A narrowing of the large blood vessel (aorta) that leads from the heart. Coarctation of the aorta is usually present at birth (congenital) and may occur with other heart defects. Many people have no symptoms and the condition often isn't detected until adulthood. The most common symptom in adults is high blood pressure. Rarely, severe cases can cause heart failure in babies. Treatment involves surgery or a catheter-based procedure to fix the narrowing.

1. COARCTATION 0F
AORTA

2. Coarctation refers to narrowing of the
thoracic aorta

3. COARCTATION 0F AORTA
There are two forms of aortic coarctation
an “infant” form:- with the infant form, which accounts for about 70% of cases, the
coarctation comes after the aortic arch,
an “adult” form.:-coarctation comes before the ductus arteriosus.

4. PATHOGENESIS
the exact pathogenesis is unknown, the theories for development of congenital CoA are as
follows:
UNDERDEVELOPMENT OF THE FOETALAORTIC ARCH DUE TO REDUCED
ANTEGRADE INTRAUTERINE BLOOD FLOW
EXTENSION OF DUCTAL TISSUE INTO THE WALL OF THE FOETAL THORACIC
AORTA

5. INFANTILE (PREDUCTAL ) COARCHTATION

6. WHAT HAPPENS IN INFANTILE COARCHTATION
dutu
s
HIGH
PRESSURE
LOW
PRESSURE

7. NORMAL PULMONARY ARTERIES BLOOD FLOW

8. PULMOARY ARTERIES FLOW IN ADULT COARCHTATION
NO REVERSED FLOW
NO RIB NOTCHING

9. RIB NOTCHING

10. CLINICAL FEATURES
ASYMPTOMATIC CHILD
(ADULT COARCHTATION)
SYMPTOMATIC CHILD
(INFANTILE COARCHTATION)
• poor feeding, pale skin
• irritability
• heavy sweating
• difficulty breathing
• Dyspnea
• oliguria, anuria
• Weak and thready pulses are present
throughout
• Occasional complaints of leg pain.
• The pulse in the leg is absent or weak
and delayed
• Hypertension in the arm or higher
BP readings in the arm than in the
thigh may be present

11. GENERAL EXAMINATION FINDINGS
• Disparity in the pulse and blood pressure in the arms and legs-feeble or absent
femoral pulses are seen with strong arm pulses.
• Blood pressure is higher in the upper limbs
• Radio femoral delay
• Suzman sign (pulsation over the back due to bronchopulmonary collaterals)
• Differential cyanosis (pink upper extremities and cyanosed lower extremities)

12. COMPLICATIONS
• Delay in treatment may result in left ventricular dysfunction and degenerative changes in
the aortic wall. Most of the cases of preductal CoA develop CHF by 3 months of age.
Death may occur due to renal shutdown
 Cranial hypertension
 Bronchopulmonary collaterals
 Severe pulmonary hypertension
 Congestive cardiac failure
 Intracranial bleeding
 Hypertensive encephalopathy

13. INVESTIGATIONS
ASYMPTOMATIC CHILD
(ADULT COARCHTATION)
SYMPTOMATIC CHILD
(INFANTILE COARCHTATION)
• X-RAY:-marked cardiomegaly
with pulmonary edema or
pulmonary venous congestion
occurs in symptomatic cases
• ECG:-Right ventricular
hypertrophy
• Karyotyping for Turner syndrome
• X-RAY:-Cardiac size will be normal or
slightly enlarged in asymptomatic cases
• Notching of the lower border of ribs
 Echocardiogram with colour Doppler
studies
 Angiography
 CT angiogram
 MRI

14. MANAGEMENT
MEDICAL MANAGEMENT
 Asymptomatic cases should be treated conservatively.
 Treat hypertension if present.
 CHF is treated with antifailure/ anticongestive measures
including digoxin and diuretics.
 Prostaglandin E1 infusion may be needed to maintain the
patent ductus arteriosus.

15. SURGICAL MANAGDMENT
• Balloon angioplasty of the COA may be the procedure of choice in
selected patients who meet the criteria.
• Resection of the coarctation segment and end-to-end anastomosis is
the procedure of choice
• Patch aortoplasty

16. PROGNOSIS
Prognosis is good.
• Mortality is less than 1% in
asymptomatic cases.
• < 5% in symptomatic cases.