Coartación de la aorta: diagnóstico pediátrico y reparación.
DOI:
https://doi.org/10.56048/MQR20225.7.3.2023.1291-1312Palabras clave:
Coartación de la aorta, cardiopatías congénitas, pacientes pediátricosResumen
Antecedentes: La Coartación de la aorta es una patología congénita que se describe como el estrechamiento de la aorta, ocasionando obstáculo del paso de la sangre; a esta enfermedad se atribuye del 8 al 10% de cardiopatías genéticas, lo que equivale a 4/10000 nacidos vivos y suele ser detectada en edad adulta.
Objetivo: Establecer el diagnóstico, tratamiento y controversia acerca de la Coartación de la Aorta en pacientes pediátricos. Métodos: Revisión bibliográfica de tipo narrativa. Resultados: Los métodos con la tasa más alta de eficacia en diagnóstico para fetos y recién nacidos son el ecocardiograma y la medición arterial bajo los parámetros cardíacos, más del 50% de casos reportados fueron confirmados posterior al nacimiento; los métodos de tratamiento usados son la angioplastia con balón y colocación de stent permitiendo la mejoría de los pacientes, tomando en cuenta la incidencia del 10 y 20% de reintervención en los pacientes tratados. Aunque existe cierta controversia, autores recomiendan la angioplastia con balón en recién nacidos; mientras que otros grupos demuestran que una corrección quirúrgica para el tratamiento es efectiva. Conclusiones: La Coartación de la aorta es un defecto, que generalmente es diagnosticada después del nacimiento, entre los exámenes complementarios pueden ser el ecocardiograma, tomografía axial computarizada y resonancia magnética. El tratamiento de mayor utilidad puede ser la angioplastia con balón o inserción de stent, es importante que los pacientes reparados tengan un seguimiento a largo plazo por los posibles riesgos.
Descargas
Métricas
Cited
DOI: 10.56048
Citas
Hijazi Z. Clinical manifestations and diagnosis of coarctation of the aorta. UpToDate [Internet]. 2023; Disponible en: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-coarctation-of-the-aorta?search=coarctation%20of%20aorta&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Fox E, Latham G, Ross F, Joffe D. Perioperative and Anesthetic Management of Coarctation of the Aorta. Seminars in Cardiothoracic and Vascular Anesthesia [Internet]. 2019;23(2):212-24. Disponible en: https://doi.org/10.1177/1089253218821953
Rogers C, Clawson R. Coarctation of the aorta. JAAPA Off J Am Acad Physician Assist [Internet]. 2019;32(6):46-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31136401/
Sojak V, Hazekamp M. Paradigm shift in treatment of coarctation of the aorta? Neth Heart J [Internet]. 2021;29(2):69-70. Disponible en: https://doi.org/10.1007/s12471-020-01536-5
Contro E, Cattani L, Balducci A, Donti A, Prandstraller D, Perolo A, et al. Prediction of neonatal coarctation of the aorta at fetal echocardiography: a scoring system. J Matern-Fetal Neonata [Internet]. 2022;35(22):4299-305. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/14767058.2020.1849109
Nurmi M, Pitkänen O, Räsänen J, Sarkola T. Accuracy of fetal echocardiography diagnosis and anticipated perinatal and early postnatal care in congenital heart disease in mid-gestation. Acta Obstet Gynecol Scand [Internet]. 2022;101(10):1112-9. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/aogs.14423
Zhu W, Williams K, Young C, Lin J, Teekakirikul P, Lo CW. Rare and Common Variants Uncover the Role of the Atria in Coarctation of the Aorta. Genes [Internet]. 2022;13(4):636. Disponible en: https://www.mdpi.com/2073-4425/13/4/636
Caengprasath N, Buasong A, Ittiwut C, Khongphatthanayothin A, Porntaveetus T, Shotelersuk V. Severe coarctation of the aorta, developmental delay, and multiple dysmorphic features in a child with SMAD6 and SMARCA4 variants. Eur J Med Genet [Internet]. 2022;65(11):104601. Disponible en: https://www.sciencedirect.com/science/article/pii/S1769721222001823
AMBOSS. Acyanotic congenital heart defects [Internet]. 2023. Disponible en: https://next.amboss.com/us/article/4403jT?q=coarctation%20of%20the%20aorta#Zc3c9c3d344aebcd85120ce46cb2d8468
Sorensen M, Sadiq I, Clifford G, Maher K, Oster M. Using pulse oximetry waveforms to detect coarctation of the aorta. Biomed Eng OnLine [Internet]. 2020;19(1):31. Disponible en: https://doi.org/10.1186/s12938-020-00775-2
Freeman K, Kronmal R, Clouse M, Conwell J, Bhat A, Young L, et al. Validation of Prenatal Aortic Arch Angle Measurements in the Diagnosis of Neonatal Coarctation of the Aorta. Pediatr Cardiol [Internet]. 2021;42(6):1365-71. Disponible en: https://doi.org/10.1007/s00246-021-02620-2
Bacha E, Hijazi Z. Management of coarctation of the aorta. UpToDate [Internet]. 2023; Disponible en: https://www.uptodate.com/contents/management-of-coarctation-of-the-aorta?search=coarctation%20of%20aorta&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
Krasemann T, Beynum I, Dalinghaus M, van Leuwen W, Bogers A, Woestijne P. Indications for stenting of coarctation of the aorta in children under 3 months of age. Neth Heart J [Internet]. 2020;28(10):546-50. Disponible en: https://doi.org/10.1007/s12471-020-01371-8
Stassen J, De Meester P, Troost E, Roggen L, Moons P, Gewillig M, et al. Covered stent placement for treatment of coarctation of the aorta: immediate and long-term results. Acta Cardiol [Internet]. 2021;76(5):464-72. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/00015385.2020.1838126
Ylinen M, Tyni V, Pihkala J, Salminen J, Sairanen H, Sarkola T. Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: a population-based study†. Eur J Cardiothorac Surg [Internet]. 2019;55(3):564-71. Disponible en: https://doi.org/10.1093/ejcts/ezy252
Woldmichael K, Aklilu T. Mission-based cardiac surgery and catheter treatment of coarctation of aorta in the young and older children: a facility based review of cases in Addis Ababa. Pan Afr Med J [Internet]. 2019;34:160. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046100/
Lecturio. Aortic Regurgitation. 2023; Disponible en: https://app.lecturio.com/#/article/2619?return=__app__%2Fsearch%2Fconcepts%2Fcoartacion%2520de%2520la%2520aorta
Seckeler M, White S, Fox K. Increased risk of intraventricular hemorrhage in low birth weight infants with aortic coarctation. J Matern Fetal Neonatal Med [Internet]. 2020;33(8):1273-5. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/14767058.2018.1517319?journalCode=ijmf20
Bhatt A, Lantin M, Daniels C, Jaquiss R, Landis B, Marino BS, et al. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med [Internet]. 2022;9:817866. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174545/
Liu Y, Chen S, Zühlke L, Black G, Choy M, Li N, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol [Internet]. 2019;48(2):455-63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30783674/
Ganigara M, Doshi A, Naimi I, Mahadevaiah GP, Buddhe S, Chikkabyrappa SM. Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children. Semin Cardiothorac Vasc Anesth [Internet]. 2019;23(4):379-86. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31535945/
Taweevisit M, Thorner P. Cardiac Findings in Fetal and Pediatric Autopsies: A 15-Year Retrospective Review. Fetal Pediatr Pathol [Internet]. 2019;38(1):14-29. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30633599/
Duta S, Veduta A, Vayna AM, Panaitescu A, Nedelea F, Peltecu G. The outcome of structural heart defects diagnosed in the first trimester of pregnancy. J Matern Fetal Neonatal Med [Internet]. 2021;34(9):1389-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31282223/
Cangussú L, Lopes M, Barbosa R. The importance of the early diagnosis of aorta coarctation. Rev Assoc Med Bras [Internet]. 2019;65(2):240-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30892450/
Vigneswaran T, Bellsham H, Chubb H, Simpson J. Early Postnatal Echocardiography in Neonates with a Prenatal Suspicion of Coarctation of the Aorta. Pediatr Cardiol [Internet]. 2020;41(4):772-80. Disponible en: https://doi.org/10.1007/s00246-020-02310-5
Pavlicek J, Klaskova E, Prochazka M, Dolezalkova E, Matura D, Spacek R, et al. Congenital heart defects according to the types of the risk factors - a single center experience. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet [Internet]. 2019;32(21):3606-11. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/14767058.2018.1468883
Ficara A, Syngelaki A, Hammami A, Akolekar R, Nicolaides K. Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosis of fetal abnormalities. Ultrasound Obstet Gynecol [Internet]. 2020;55(1):75-80. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/uog.20857
Lehnert A, Villemain O, Gaudin R, Méot M, Raisky O, Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg [Internet]. 2019;29(3):469-75. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31089681/
Park S, Goo H, Won H. Coarctation of the Aorta (COA). En: An Illustrated Guide to Congenital Heart Disease: From Diagnosis to Treatment – From Fetus to Adult [Internet]. Singapore: Springer; 2019. p. 145-68. Disponible en: https://doi.org/10.1007/978-981-13-6978-0_9
Yan T, Qin J, Zhang Y, Li Q, Han B, Jin X. Research and application of intelligent image processing technology in the auxiliary diagnosis of aortic coarctation. Front Pediatr [Internet]. 2023;11. Disponible en: https://www.frontiersin.org/articles/10.3389/fped.2023.1131273
Fricke K, Liuba P, Weismann CG. Fetal Echocardiographic Dimension Indices: Important Predictors of Postnatal Coarctation. Pediatr Cardiol [Internet]. 2021;42(3):517-25. Disponible en: https://doi.org/10.1007/s00246-020-02509-6
Vigneswaran T, Zidere V, Chivers S, Charakida M, Akolekar R, Simpson JM. Impact of prospective measurement of outflow tracts in prediction of coarctation of the aorta. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol [Internet]. 2020;56(6):850-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31875324/
Liu J, Cao H, Zhang L, Hong L, Cui L, Song X, et al. Incremental Value of Myocardial Deformation in Predicting Postnatal Coarctation of the Aorta: Establishment of a Novel Diagnostic Model. J Am Soc Echocardiogr [Internet]. 2022;35(12):1298-310. Disponible en: https://www.sciencedirect.com/science/article/pii/S0894731722003583
Ravindra K, Chanana N, Mor S. Exposure to air pollutants and risk of congenital anomalies: A systematic review and metaanalysis. Sci Total Environ [Internet]. 2021;765:142772. Disponible en: https://www.sciencedirect.com/science/article/pii/S0048969720363014
Hu C, Huang K, Fang Y, Yang X, Ding K, Jiang W, et al. Maternal air pollution exposure and congenital heart defects in offspring: A systematic review and meta-analysis. Chemosphere [Internet]. 2020;253:126668. Disponible en: https://www.sciencedirect.com/science/article/pii/S0045653520308614
Martins J, Zachariah J, Selamet E, Truong U, Morris S, Kutty S, et al. Impact of Treatment Modality on Vascular Function in Coarctation of the Aorta: The LOVE‐COARCT Study. J Am Heart Assoc Cardiovasc Cerebrovasc Dis [Internet]. 2019;8(7):e011536. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509735/
Lee A, Reddy M, Chai M, Grange I, Green E, Rolnik DL, et al. Subjective and Objective Sonographic Assessment for the Prenatal Detection of Neonatal Coarctation of the Aorta. Fetal Diagn Ther [Internet]. 2023;1-8. Disponible en: https://doi.org/10.1159/000530020
Wang Y, Liu C, Zhang Y, Wang M. Prenatal diagnosis of coarctation of the aorta with a long and angled isthmus by two- and three-dimensional echocardiography: a case report. BMC Cardiovasc Disord [Internet]. 2021;21(1):176. Disponible en: https://doi.org/10.1186/s12872-021-01987-7
Morgan C, Mueller B, Thakur V, Guerra V, Jull C, Mertens L, et al. Improving Prenatal Diagnosis of Coarctation of the Aorta. Can J Cardiol [Internet]. 2019;35(4):453-61. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0828282X18313801
Bahado R, Vishweswaraiah S, Aydas B, Yilmaz A, Saiyed N, Mishra N, et al. Precision cardiovascular medicine: artificial intelligence and epigenetics for the pathogenesis and prediction of coarctation in neonates. J Matern Fetal Neonatal Med [Internet]. 2022;35(3):457-64. Disponible en: https://doi.org/10.1080/14767058.2020.1722995
Vena F, Donarini G, Scala C, Tuo G, Paladini D. Redundancy of foramen ovale flap may mimic fetal aortic coarctation. Ultrasound Obstet Gynecol [Internet]. 2020;56(6):857-63. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/uog.22008
Dijkema E, Dik L, Breur J, Sieswerda G, Haas F, Slieker M, et al. Two decades of aortic coarctation treatment in children; evaluating techniques. Neth Heart J [Internet]. 2021;29(2):98-104. Disponible en: https://doi.org/10.1007/s12471-020-01513-y
Meliota G, Lombardi M, Zaza P, Tagliente M, Vairo U. Balloon angioplasty of aortic coarctation in critically ill newborns using axillary artery access. Ann Pediatr Cardiol [Internet]. 2020;13(1):67-71. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979016/
Bruckheimer E, Lee B, Birk E, Butera G, Petirrojo M, Roberts F, et al. Large Diameter Advanta V12 Covered Stent Trial for Coarctation of the Aorta: COARC Study | Circulation: Cardiovascular Interventions. Circ Cardiovasc Interv [Internet]. 2021;14(12). Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.121.010576
Sallmon H, Berger F, Cho M, Opgen B. First use and limitations of Magmaris® bioresorbable stenting in a low birth weight infant with native aortic coarctation. Catheter Cardiovasc Interv [Internet]. 2019;93(7):1340-3. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/ccd.28300
Rodriguez C, Romero M, Ojeda S, Suarez L, Hidalgo F, Mazuelos F, et al. TCT-242 Late Complications in Patients With Stent-Treated Coarctation of the Aorta: Long-Term Follow-Up. J Am Coll Cardiol [Internet]. 2021;78(19):B98-B98. Disponible en: https://www.jacc.org/doi/full/10.1016/j.jacc.2021.09.1095
Lee M, Babu S, Kempny A, Uebing A, Montanaro C, Shore D, et al. Long-term mortality and cardiovascular burden for adult survivors of coarctation of the aorta. Heart Br Card Soc [Internet]. 2019;105(15):1190-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30923175/
McVadon D, Zyblewski S, M.Chowdhury S. Preoperative Imaging of Critical Coarctation of the Aorta: Impact on Surgical Approach and Outcomes. Pediatric Cardiology [Internet]. 2023; Disponible en: https://assets.researchsquare.com/files/rs-3015442/v1/ba09a1ea-5978-4d2d-b5a5-4a6383600efb.pdf?c=1686061065
Peng R, Zheng Q, He M, Shang J, Xie H. Comparisons of foramen ovale flap in the fetuses with true and false positive diagnosis of coarctation of the aorta. Quant Imaging Med Surg [Internet]. 2022;12(4):2303-10. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923842/
Meysonnier C, Di Filippo S, Pangaud N, Galoin C, Joly H, Massardier J, et al. Prospective study for antenatal diagnosis of coarctation of the aorta. Eur Heart J [Internet]. 2019;40(1):ehz745.1028. Disponible en: https://doi.org/10.1093/eurheartj/ehz745.1028
Gómez E, Herraiz I, Escribano D, Rodríguez J, Villalaín C, Galindo A. Application of a Global Multiparameter Scoring System for the Prenatal Prediction of Coarctation of the Aorta. J Clin Med [Internet]. 2021;10(16):3690. Disponible en: https://www.mdpi.com/2077-0383/10/16/3690
Sandoval J, Leng M, Lee K, Asoh K, Chaturvedi R. Balloon Angioplasty for Native Aortic Coarctation in 3- to 12-Month-Old Infants. Circ Cardiovasc Interv [Internet]. 2020;13(e008938). Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.120.008938
Khoshhal S, Al-Mutairi M, Alnajjar A, Morsy M, Salem S, Salmi AA, et al. The efficacy and safety of percutaneous balloon angioplasty for aortic coarctation in children. Saudi Med J [Internet]. 2020;41(11):1252-8. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804232/
Amoozgar H, Nouri N, Shabanpourhaghighi S, Bagherian N, Mehdizadegan N, Edraki MR, et al. Effect of coarctation of aorta anatomy and balloon profile on the outcome of balloon angioplasty in infantile coarctation. BMC Cardiovasc Disord [Internet]. 2021;21(1):594. Disponible en: https://doi.org/10.1186/s12872-021-02396-6
Ibrahim S, Al-Ethawi A, Al-Hamash S, Al-Kaaby B. On the role of balloon angioplasty in infantile and childhood coarctation of aorta. Cir Cardiovasc [Internet]. 2020;27(1):9-15. Disponible en: https://www.sciencedirect.com/science/article/pii/S113400961930275X
Yılmazer M, Vuran G, Meşe T, Güven B, Zihni C, Gerçeker E, et al. Endovascular treatment of aortic coarctation with a novel BeGraft aortic stent in children and young adults: a single-centre experience with short-term follow-up results. Cardiol Young [Internet]. 2022;32(3):451-8. Disponible en: https://www.cambridge.org/core/journals/cardiology-in-the-young/article/abs/endovascular-treatment-of-aortic-coarctation-with-a-novel-begraft-aortic-stent-in-children-and-young-adults-a-singlecentre-experience-with-shortterm-followup-results/21C5310FC39F65FD0819C5E0C0E26C7E
Hatoum I, Haddad R, Saliba Z, Abdel T. Endovascular stent implantation for aortic coarctation: parameters affecting clinical outcomes. Am J Cardiovasc Dis [Internet]. 2020;10(5):528-37. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811920/
Castaldi B, Ciarmoli E, Di Candia A, Sirico D, Tarantini G, Scattolin F, et al. Safety and efficacy of aortic coarctation stenting in children and adolescents. Int J Cardiol Congenit Heart Dis [Internet]. 2022;8:100389. Disponible en: https://www.sciencedirect.com/science/article/pii/S2666668522000726
Warmerdam E, Krings G, Meijs T, Franken A, Driesen B, Sieswerda GT, et al. Safety and efficacy of stenting for aortic arch hypoplasia in patients with coarctation of the aorta. Neth Heart J [Internet]. 2020;28(3):145-52. Disponible en: https://doi.org/10.1007/s12471-019-01353-5
Laure M, Calvieri C, Chinali M, Giannico S, Cafiero G, Giordano U. Surgical Versus Percutaneous Stenting Treatment of Isolated Aortic Coarctation: Long-Term Follow-Up. Congenit Heart Dis [Internet]. 2021;16(5):457-67. Disponible en: https://www.techscience.com/chd/v16n5/42685
Boe B, Armstrong A, Janse S, Loccoh E, Stockmaster K, Holzer RJ, et al. Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg. Circ Cardiovasc Interv [Internet]. 2021;14(2):e009399. Disponible en: https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.120.009399
Mini N, Zartner P, Schneider M. Stenting of critical aortic coarctation in neonates between 600 and 1,350 g. Using a transfemoral artery approach. A single center experience. Front Cardiovasc Med [Internet]. 2022;9:1025411. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9601737/
van Kalsbeek R, Krings G, Molenschot M, Breur J. Early and midterm outcomes of bare metal stenting in small children with recurrent aortic coarctation. EuroIntervention [Internet]. 2021;16(15):e1281-7. Disponible en: https://europepmc.org/articles/PMC9724864
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 MQRInvestigar
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
®
Los autores se comprometen a respetar la información académica de otros autores, y a ceder los derechos de autor a la Revista MQRInvestigar, para que el artículo pueda ser editado, publicado y distribuido. El contenido de los artículos científicos y de las publicaciones que aparecen en la revista es responsabilidad exclusiva de sus autores. La distribución de los artículos publicados se realiza bajo una licencia 
