This document summarizes three common obstructive congenital heart defects: pulmonary stenosis, aortic stenosis, and coarctation of the aorta. Pulmonary stenosis involves obstruction of blood flow from the right ventricle to the pulmonary artery. Aortic stenosis is a narrowing of the aortic valve that restricts outflow from the left ventricle. Coarctation of the aorta is a narrowing of the aorta near the ductus arteriosus, creating differential blood pressures between the upper and lower body. The document outlines the clinical features, physical exam findings, investigations, and management options for each of these three conditions.

1. Obstructive defects.
Congenital Heart Disease.
Y5 MBBS | UWI Cave Hill.
Vasha Ramgobin.
Neil Roopchan.
Valmiki Seecheran.

2. Introduction.
• Obstructive defects occurs when heart valves,
arteries or veins are abnormally narrow or
blocked.
• Common defects-
– Pulmonary stenosis.
– Aortic stenosis.
– Coarctation of the aorta.

3. Pulmonary stenosis.
• A dynamic or fixed obstruction of flow from
the right ventricle to pulmonary artery.
• Usually diagnosed in children.
• Clinical features.
– Asymptomatic.
– Poor exercise tolerance.
– Right ventricular failure/cyanosis.

4. Pulmonary stenosis.
• Physical signs.
– Ejection systolic.
– Best heard at upper left sternal edge. Murmur radiates
backwards.
– Thrill may be present
– Ejection click best heard at the upper left sternal edge
– When severe, there is a prominent right ventricular impulse
(heave).
• Investigations.
– CXR.
– ECG – Right ventricular hypertrophy – Up right T wave in V1.
• Management.
– Transcatheter ballon dilation.

5. Aortic stenosis.
• The aortic valve leaflets are partly fused
together giving a restrictive exit from the left
ventricle.
• Clinical features:
– Asymptomatic murmur.
– Reduced exercise tolerance.
– Chest pain of exertion.
– Syncope.

6. Aortic stenosis.
• Physical signs.
– Small volume, slow rising pulse.
– Carotid thrill – always.
– Ejection systolic.
– Best heard at the upper right sternal edge. Radiates to neck.
– Delayed and soft aortic second sound.
– Apical ejection click.
• Investigation.
– CXR.
– Doppler Echo – used to estimate pressure across valves.
– ECG.
• LBB due to calcification.
• LVH.
• Poor R wave progression.
• Management.
– Surgical – valve replacement (prosthetic & metal).
– Balloon dilation used to alleviate stenosis.

7. CoA.
• CoA is where there is a narrowing in the aorta
in the region of the ductus arteriosus. L-R
shunt. (10-20% in Turner’s syndrome).
• Three (3) types.
– Proximal to ductus arteriosus.
– At the ductus ateriosus.
– Distal to the ductus arteriosus.

8. CoA.
• Clinical features.
– Breathless, grey and collapsed with hepatomegaly.
– Pulses are stronger in arms than legs.
– B.P is lower in legs than arms. (Upper body HTN &
Lower body HTN).
– No murmurs.
• Management.
– Prostaglandin E is given to reopen duct.
– Manage HTN.
– High pressure ventilation.
– Surgical balloon treatment + stenting.

9. Thank you.