CHD: coarctation of aorta

Question 1

what is COA

Answer 1

-narrowing of aorta which may occur anywhere along aorta

Question 2

most common COA

Answer 2

juxtaductal

-below the origin of subclavian artery at the ductus

Question 3

COA prominent in

Answer 3

males

Question 4

associated syndrome

Answer 4

• turners (XO)

- familial LVOTO

Question 5

what is associated with COA

Answer 5

• bicuspid aortic valve
• VSD
• PDA
• MS
• MR
• aneurysm of circle of willis

Question 6

juxtaductal coarctation

Answer 6

• 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

Question 7

severe juxtaductal coarctation

Answer 7

may supply lower half of body with desaturated blood from RV

-differential cyanosis (red at top, blue at bottom)

Question 8

cardiac auscultation

Answer 8

• 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)

Question 9

which pulses are weak with COA

Answer 9

femoral

Question 10

older infant child presentation

Answer 10

may be asymptomatic

leg pain/weakness after exercise

Question 11

adult presentation

Answer 11

HTN
HA
epistaxis 
dizziness
palpitations

Question 12

what makes diagnosis of COA

Answer 12

LE pulses weak/difficult to find

UE pulses bounding

Question 13

CXR

Answer 13

• 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

Question 14

BA esophagram

Answer 14

displacement of esophagus by post stenotic dilated aorta

Question 15

Echo

Answer 15

normal or LVH, biventricular hypertrophy

Question 16

echo

Answer 16

demonstrates coarct and flow

Question 17

COA prognosis in infants

Answer 17

• immediate intervention if lower circulation is ductal dependent
• prostaglandin E1 infusion

Question 18

COA prognosis in older children

Answer 18

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

Question 19

major problems with COA

Answer 19

bacterial endocarditis

Question 20

COA treatment

Answer 20

surgery

• ballon angioplasty (associated with aneurysm and recurrent coarctation)
• graft
• reanastomoses
• subclavian graft

Question 21

complications from COA

Answer 21

• post-op: hypotension
• postcoractectomy syndrome
• restenosis (in infants) MRI to follow
• bacterial endocarditis

Question 22

postcoractectomy syndrome

Answer 22

HTN and abdominal pain from inability of mesenteric arteries to regulate BP with new perfusion
-treat HTN
decompress bowel

Question 23

late repair of COA can result in

Answer 23

associated with coronary artery disease, persistent or recurrent HTN, recurrent coarctation, cerebrovascular disease and if present, any sequelae from bicuspid aortic valve