Chapter 26: Coarctation of the Aorta (Children)

Question 1

Coarctation of the Aorta (CoA)

Answer 1

a narrowing or stricture of the descending aorta distal to the carotid arteries

• a congenital narrowing of the aorta, which is the largest artery present at the top of the heart
• acyanotic
• obstructive lesion
• coarctation is classified by its location: preductal, ductal, or post-ductal

Question 2

When do physicians suspect a CoA?

Answer 2

> Normally blood pressure (BP) in the legs should be higher or equal to that in the arms
-when a BP in the lower extremities is lower than that of the upper arms by 10 mm Hg or more =suspects CoA
occasionally, the BP is the right arm is higher than the left; this usually occurs with a preductal coarctation in which the flow to the left arm is supplied by the flow of the blood through the ductus, which is a lower pressure system; for this reason, if only one upper extremity is used as a comparison with the lower extremities, it should be the right arm. If a child is hypertensive CoA is suspected

Question 3

Signs and Symptoms

Answer 3

> murmur
-not always present
-systolic ejection murmur heard at upper right sternal border and left sternal border
-cycle radiates to left axilla and left intrascapular area of the back
may show signs of CHF
child may have pain in the legs or cyanotic lower extremities

Question 4

Diagnosis

Answer 4

high gradient, which is the difference in the pressure measurements between the arms and legs (use right arm if comparing with one arm)

Question 5

Nursing Care

Answer 5

focuses on postoperative management of child

• child is followed by health-care provider for evidence of restenosis (recurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow)
• monitoring of upper and lower blood pressures
• post-surgically the child may have rebound hypertension; the ventricles have become accustomed to pushing hard against the narrowed area in the aorta; when this area is opened up, the heart muscle still wants to contract strongly against the gradient; if there is nothing to push against, there is still an abnormally high blood pressure; this is controlled by antihypertensive agents for 6 months to a year after surgery and may be required through life

Question 6

Medical Care

Answer 6

pharmacological agents include after-load (wall stress) reducing agents, which control the blood pressure
-captopril (Capoten) and enalapril (Vasotec)

Question 7

Surgical Care

Answer 7

surgery is always indicated

-invasive treatment for older infants and adolescents involves a balloon angioplasty and stent placement