Coarctation of the Aorta
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COARCTATION OF THE AORTA DEFINITION Coarctation of the aorta is defined as a narrowing in the aorta Most commonly at the site of insertion of the ductus arteriosus, just distal to the left subclavian artery. (juxta- ductal) EPIDEMIOLOGY More common in boys Common congenital heart defect o About 6-8% of all congenital heart defects AETIOLOGY 2 theories: 1. Narrowed segment is under- developed during foetal life due to reduced blood flow across the developing arch 2. Ductal tissue extends into the thoracic aorta, and when the ductus arteriosus constricts and closes postnatally, the thoracic aorta is constricted ASSOCIATIONS Bicuspid aortic valve Turner’s Syndrome HISTORY AND EXAMINATION Radio-femoral delay Weak femoral pulse Increased BP o Presenting at a young age or resistant to treatment Scapular bruit Systolic murmur (best heart over the left scapula) INVESTIGATIONS ECG o May be normal or show RVH or LVH Echocardiogram o Discrete narrowing in the thoracic aorta o Pressure gradient across narrowing CT or MRI-aortogram CXR shows rib notching o Due to dilated intercostal arteries MANAGEMENT Surgery Balloon dilatation +/- stenting
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Medical student notes on coarctation of the aorta
Transcript of Coarctation of the Aorta
COARCTATION OF THE AORTA
DEFINITION Coarctation of the aorta is defined as a narrowing in the aorta Most commonly at the site of insertion of the ductus arteriosus, just distal to the left subclavian artery. (juxta-ductal)
EPIDEMIOLOGY More common in boys Common congenital heart defect About 6-8% of all congenital heart defects
AETIOLOGY2 theories:1. Narrowed segment is under-developed during foetal life due to reduced blood flow across the developing arch2. Ductal tissue extends into the thoracic aorta, and when the ductus arteriosus constricts and closes postnatally, the thoracic aorta is constricted
ASSOCIATIONS Bicuspid aortic valve Turners Syndrome
HISTORY AND EXAMINATION Radio-femoral delay Weak femoral pulse Increased BP Presenting at a young age or resistant to treatment Scapular bruit Systolic murmur (best heart over the left scapula)
INVESTIGATIONS ECG May be normal or show RVH or LVH Echocardiogram Discrete narrowing in the thoracic aorta Pressure gradient across narrowing CT or MRI-aortogram CXR shows rib notching Due to dilated intercostal arteries
MANAGEMENT Surgery Balloon dilatation +/- stenting
COMPLICATIONS Coronary artery disease Secondary to persistent hypertension HTN Recoarctation after repair May occur due to scar formation at the site of intervention Most of these recoarctation may be managed with balloon angioplasty Aortic aneursym
