COARCTATION: Definition
Congenital narrowing of the aorta (usually at the isthmus ) that creates a pressure gradient
COARCTATION: Classification
PreductalJuxtaDuctal
Postductal
COARCTATION: pathophysiology
Raised LV afterload → LV hypertrophy
Collateral circulation between aorta proximal and distal to the coarctation
Inflow
Subclavian arteries
Internal mammaries
Vertebral
Costocervical
Thyrocervical trunk
Outflow
Intercostal arteries distal to the coarctation (esp.3rd and 4th ) into the descending thoracic aorta
Aneurysm formation- intercostal, Berry aneurysms
COARCTATION: clinical features 1
Vary according to ageInfancy
Usually in heart failure
Tachypnoea
Feeding problems
Sweating
Signs
Gallop rhythm
Systolic murmur LSE and also posteriorly ( over coarctation site)
Radio-femoral delay or absence of femoral pulse.
COARCTATION: Clinical features 2
Childhood ( 1-14yrs )Most are asymptomatic
Upper extremity hypertension occur in 90%
CXR – cardiomegaly and rib notching
ECG – Left Ventriclar hypertrohpy
COARCTATION: Clinical features 3
Adolescence and Adult life ( >14yrs )Many still asymptomatic
Hypertension very common and more severe
Heart failure usually occurs at ≥30yrs
Palpable collateral circulation posteriorly
Rib notching on CXR
Figure 3 sign in CXR left upper mediastinal shadow
COARCTATION: Treatment
MedicalTreatment of heart failure
Control of hypertension when present
Surgical
Definitive treatment
Coarctetomy + end to end anastomosis
Subclavian flap aortoplasty
Prosthetic patch graft aortoplasty
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