CHD: coarctation of aorta Flashcards Preview

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Flashcards in CHD: coarctation of aorta Deck (23):
1

what is COA

-narrowing of aorta which may occur anywhere along aorta

2

most common COA

juxtaductal
-below the origin of subclavian artery at the ductus

3

COA prominent in

males

4

associated syndrome

-turners (XO)
-familial LVOTO

5

what is associated with COA

-bicuspid aortic valve
-VSD
-PDA
-MS
-MR
-aneurysm of circle of willis

6

juxtaductal coarctation

-blood flows through aorta after birth and is slowed by constriction->LV hypertrophy and HTN
-blood pressure in vessels preceding coarct is higher than after
-decreased renal perfusion can cause HTN

7

severe juxtaductal coarctation

may supply lower half of body with desaturated blood from RV
-differential cyanosis (red at top, blue at bottom)

8

cardiac auscultation

-loud S2
-systolic murmur along LSB and in back, or along 3rd, 4th interspaces transmitted to neck
-thrill or systolic ejection click in suprasternol notch from bicuspid aortic valve (70%)
-systolic murmur of AS at 3 R space
-systolic or continuous murmurs of collateral circulation over R and L sides of the chest (ant/post)

9

which pulses are weak with COA

femoral

10

older infant child presentation

may be asymptomatic
leg pain/weakness after exercise

11

adult presentation

HTN
HA
epistaxis
dizziness
palpitations

12

what makes diagnosis of COA

LE pulses weak/difficult to find
UE pulses bounding

13

CXR

-may be normal
-if >10 yrs: LV prominence, enlarged L subclavian shadow, figure 3 in aorta from constriction of coarct. followed by post stenotic dilatation
-rib notching
-infants can have ventricular enlargement and increased pulmonary vascular markings

14

BA esophagram

displacement of esophagus by post stenotic dilated aorta

15

Echo

normal or LVH, biventricular hypertrophy

16

echo

demonstrates coarct and flow

17

COA prognosis in infants

-immediate intervention if lower circulation is ductal dependent
-prostaglandin E1 infusion

18

COA prognosis in older children

unoperated-> early death b/c UE HTN, intracranial hemorrhage, aneurysms of vessels in brain, descending aorta, collateral circulation, premature coronary artery disease, hypertensive encephalopathy, CHF

19

major problems with COA

bacterial endocarditis

20

COA treatment

surgery
-ballon angioplasty (associated with aneurysm and recurrent coarctation)
-graft
-reanastomoses
-subclavian graft

21

complications from COA

-post-op: hypotension
-postcoractectomy syndrome
-restenosis (in infants) MRI to follow
-bacterial endocarditis

22

postcoractectomy syndrome

HTN and abdominal pain from inability of mesenteric arteries to regulate BP with new perfusion
-treat HTN
decompress bowel

23

late repair of COA can result in

associated with coronary artery disease, persistent or recurrent HTN, recurrent coarctation, cerebrovascular disease and if present, any sequelae from bicuspid aortic valve