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      A severe coarctation of aorta in a 72-year-old female: a case report

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      Cases Journal
      Cases Network Ltd

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          Abstract

          Aortic coarctation is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 72-year-old female. Our patient was relatively asymptomatic until she presented with exertional dyspnea and fatigue in her seventh decade of life. The patient was managed conservatively with aggressive antihypertensive medication. After the 1-year follow-up visit, the patient was in good clinical condition, without, however, adequate control of blood pressure.

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          Natural history of coarctation of the aorta.

          With the increasing number of subjects with coarctation of the aorta having operations, its natural history becomes more difficult to determine. The expectation of life has been calculated by two quite independent methods: (1) from 304 reported necropsies, and (2) from 22 deaths among 161 subjects followed for 716 patient-years. These were mostly patients rather than unselected school-children, but many were quite free from symptoms and were sent only because a murmur was heard on examination. Knowing how long they had been under observation, mortality rates could be calculated for each decade. They rise gradually but not very regularly, from 1.6 per cent in the first two decades to 6.7 per cent per annum in the sixth and later decades. The two methods give results in close agreement, closer than could be expected considering the relatively small numbers of patients and patient-years. The percentages of deaths at the end of each decade found by the two methods never differ by more than +/-4 per cent and are often much closer. Of those surviving the serious hazards of the first one or two years, 25 per cent die before they reach 20, 50 per cent by 32, 75 per cent by 46, and 90 per cent by 58 years. The arithmetical mean of the ages of death is 34 years instead of 71 years as normally. These means, however, hide a very wide range, with standard deviations of at least +/-15 per cent. For coarctation the median is 31 years and the mode is widely spread through the second to fifth decades rather than closely clustered round a point. This poor outlook makes an operative mortality in the region of 5 per cent a small price to pay for the greatly increased security afterwards. We do not yet know how much the risk of bacterial endocarditis or of intracranial haemorrhage will be reduced in the long run because there may be bicuspid aortic valves or intracranial berry aneurysms. The exact incidence of subacute bacterial endocarditis is uncertain, somewhere between 0.6 (from necropsy series) and 1.3 per cent per annum in clinical series. The range was similar for persistent ductus arteriosus, but paradoxically 1.5 for the necropsy series and 0.5 for the clinical series. Clearly the incidence is high in all the four malformations shown in Table 5, about 0.9+/-0.4 per cent per annum.
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            Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction.

            The long-term clinical course was studied in 646 patients, who underwent isolated operative repair of coarctation of the aorta at the Mayo Clinic from 1946 to 1981. There were 17 perioperative deaths, and 58 patients were lost to follow-up. Of the 571 patients with long-term follow-up, 11% required subsequent cardiovascular surgery, and 25% developed hypertension. There were 87 late deaths. The mean age at death was 38 years (range, 0-67 years). Estimated survival analysis revealed 91% of patients alive at 10, 84% at 20, and 72% at 30 years after operative repair. The most common cause of late death was coronary artery disease in 32 patients, followed by sudden death, heart failure, cerebrovascular accidents, and ruptured aortic aneurysm. Age, sex, and postoperative systolic blood pressure were found to be independently predictive of survival. For patients less than 14 years of age at the time of initial coarctectomy, survival to 20 years was 91%, and for patients 14 years or older at the time of operation, survival was 79%. The best survivorship was observed in patients operated on at 9 years of age or less. The higher the postoperative systolic pressure, the higher the probability of death. This study has the largest population undergoing repair of coarctation of the aorta with a median follow-up of as long as 20 years. Four main points emerged. 1) Age at the time of initial repair is the most important predictor of long-term survival. Surgery should be offered to patients after age 1 year or sooner if hypertension is severe. 2) Coronary artery disease is the most common cause of late death.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Coarctation of the aorta: natural history and outcome after surgical treatment.

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                Author and article information

                Journal
                Cases J
                Cases Journal
                Cases Network Ltd
                1757-1626
                15 June 2009
                2009
                : 2
                : 6308
                Affiliations
                [1]simpleDepartment of Cardiology, “G.Hatzikosta”, General Hospital of Ioannina 45001 IoanninaGreece
                Article
                6308
                10.4076/1757-1626-2-6308
                2740002
                19829783
                cf5e0a23-3187-4ff3-b428-8c9ae96cdb68
                © 2009 Kountouris et al.; licensee Cases Network Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 March 2009
                : 11 May 2009
                Categories
                Case report

                Medicine
                Medicine

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