Coarctation of aorta

5,900 views

Published on

COARCTATION OF AORTA

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,900
On SlideShare
0
From Embeds
0
Number of Embeds
19
Actions
Shares
0
Downloads
178
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Coarctation of aorta

  1. 1. COARCTATION OF AORTA
  2. 2. MORGAGNI in 1760 40 – 80 % patients have a bicuspid aortic valve.
  3. 3.  There is localised narrowing of the aortic arch, just distal or proximal to the ductus or ligamentum arteriosus
  4. 4.  DUCTUS TISSUETHEORY  HEMODYNAMIC THEORY
  5. 5.  6-8% OF ALL CHD  Male:female is 2:5
  6. 6.  Turners syndrome  Bicuspid aortiv valve 30-40%  VSD  PDA  Aortic stenosis  Mitral stenosis  Intra cerebral associations
  7. 7. EMBRYOLOGY
  8. 8.  6—8 th week of gest  4th and 6th aortic arches  4th arch  Connect dorsal to ventral aorta  Form aortic arch  6th arch  Develop distally to DA
  9. 9. RT COMMON CAROTID RT SUB CLAVIAN BRACHIO CEPHALIC LT SUB CLAVIAN LEFTCOMMON CAROTID
  10. 10. DUCTAL PREDUCTAL POSTDUCTAL TYPES
  11. 11. LOCALISED LESION
  12. 12. HYPOPLASTIC SEGMENT
  13. 13. SIMPLE
  14. 14. COMPLEX
  15. 15.  EARLY DAYS  PDA  ACYNOTIC
  16. 16.  POSTDUCTAL
  17. 17.  Perfusion of lower body depends upon rt ventricular output  Right to left shunting  Upper extrimities pink and lower blue  Severe pulmonary HTN  LT ventricular hypertrophy  HEART FAILURE
  18. 18.  HTN – Upper body  Palpable collaterals  Thrill  Heave
  19. 19.  PULSES  BP  MURMUR
  20. 20.  DEPENDSON PATENCY OF PDA  ShocK and HF  METABOLIC DISTURBANCES  Hypothermia  Hypoglycemia  Hypo perfusion  Renal failure
  21. 21.  Upper extrimity HTN  Widened pulse pressure  Varibility in rt and lt arm pressures  Murmurs
  22. 22.  . Grade 1  refers to a murmur so faint that it can be heard only with special effort.  A grade 2 murmur is faint, but is immediately audible.  Grade 3 refers to a murmur that is moderately loud, and  grade 4 to a murmur that is very loud
  23. 23.  . A grade 5  murmur is extremely loud and is audible with one edge of the stethoscope touching the chest wall.  A grade 6 murmur is so loud that it is audible with the stethoscope just removed from contact with the chest wall. In general, murmurs with an intensity of grade 4 or higher are accompanied by a palpable thrill.
  24. 24. Intermittent claudication (due to a temporary inadequate supply of oxygen to the muscles of the leg) Pain and weakness of legs and Dyspnea on running
  25. 25.  ANTENATAL  Fetal echo  16-18 weeks of gestation  Helpful identifiers:  Long segment  Small LV  Dilated RV  Flow through ductus  difficult to detect coarctation
  26. 26. cardiomegaly Rib notching 3 sign X RAY
  27. 27. RIB NOTCHING
  28. 28.  High parasternal, suprasternal long axis  Shelf within lumen of thoracic aorta  Color and pulse wave doppler to locate area  Continuous wave doppler to detect maximum flow velocity
  29. 29.  ECG  MRI  BARIUM SWALLOW  CARDIAC  CATHETERISATION
  30. 30.  MEDICAL  Initial stabilisation  Ionotropic drugs  Prostaglandin E 1 IV  .01mcg/kg/mt
  31. 31. SURGICAL REPAIR
  32. 32. ENDTO END ANASTAMOSIS EXCISION OF COA INTERRUPTED SUTURING
  33. 33. LEFT SUB CLAVIAN FLAP LIGATE LT SUB CLAVIAN ARTERY CLOSE SUBCLAVIAN ARTERY FLAP OVERTHE COA AND SUTURE IN PLACE
  34. 34. PROSTHETIC PATCH AORTOPLASTY LONGITUDINAL INCISION MADE ACROSS COA AREA ENLARGEDWITH PATCH
  35. 35. BYPASS GRAFT ATUBE IS SEWN BETWEEN ASCENDING AND DESCENDING AORTA
  36. 36. BALLOON ANGIOPLASTY
  37. 37. STENT IMPLANTATION
  38. 38.  ResidualCOA  Recurrent COA  Systemic arterial HTN  CAD  PROGRESSIVE VALVE DISEASE  Bicuspid stenosis  Bicuspid regurgitation  Aortic aneurysm  Bact endocarditis

×