Aortic Coarctation

Question 1

What is aortic coarctation?

Answer 1

Constriction of a segment of the aorta, usually near the ductus arteriosus

Question 2

What are the types of aortic coarctation?

Answer 2

○ Infantile - pre-ductal
○ Adult
	- Juxta-ductal (most common): usually occurs at the time of closure of ductus arteriosus
	- Post-ductal
	- Middle aortic

Question 3

Risk factors for aortic coarctation

Answer 3

• Male gender
• Young age
• Turner’s syndrome
• DiGeorge’s syndrome
• Hypoplastic left heart syndrome

Question 4

Signs and symptoms of aortic coarctation

Answer 4

May be asymptomatic in setting of non-severe stenosis:

Sx: chest pain, arrhythmia Sx, claudication, renal failure Sx, cyanosis

Signs:

• inc upper limb BP, arterial hypertension
• systolic murmur
• laterally displaced apex beat
• lower extremity pulses diminished or delayed
• radio-femoral delay

Question 5

What is the pathophysiology of aortic coarctation (i.e. how does it lead to its signs and symptoms?

Answer 5

Narrowing of aorta causes:
• Increased blood flow to upper limb and decreased blood flow to lower limb
	○ Weak femoral pulses
	○ Increased upper limb blood pressure
	○ Radio-femoral delay
• Increased afterload
	○ Laterally shifted apex beat
	○ LVH→Systolic murmur

Question 6

What are some Ix you should do for aortic coarctation?

Answer 6

• ECG
• CXR
• (GS) Echo: discrete narrowing in thoracic aorta, pressure gradient across narrowing
• CT angiography, MR angiography
  Cardiac catherisation: gradient of above 20 mmHg across coarctation is indicative of severe coarctation

Question 7

What are some CXR findings for aortic coarctation?

Answer 7

• Cardiomegaly
• ‘3’sign at site of coarctation representing pre- and post-coarctation dilatations
  erosions of anterior ribs

Question 8

Why is aortic coarctation well tolerated in utero?

Answer 8

Because blood is shunted across PDA

Question 9

Outline the management for

Answer 9

• Lifelong cardiology follow-up
• neonates: PGE1administration to maintain patency of ductus arteriosus
• surgical repair:
  • end-to-end anastomosis
  • arch reconstruction with placement of patch (medium-length narrowing)
  • bypass graft (long narrowings) +/- stent (older kids)
• balloon angioplasty
• Meds to control hypertension (beta-blockers, ACE inhibitors, AngR blockers, cardiac glycosides, loop diuretics)