1/17/2022

Cardiology IV
Done by
DR.Sinan Alzubaidi

COARTICATION OF AORTA
- There is an obstruction or narrowing of the aortic arch near the origin of the left subclavian artery
precisely at the insertion of the ductus arteriosus.
-- Commonly presented with hypertension.

PathoPhysiology:
flow will ↓ from proximal
to distal aortic arch.
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Coarctation of aorta

• The anomaly occurs as twice in male than female

• Coa associated with turner syndrome
• Is associated with bicuspid aortic valve in 70 % of patients
• Mitral valve abnormalities (parachute mitral valve, or
supravalvular mitral ring) and subaortic stenosis is associated
abnormality
• When this group of left sided obstructive lesion occur together
we call it shone complex

Clinical Features:

- Depends on the severity of the obstruction and the patency of the ductus arteriosus.

- most of the clinical features appear after closure of the ductus, so there are 2 types:

1- duct dependent COA.

2- adult (non duct dependent )COA.

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Ductus-dependent COA;
1. Usually presented in early life (3-10) days of age with features of heart failure or
circulatory collapse because at this age the ductus arteriosus will be closed .
2. there will be no murmur because of the absence of the collateral circulation.
*So always should check the femoral artery pulse which may be absent or there is radio-
femoral delay.
3. Later on hypertension & the blood pressure in the upper limbs is higher than in the lower
limbs.
In normal persons (except neonates), systolic blood pressure in the legs
obtained by the cuff method is 10-20 mm Hg higher than that in the arms.
4. COA is the commonest cause of hypertension in infants.
It is important to determine the blood pressure in each arm;
a pressure higher in the right than the left arm suggests
involvement of the left subclavian artery in the area of coarctation

signs & symptoms

Needs several years to develop signs & symptoms include:

1-Usually asymptomatic

2-hypertension

3-Murmurs either due to bicuspid valve dysfunction,

or due to ↑ collateral circulation.
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Investigations:
- Chest x-ray:
- duct dependent: either normal or Cardiomegaly if associated with heart failure
- adult type: either normal
Rib notching due to collateral circulation.
* 3 sign (aortic arch, coarctation, & pulm. artery appear as the number 3).
-ECG:
- duct dependent: normal or RVH.
- adult type: LVH
-ECHO :

Complications:

1- hypertensive heart diseases.

2- congestive heart failure early in life.

3- intracranial hemorrhage & stroke.

4- infective endocarditis

5- rupture of the aorta.

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Treatment:
duct dependent:
1. first we must resuscitate & ventilate the child.
2. maintain patency of ducts arteriosus by infusion 5-20μg/kg of PG-E1 (prostaglandin ) within
24 hrs.
3. later on --do surgery.
adult type: If pressure gradient is over 20 mm Hg we do surgery either by:
1. Resection & end to end anastamosis.
2. Catheterization (balloon dilatation with stenting).

Thank you