Coarctation of Aorta
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  • 1. Coarctation of Aorta Dr. Kalpana Malla MBBS MD (Pediatrics) Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]
  • 2. Coarctation of aorta• 8-10% of CHDs• M:F ratio 2:1• Pathology: indentation involving anterior, lateral & posterior wall of aorta Postductal type: distal to ductus/ ligamentum arteriosum or subclavian artery -adult type Preductal-proximal (infantile)
  • 3. Coarctation of the Aorta• Localized narrowing of the aorta• M>F• Associated with Turner’s Syndrome• Most common clinical sign: weak pulses & decreased blood pressure in the lower extremities
  • 4. Hemodynamics:• Preductal type: very high load on left ventricle elevation of both systolic & diastolic pressures absence of collaterals immediately symptomatic with CCF from birth• Postductal type: development of collaterals connecting branches of subclavian artery to arteries arising from aorta from in-utero life distal level of coarctation spares infant from LVF
  • 5. Clinical manifestations:• Symptomatic infants- H/O poor feeding, dyspnea, poor weight gain, signs of acute circulatory shock in first 6 weeks of life• Weakness or pain in legs after exertion
  • 6. Clinical manifestations:• Intermittent claudication• Dyspnea on running• Physical examination: pale, respiratory distress, weak femoral pulses, radio-femoral delay, BP in arms more than in legs
  • 7. Precordial examinationHeart size N – apex normal site but heaving• Systolic thrill in suprasternal notch• S1 – accentuated with constant ejection click• S2 – normally split with loud A2• Murmur - ejection systolic murmur grade 2-4/6 at URSB & mid or lower left sternal border, systolic murmur at interscapular area (left)
  • 8. Diagnosis:• CXR: heart size N with prominent ascending aorta and aortic knuckle “3” sign on over-penetrated films rib notching between 4th and 8th ribs• “E” sign on barium swallow• ECG: left axis deviation, LVH• Echo: coarctation visualized
  • 9. Management:• Medical: control of CCF in infancy dental hygiene Infective endocarditis prophylaxis Treat HTN Balloon angioplasty• Surgical: resection of coarctation and end-to-end anastomosis at any age but lowest risk at 1-10yrs
  • 10. Thank youDownload more documents and slide shows on The Medical Post [ www.themedicalpost.net ]