Coarction Of Aorta (pathology)

Question 1

What is coarctation of the aorta?

Answer 1

Aortic narrowing - close to where ligamentum arteriosum (remnant of ductus arteriosus) inserts

Question 2

What are the types of coarctation (3)?

Answer 2

1) Preductal - potentially life threatening – associated with Turner syndrome
2) Ductal
3) Post-ductal - common in adults

Question 3

What is the pathology of Post-ducal coarctation?

Answer 3

• Hypertension in upper extremities -> blood flow increases in branches prior to coarctation
• Weak lower limb pulses-> decreased blood flow past coarctation (might activate RAAS= secondary hypertension)
• Rib notching (deformation of superior or inferior rib surface)-> if collateral circulation involved

Question 4

What are the symptoms of coarctation in infancy (2)?

Answer 4

Often severe in infancy:

• Failure to thrive
• HF

Question 5

What are the symptoms of coarctation in later life (2)?

Answer 5

• Hypertension in upper extremities but hypotension in legs
• CV complications:
  • HF
  • MI
  • Stroke
  • Aortic dissection

Question 6

What are the signs of coarctation of aorta(4)?

Answer 6

• Cold legs
• Poor leg pulses
• Before left subclavian artery (brachiocephalic trunk split):
  • Radial-radial and RIGHT radial-femoral delay
• After left subclavian artery:
  • No radial-radial delay
  • RIGHT + LEFT radio-femoral delay

Question 7

What are the investigations for coarctation of aorta?

Answer 7

• CXR
  • Can observe rib notching because of dilatation of intercostal arteries
• Cardiac MRI (CMRI)

Question 8

What is the treatment for coarctation of the aorta?

Answer 8

• Percutaneous intervention (stent)

- Surgical correction