Weak Femoral Pulses Research Articles

Un-diagnosed coarctation of the aorta in a 27-year-old adult with a rare presentation: a rare case report

Introduction and importance: Coarctation of the aorta (COA) is a rare form of congenital heart disease that is typically diagnosed in children. COA is known to present with hypertension, weak or absent femoral pulses, heart failure in older patients, but the presentation of COA as calf atrophy is extremely rare. This article reports the successful surgical repair of a 27-year-old adult with undiagnosed COA. Case presentation: A 27-year-old-male has presented with calf atrophy, which was diagnosed as COA transthoracic echocardiography and computed tomography angiography indicate COA, which is treated with successful surgical repair. Clinical discussion: COA is typically diagnosed in children with a rare incidence in adults. Calf atrophy is an extremely rare presentation and uncommon. He has calf atrophy, which led to the diagnosis of COA in 27 years. The presentation in this medium-aged population with this rare manifestation gives our case significance to be one of the unique reported cases. Conclusion: COA is uncommon to be found in adults and the presentation with calf atrophy is even rare. The authors revealed that COA can be found in adults and with an unexpected manifestation and highlights the significance of early detection, and timely referral to a specialist can enable proper management, which includes surgical correction.

Intoxicação por amitraz em um gato

ABSTRACT: A 4-month-old male Himalayan cat presented with clinical signs of acute lethargy and motor incoordination after being treated with amitraz for parasite control. On clinical examination, the patient was lethargic and ataxic with severe pulicosis, hypothermia, pale mucous membranes, bradycardia, weak femoral pulses, hyperglycemia, and bilateral mydriasis. Blood tests revealed non-regenerative hypochromic microcytic anemia. Serum alanine levels were elevated tenfold. The patient received supportive treatment with atipamezole (an α2-adrenergic antagonist) at a dose of 0.1 mg/kg intramuscularly. After 24 h of hospitalization and constant monitoring, the patient recovered and was discharged. The published literature showed that the active ingredient amitraz is effective in the treatment of some parasitic diseases in cats, such as scabies and demodicosis; therefore, it is still used for this purpose. Given the small therapeutic margin of this insecticide, veterinarians should caution owners about its potential toxicity. This report emphasized the significance of amitraz intoxication in feline species and the success of the treatment, which should be initiated in the first hour after intoxication.

Endoleak Type III and COVID-19: A Lethal Combination

A 72 year old man presented with new onset intermittent claudication and weak femoral pulses bilaterally. After endovascular repair of a 6.0 cm abdominal aortic aneurysm (AAA) in 2018 (AFX2 plus Vela, Endologix, Irvine, CA, USA), the patient discontinued follow up after three months with a stable aneurysm. Computed tomography angiography showed AAA diameter increase to 6.8 cm and component disconnection (type III endoleak, arrow, A). Decreased main body perfusion caused claudication (arrow, B). Open repair risk was considered too high because of an active COVID-19 infection. While waiting for endovascular materials, the patient died in hospital from AAA rupture, confirmed by autopsy.Image 1

Spontaneous Aortic Thrombosis in a Neonate

Spontaneous aortic thrombosis is a serious clinical entity with clinical features that mimic neonatal coarctation of aorta. While both conditions manifest with weak femoral pulses, pallor and poikilothermia of lower limbs are unique to spontaneous aortic thrombosis. Proper imaging helps in precise diagnosis. A combination of thrombolysis and anticoagulation is used for resolution of thrombus. We present images of a neonate with spontaneous aortic thrombosis and its clinical management strategies.

Endovascular repair of recurrent aortic coarctation with a custom made hourglass shaped stent graft

A 76-year-old male patient with previous open repair resection and end-to-end anastomosis in young adulthood of a congenital coarctation of the descending thoracic aorta was referred to our center for a symptomatic recurrence (A). The patient reported dyspnea and lower extremity fatigue, whereas clinical examination showed weak femoral pulses and a 50 mm Hg gradient between brachial and ankle systolic blood pressure measurements. Medical history was otherwise unremarkable and renal function was normal.

Screening Coarctation of Aorta with Clinical and Echocardiographic Profiles in Infants: A Pilot Study

Aim: To determine the profiles of clinical features including four-limb blood pressure (BP), saturations of peripheral oxygen (SpO2), and echocardiographic features in infants with coarctation of aorta (CoA) to facilitate congenital heart diseases screening. Methods: The charts of infants with CoA were retrospectively reviewed. All in-hospital infants suspected of congenital heart diseases by clinical teams were prospectively measured of four limbs BPs and SpO2 in a regional cardiac transferring center during 2013 and 2019. Echocardiography as a gold standard test was followed within 2 days after suspicion. All infants were divided into non-significant CoA group or significant CoA group based on the difference of BPs between right arm and lower limbs. Predictors of non-significant CoA were determined with multivariable logistic regression. Results: One hundred thirty-three infants with CoA were identified. The BPs on upper limbs were higher than those on lower limbs (P = 0.001). No statistical difference in SpO2 was found between four limbs. Fifty-three (39.8%) infants presented with significant CoA. Thirty-four infants presented with low SpO2 and 26 of 34 presented with non-significant CoA. Small ascending aorta diameter [0.070 (95% CI: 0.005–0.136), P = 0.036] was an independent risk factors for non-significant CoA. Eighteen (13.5%) infants with CoA didn’t present with any of the BP difference, low SpO2, murmur, or weak femoral pulse. Conclusion: Less than half of the infants with CoA presented with a significant BP difference. Another one fifth presented with low SpO2. Small ascending aorta diameter was an independent factor for non-significant CoA.

Late diagnosis of coarctation of the aorta in a 44-year-old male: a case report

BackgroundCoarctation of the aorta is a rare congenital disease. In adults, the main manifestations include hypertension, weak or absent femoral pulses, heart failure, and left ventricular hypertrophy.Case presentationWe present a case involving a late diagnosis of coarctation of the aorta detected during aortography in a 44-year-old man. The patient underwent stent implantation and aortoplasty. After 2 years of follow-up, the patient was in good condition.ConclusionsThis case shows that coarctation of the aorta can be cured and that hypertension caused by the condition can be controlled to some extent with medication. Based on our findings, we recommend a detailed physical examination for all patients suspected of having coarctation of the aorta; the examination should include blood pressure measurements of both the upper and lower extremities. The case of coarctation of the aorta is not common or easy to be found in medium-aged population. Better BP control, earlier repair, and transcatheter intervention may result in a good outcome in that case.

Metoda plastyki łuku aorty z zachowaniem przewodowego przepływu systemowego w leczeniu krytycznej koarktacji o morfologii bovine trunk

Introduction. Coarctation of the aorta is a congenital heart defect defined as aortic narrowing at the isthmus. It may occur in association with other defects, which requires a discussion regarding the choice of optimal therapy. Critical aortic coarctation with aortic hypoplasia and so-called bovine trunk anatomy is one of the more challenging forms of this defect, characterized by a common origin of the brachiocephalic trunk and the left common carotid artery, which form a common vessel extending as a direct continuation of the ascending aorta. Therapeutic decisions are made depending on the distance between the ascending aorta and the isthmus and descending aorta, taking into account the typical management of hypoplastic aortic arch. Material and methods. The clinical presentation in the neonatal period includes weak or absent femoral pulse, pallor, apathy, dyspnea and signs of systemic hypoperfusion with progressive lung edema and acidosis. The diagnosis is mostly based on echocardiography while magnetic resonance imaging or computed tomography allow detailed imaging of the collateral vessels. The most important diagnostic issues are the anatomy of the defect, severity of concomitant aortic isthmus narrowing, and its hemodynamic effect. The medical management is directed at maintaining patency of the ductus arteriosus with prostaglandin E1 infusion and an appropriate balance between peripheral systemic and pulmonary resistance. The recommended treatment of choice is an early surgical correction of the aortic arch defect. The aortic arch reconstruction method with ductus-dependent systemic flow preservation implies resection of the coarctation along with the isthmus narrowing and proximal end-to-side anastomosis, with reconstruction of the inflow to the left subclavian artery using a hypoplastic distal segment of the aortic arch. The operation is performed by the left posterolateral thoracotomy without using extracorporeal circulation. Conclusions. The prerequisite for selecting a neonate for the proposed procedure is a detailed assessment of aortic arch anatomy, with particular attention to the measurement of the distance between the ascending aorta and the area where the ductus arteriosus connects to the descending aorta. The major advantage of this technique is the ability to perform an off-pump procedure via the lateral access, using only healthy native patient tissues for aortic flow restoration.

Diagnostic values of the femoral pulse palpation test

ObjectivesTo calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants.DesignPopulation-based cohort study.SettingStockholm-Gotland County 2008–2012.PatientsAll singleton live-born...

Supraventriculaire tachycardie met isoritmische atrioventriculaire dissociatie bij een labrador-retriever

Een vrouwelijke, gesteriliseerde labrador-retriever van zeven jaar oud werd aangeboden met klachten van tachypneu, kokhalzen en abdominale distensie. Op het lichamelijk onderzoek werden een systolische hartruis met een intensiteit van 3/6 en punctum maximum links apicaal, tachycardie en zwak geslagen, femorale polsen opgemerkt. Een undulatieproef was positief. Na echocardiografisch en elektrocardiografisch onderzoek werden dilatorische cardiomyopathie (primair of secundair) en supraventriculaire tachycardie (SVT) vastgesteld. Na instelling van een behandeling met digoxine werd tijdens de opvolging een isoritmische atrioventriculaire dissociatie (IAVD) waargenomen en bleek de SVT onvoldoende onder controle gebracht. Na het overschakelen op diltiazem werd op het ECG vastgesteld dat de tachycardie onder controle was. Echocardiografisch onderzoek toonde aan dat het hart zich hersteld had. De hond vertoonde de daaropvolgende twee jaar geen cardiale symptomen meer. In deze casus wordt de zeldzame aritmie IAVD in combinatie met SVT beschreven. Daarnaast wordt het belang aangetoond van SVT als mogelijk reversibele oorzaak van een DCM-fenotype op echocardiografie.

Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

Use of the AndraStent XL and XXL for the treatment of coarctation of the aorta in children and adults: immediate and midterm results.

The aim of this study is to present our experience with a new type of extra-large stent, namely the AndraStent XL/XXL. AndraStents were implanted in 46 patients, 38 with native coarctation of the aorta (CoA) and eight with recurrent coarctation of the aorta following previous surgery (ReCoA). All patients had arterial hypertension in the upper limbs, absent or weak femoral pulses, and continuous flow in the abdominal aorta on Doppler examination. The median age of patients was 25 years (range from nine to 65). The stents (cobalt-chromium with semi-open cell design) were manually mounted on balloon catheters and delivered through 10 to 14 Fr Mullins sheaths using a conventional femoral approach. All procedures were successful (no stent migration, proper expansion, no aorta dissection/rupture, major bleeding or major vessel injury). The systolic gradient across the aorta decreased from 40.6 mmHg before the procedure to 11.6 mmHg after the procedure (p<0.001). The mean fluoroscopy time was 5.7 minutes. Imaging examinations were scheduled and performed between six and 12 months after the initial procedure in 40 patients (angiography or angio CT or both). Procedural outcome remained favourable during a mean 2.4 years of follow-up. Neither stent fracture nor dislocation was observed in any patient at follow-up. In two patients, small aneurysm formation was observed six and eight months after the procedure -they were treated successfully with subsequent covered stent implantation. Re-dilatation of the implanted stent was performed between four and 26 months in 14 patients. Implantation of new large cobalt-chromium stents is a good therapeutic option for the treatment of native and recurrent CoA.

Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog

A six‐year‐old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiological parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after injecting intravenous cefazolin, the audible signal from the Doppler ultrasound unit stopped. Rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous adrenaline (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second‐line therapy and delay in administering adrenaline, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.

Late Diagnosis of Coarctation Despite Prenatal Ultrasound and Postnatal Pulse Oximetry.

To determine what contribution prenatal ultrasound screening and neonatal pulse oximetry screening (POS) make to the timely diagnosis of neonatal coarctation of the aorta (CoA). We identified infants and fetuses diagnosed with isolated CoA in our referral area between 2003 and 2012 who died without surgery, underwent surgical repair before 2 months of age, or were terminated after a prenatal diagnosis. Clinical data were collected from hospital charts. Only 3 of the 90 cases were diagnosed prenatally. Two of the 3 were born alive and in 1 case the couple opted for termination of pregnancy. Nineteen of the remaining 87 cases were born in units that used POS (hand and foot) and 4 of 19 screened positive. Of the remaining 83 cases, 46 were discharged undiagnosed (7 after nondiagnostic echocardiography), including 9 with a murmur and weak femoral pulses and 8 with a murmur and normal pulses. One was diagnosed postmortem after dying at home, and 22 of the remaining 45 discharged infants were in circulatory failure on readmission. Five of the patients who were not discharged died without surgery and undiagnosed CoA was the most probable cause of death in 2 of these patients. The contribution of prenatal ultrasound screening and postnatal POS to the timely diagnosis of CoA was low. Careful physical examination of all newborns therefore continues to play a fundamental role in detecting this life-threatening cardiac defect, and better screening methods need to be developed.

Bilateral femoral arterial dirofilariasis caused by Dirofilaria immitis in a dog

A two-year-old intact male Anatolian shepherd dog presented with a one-month history of bilateral hindlimb lameness and digital necrosis. Supportive evidence of systemic arterial parasitism included ultrasonographic findings of parallel...

Trombosis aórtica en un neonato

The aortic thrombosis is not frequent during the neonatal period. The canalization of umbilical artery is the main risk factor. There are several options for the treatment, such as thrombolysis, thrombectomy and the anticoagulation, which are used in terms of the thrombosis localization and the symptoms that are observed. We present the case of a newborn who consulted for weak femoral pulses, coldness and poor perfusion of lower limbs. The aorta restriction was ruled out using the echocardiography; Doppler abdominal ecography showed aortic thrombosis at an underrenal level. There was not a previous umbilical catheterism.

Coarctation of the Aorta, Known Yet Can Be Missed

The clinical presentation of coarctation of aorta (CoA) is well known; however, it is the most common congenital heart disease in the newborn period to be missed, with significant mortality and morbidity associated with missing the diagnosis. We report a 20-day-old newborn boy who presented with congestive heart failure and weak femoral pulses. Chest X-ray (CXR) showed cardiomegaly and pulmonary edema and electrocardiography (ECG) showed extreme right axis deviation and absent left ventricular forces in the left precordial leads. Based on these, clinical suspicion of coarctation of aorta was made and confirmed by echocardiography. After initial stabilization with prostaglandin E2 infusion, child underwent urgent coarctation of aorta repair with uneventful post-operative course. High index of suspicion for coarctation of aorta in a newborn with such presentation is required and urgent referral to Pediatric Cardiology and cardiac surgery center is mandatory to reduce the morbidity and mortality associated with missing the diagnosis.

Native atretic coarctation of the aorta in a 37-year-old hypertensive woman, treated with a low-profile covered stent

We report on a 37-year-old woman with essential systemic hypertension. An MRI was performed because of weak femoral pulses, depicting a severe almost atretic coarctation of the aorta (Fig. 1). Angiography of the proximal distal thoracic aorta was simultaneously performed (Fig. 2a). The transverse arch was narrow (16 mm), as was the diameter of the terminal aortic arch distal to the left subclavian artery (10 mm). Distal of the coarctation the diameter of the descending aorta was 11 mm. A trajectory of 2 mm in length seemed atretic. The atretic segment could be crossed in an antegrade fashion with a straight 0,014 in. coronary wire and balloon pre-dilatation was performed with a 5 mm coronary balloon. Thereafter, a multi-purpose catheter could be advanced retrogradely across the coarctation segment. A 9 French Mullins sheath (Cook) was advanced to the transverse aortic arch. A 41 mm long Advanta V12 premounted covered stent (Atrium, Hudson, USA) on a 12 mm high pressure balloon was implanted. Consecutive angiography revealed complete expansion of the stent up to 12 mm without residual stenosis, and no aneurysm formation (Fig. 2b). Fig. 1 MRI imaging of the left ventricle (LV), ascending aorta (AAo). The left subclavian artery (LSA) is dilated and the descending aorta (DAo) is hypoplastic. The coarctation imposes as atresia. There are numerous collaterals. RV: right ventricle Fig. 2 a Simultaneous angiography of the proximal and distal descending aorta; anterior projection. Atretic coarctation (CoA). Some small collaterals can be seen right of the coarctation. Abbreviations: Cath: catheter, DAo: descending aorta, LSA: left subclavian ... In conclusion, treatment with placement of a low-profile covered stent, using a simultaneous radial and femoral approach and pre-dilatation, delivered an excellent result without complications and a short hospital stay. The patient’s blood pressure returned to normal and her antihypertensive medication could be stopped within 3 weeks after stent implantation. We emphasise that in so-called ‘unexplained’ systemic hypertension, especially in young adults, coarctation of the aorta has to be excluded [1, 2]. When coarctation is confirmed primary stenting is the first choice therapeutic option [3–5].

Shunting Between the CVC and Both the Azygos Vein and Thoracic Duct in a Dog with CTDS

A 5 mo old female rottweiler was referred for evaluation of a suspected congenital heart disease. Clinical signs included anorexia, exercise intolerance, and severe loss of body condition. Clinical examination revealed dyspnea, pale mucous membranes, and weak femoral pulses. Pleural and abdominal effusions and iron deficiency anemia were identified. A distended intrathoracic caudal vena cava (CVC) visible on thoracic radiographs suggested that the modified transudate abdominal effusion was the result of improper venous return to the right side of the heart. Cor triatriatum dexter (CTD) was diagnosed via echocardiography but did not explain all the anomalies detected during a contrast echocardiography. Abnormal communications between the CVC and azygos vein and the CVC and thoracic duct were subsequently identified by abdominal ultrasonography and angiography. Medical management with diuretics, iron supplements, and surgical treatment of CTD resulted in normalization of the respiratory rate, the exercise intolerance, and the anemia. To the authors' knowledge, this is the first reported case of CTD associated with shunts between the CTV and both the azygos vein and thoracic duct in dogs. This report emphasizes the importance of presurgical assessment of concurrent thoracic and abdominal congenital vascular abnormalities.

Invasion of fat into the brain case in a cat

FAT in the brain case has occasionally been reported in the human literature and is usually secondary to intracranial fat-containing tumours or iatrogenically caused by free fat grafts placed into...