Coarctation of the Aorta Flashcards
What is coarctation of the aorta?
Narrowing of a section of the aorta
Where does coarctation of the aorta most commonly occur?
At the site of insertion of the ductus arteriosus, just distal to the left subclavian artery
How does coarctation less commonly occur?
- As diffuse arch hypoplasia with a long segment of narrowing proximal to the left subclavian
- In the abdominal aorta
Does coarctation occur alone?
No, it is common with other congenital heart defects
What defects can coarctation occur with?
- Bicuspid aortic valve
- VSD
- Aortic stenosis
- PDA
- Etc.
How does coarctation affect circulation proximal to it?
Creates pressure overload
How does coarctation affect circulation distal to it?
Creates hypoperfusion
How does proximal pressure overload affect the heart?
Can cause left ventricular hypertrophy
What effect does proximal pressure overload have on the upper part of the body?
Causes hypertension
What part of the body is particularly vulnerable to hypertension in coarctation of the aorta?
The brain
What parts of the body does distal hypoperfusion affect?
Abdominal organs and lower extremities
How does hypoperfusion affect the intestines?
Increases the risk of sepsis due to enteric organisms
What are the risk factors for coarctation of the aorta?
- Male
- Family history
- Turner’s Syndrome
What are the clinical signs of coarctation of the aorta?
- Systemic hypertension in right arm
- Ejection systolic murmur
- Radio-femoral delay
- Claudication
What 3 tests are most useful in coarctation of the aorta?
- CXR
- ECG
- Echo
What signs can be seen on a CXR in coarctation of the aorta?
- Rib notching
- ‘3’ sign
What causes rib notching?
Development of large collateral intercostal arteries running under the ribs posteriorly to bypass the obstruction
What is the ‘3’ sign?
A visible notch in the descending aorta at the site of coarctation
What will an ECG show in coarctation of the aorta?
Left ventricular hypertrophy
What will an echo show in coarctation of the aorta?
Discrete narrowing in the thoracic aorta and pressure gradient across it
What other tests may be helpful in investigating coarctation of the aorta?
- CT angiography
- MRI
- Cardiac cathaterisation
What are the differentials for coarctation of the aorta?
- Arotic stenosis
- Interrupted aortic arch
- Left ventricular outflow tract obstruction
What is the definitive treatment for coarctation of the aorta in children <1?
Surgical repair
What is important in acute critical coarctation?
Maintaining ductal patency with alprostadil
What does the type of surgical repair depend on?
Extent of the coarctation
What are the types of surgical repair used?
- End-to-end anastamosis
- Arch reconstruction
- Bypass graft
What other treatment option is available in children >1?
Percutaneous repair
What are the potential complications of coarctation of the aorta?
- Aortic stenosis
- Hypertension
- Stroke
- Aortic aneurysm
- Aortic dissection
- Premature CHD
- Heart failure
- Brain aneurysm or haemorrhage
