CHD: coarctation of aorta Flashcards
what is COA
-narrowing of aorta which may occur anywhere along aorta
most common COA
juxtaductal
-below the origin of subclavian artery at the ductus
COA prominent in
males
associated syndrome
- turners (XO)
- familial LVOTO
what is associated with COA
- bicuspid aortic valve
- VSD
- PDA
- MS
- MR
- aneurysm of circle of willis
juxtaductal coarctation
- blood flows through aorta after birth and is slowed by constriction->LV hypertrophy and HTN
- blood pressure in vessels preceding coarct is higher than after
- decreased renal perfusion can cause HTN
severe juxtaductal coarctation
may supply lower half of body with desaturated blood from RV
-differential cyanosis (red at top, blue at bottom)
cardiac auscultation
- loud S2
- systolic murmur along LSB and in back, or along 3rd, 4th interspaces transmitted to neck
- thrill or systolic ejection click in suprasternol notch from bicuspid aortic valve (70%)
- systolic murmur of AS at 3 R space
- systolic or continuous murmurs of collateral circulation over R and L sides of the chest (ant/post)
which pulses are weak with COA
femoral
older infant child presentation
may be asymptomatic
leg pain/weakness after exercise
adult presentation
HTN HA epistaxis dizziness palpitations
what makes diagnosis of COA
LE pulses weak/difficult to find
UE pulses bounding
CXR
- may be normal
- if >10 yrs: LV prominence, enlarged L subclavian shadow, figure 3 in aorta from constriction of coarct. followed by post stenotic dilatation
- rib notching
- infants can have ventricular enlargement and increased pulmonary vascular markings
BA esophagram
displacement of esophagus by post stenotic dilated aorta
Echo
normal or LVH, biventricular hypertrophy
echo
demonstrates coarct and flow
COA prognosis in infants
- immediate intervention if lower circulation is ductal dependent
- prostaglandin E1 infusion
COA prognosis in older children
unoperated-> early death b/c UE HTN, intracranial hemorrhage, aneurysms of vessels in brain, descending aorta, collateral circulation, premature coronary artery disease, hypertensive encephalopathy, CHF
major problems with COA
bacterial endocarditis
COA treatment
surgery
- ballon angioplasty (associated with aneurysm and recurrent coarctation)
- graft
- reanastomoses
- subclavian graft
complications from COA
- post-op: hypotension
- postcoractectomy syndrome
- restenosis (in infants) MRI to follow
- bacterial endocarditis
postcoractectomy syndrome
HTN and abdominal pain from inability of mesenteric arteries to regulate BP with new perfusion
-treat HTN
decompress bowel
late repair of COA can result in
associated with coronary artery disease, persistent or recurrent HTN, recurrent coarctation, cerebrovascular disease and if present, any sequelae from bicuspid aortic valve
