent is seen in the descending aorta ( arrow ) ( a ). The peak gradient across this stent is about 12 mmHg ( b ). AO aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_156 ) contains supplementary
material, which is available to authorized users.
508
a
c
b
Fig. 156.3 The muscular VSD is seen in the parasternal short-axis view ( arrow ) ( a ). The VSD measures 8 mm on the left ventricular side ( b ) and
9 mm on the right ventricular side ( c ). LV left ventricle, RV right ventricle
ab
Fig. 156.2 There is a turbulent fl ow across the interventricular septum, which is in favor of a ventricular septal defect ( VSD ) (muscular type)
( arrow ) ( a ). The peak velocity across the VSD is more than 4 m/s ( b ). LV left ventricle, RV right ventricle
Case 156 Coarctoplasty Plus Stent Implantation, Ventricular Septal Defect, and Bicuspid Aortic Valve
509
Diagnosis
The patient, who had coarctoplasty plus implantation of a
stent, was diagnosed with a muscular VSD and a bicuspid
aortic valve.
Lesson
Bicuspid aortic valve and small VSD are associate anomalies
with coarctation [ 2 , 157 ].
Case 156 Coarctoplasty Plus Stent Implantation, Ventricular Septal Defect, and Bicuspid Aortic Valve
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