Coarctation of the Aorta Flashcards

1
Q

What is coarctation of the aorta?

A

Narrowing of a section of the aorta

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2
Q

Where does coarctation of the aorta most commonly occur?

A

At the site of insertion of the ductus arteriosus, just distal to the left subclavian artery

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3
Q

How does coarctation less commonly occur?

A
  • As diffuse arch hypoplasia with a long segment of narrowing proximal to the left subclavian
  • In the abdominal aorta
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4
Q

Does coarctation occur alone?

A

No, it is common with other congenital heart defects

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5
Q

What defects can coarctation occur with?

A
  • Bicuspid aortic valve
  • VSD
  • Aortic stenosis
  • PDA
  • Etc.
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6
Q

How does coarctation affect circulation proximal to it?

A

Creates pressure overload

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7
Q

How does coarctation affect circulation distal to it?

A

Creates hypoperfusion

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8
Q

How does proximal pressure overload affect the heart?

A

Can cause left ventricular hypertrophy

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9
Q

What effect does proximal pressure overload have on the upper part of the body?

A

Causes hypertension

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10
Q

What part of the body is particularly vulnerable to hypertension in coarctation of the aorta?

A

The brain

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11
Q

What parts of the body does distal hypoperfusion affect?

A

Abdominal organs and lower extremities

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12
Q

How does hypoperfusion affect the intestines?

A

Increases the risk of sepsis due to enteric organisms

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13
Q

What are the risk factors for coarctation of the aorta?

A
  • Male
  • Family history
  • Turner’s Syndrome
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14
Q

What are the clinical signs of coarctation of the aorta?

A
  • Systemic hypertension in right arm
  • Ejection systolic murmur
  • Radio-femoral delay
  • Claudication
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15
Q

What 3 tests are most useful in coarctation of the aorta?

A
  • CXR
  • ECG
  • Echo
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16
Q

What signs can be seen on a CXR in coarctation of the aorta?

A
  • Rib notching

- ‘3’ sign

17
Q

What causes rib notching?

A

Development of large collateral intercostal arteries running under the ribs posteriorly to bypass the obstruction

18
Q

What is the ‘3’ sign?

A

A visible notch in the descending aorta at the site of coarctation

19
Q

What will an ECG show in coarctation of the aorta?

A

Left ventricular hypertrophy

20
Q

What will an echo show in coarctation of the aorta?

A

Discrete narrowing in the thoracic aorta and pressure gradient across it

21
Q

What other tests may be helpful in investigating coarctation of the aorta?

A
  • CT angiography
  • MRI
  • Cardiac cathaterisation
22
Q

What are the differentials for coarctation of the aorta?

A
  • Arotic stenosis
  • Interrupted aortic arch
  • Left ventricular outflow tract obstruction
23
Q

What is the definitive treatment for coarctation of the aorta in children <1?

A

Surgical repair

24
Q

What is important in acute critical coarctation?

A

Maintaining ductal patency with alprostadil

25
Q

What does the type of surgical repair depend on?

A

Extent of the coarctation

26
Q

What are the types of surgical repair used?

A
  • End-to-end anastamosis
  • Arch reconstruction
  • Bypass graft
27
Q

What other treatment option is available in children >1?

A

Percutaneous repair

28
Q

What are the potential complications of coarctation of the aorta?

A
  • Aortic stenosis
  • Hypertension
  • Stroke
  • Aortic aneurysm
  • Aortic dissection
  • Premature CHD
  • Heart failure
  • Brain aneurysm or haemorrhage