Congenitlal heart disease - Coarctation of the aorta

Question 1

Coarctation of the aorta

Coarctation of the aorta describes a congenital narrowing of the descending aorta.

Overview

Answer 1

• More common in males (despite association with Turner’s syndrome)
• Narrowing of the aorta
• Infant - 70% of cases, after aortic arch, before PDA

Question 2

Coarctation of the aorta

Coarctation of the aorta describes a congenital narrowing of the descending aorta.

Features

Answer 2

Features:

• infancy: heart failure (70%)
• adult: hypertension (30%)
• radio-femoral delay
• mid systolic murmur, maximal over back
• apical click from the aortic valve
• notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children

Question 3

Coarctation of the aorta

Coarctation of the aorta describes a congenital narrowing of the descending aorta.

Associations

Answer 3

Associations

• Turner’s syndrome
• bicuspid aortic valve
• berry aneurysms
• neurofibromatosis

Treatment:

• Balloon dilation
• Surgical removal of coarctation

Question 4

Aortic stenosis

Features

Clinical features of symptomatic disease

• chest pain
• dyspnoea
• syncope

Answer 4

Features of severe aortic stenosis:

• narrow pulse pressure
• slow rising pulse
• delayed ESM
• soft/absent S2
• S4
• thrill
• duration of murmur
• left ventricular hypertrophy or failure

Question 5

Aortic stenosis

Causes

Answer 5

Causes of aortic stenosis:

• degenerative calcification (most common cause in older patients > 65 years)
• bicuspid aortic valve (most common cause in younger patients < 65 years)
• William’s syndrome (supravalvular aortic stenosis)
• post-rheumatic disease
• subvalvular: HOCM (hypertrohic obstructive cardiomyopathy)

Question 6

Aortic stenosis

Management

Murmur can radiate through carotids

Answer 6

Management:

• if asymptomatic then observe the patient is general rule
• if symptomatic then valve replacement
• if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
• balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement

Question 7

Aortic stenosis

Answer 7