COARCTATION OF AORTA

1. COARCTATION OF
AORTA

2. MORGAGNI in 1760
40 – 80 % patients have
a bicuspid aortic valve.

3.  There is localised narrowing of the aortic
arch, just distal or proximal to the ductus
or ligamentum arteriosus

4.  DUCTUS TISSUETHEORY
 HEMODYNAMIC THEORY

5.  6-8% OF ALL CHD
 Male:female is 2:5

6.  Turners syndrome
 Bicuspid aortiv valve 30-40%
 VSD
 PDA
 Aortic stenosis
 Mitral stenosis
 Intra cerebral associations

7. EMBRYOLOGY

12.  6—8 th week of gest
 4th and 6th aortic arches
 4th arch
 Connect dorsal to ventral aorta
 Form aortic arch
 6th arch
 Develop distally to DA

14. RT
COMMON
CAROTID
RT SUB
CLAVIAN
BRACHIO
CEPHALIC
LT SUB
CLAVIAN
LEFTCOMMON
CAROTID

15. DUCTAL
PREDUCTAL
POSTDUCTAL
TYPES

18. LOCALISED
LESION

19. HYPOPLASTIC
SEGMENT

20. SIMPLE

21. COMPLEX

23.  EARLY DAYS
 PDA
 ACYNOTIC

24.  POSTDUCTAL

26.  Perfusion of lower body depends upon rt
ventricular output
 Right to left shunting
 Upper extrimities pink and lower blue
 Severe pulmonary HTN
 LT ventricular hypertrophy
 HEART FAILURE

27.  HTN – Upper body
 Palpable collaterals
 Thrill
 Heave

29.  PULSES
 BP
 MURMUR

30.  DEPENDSON PATENCY OF PDA
 ShocK and HF
 METABOLIC DISTURBANCES
 Hypothermia
 Hypoglycemia
 Hypo perfusion
 Renal failure

31.  Upper extrimity HTN
 Widened pulse pressure
 Varibility in rt and lt arm pressures
 Murmurs

32.  . Grade 1
 refers to a murmur so faint that it can be
heard only with special effort.
 A grade 2 murmur is faint, but is immediately
audible.
 Grade 3 refers to a murmur that is
moderately loud, and
 grade 4 to a murmur that is very loud

33.  . A grade 5
 murmur is extremely loud and is audible with
one edge of the stethoscope touching the
chest wall.
 A grade 6 murmur is so loud that it is audible
with the stethoscope just removed from
contact with the chest wall. In
general, murmurs with an intensity of grade 4
or higher are accompanied by a palpable
thrill.

34. Intermittent claudication (due to a
temporary inadequate supply of
oxygen to the muscles of the leg)
Pain and weakness of legs and
Dyspnea on running

35.  ANTENATAL
 Fetal echo
 16-18 weeks of gestation
 Helpful identifiers:
 Long segment
 Small LV
 Dilated RV
 Flow through ductus  difficult to detect
coarctation

36. cardiomegaly
Rib notching
3 sign
X RAY

37. RIB NOTCHING

39.  High parasternal, suprasternal long axis
 Shelf within lumen of thoracic aorta
 Color and pulse wave doppler to locate area
 Continuous wave doppler to detect
maximum flow velocity

40.  ECG
 MRI
 BARIUM SWALLOW
 CARDIAC
 CATHETERISATION

41.  MEDICAL
 Initial stabilisation
 Ionotropic drugs
 Prostaglandin E 1 IV
 .01mcg/kg/mt

42. SURGICAL
REPAIR

43. ENDTO END
ANASTAMOSIS
EXCISION
OF COA
INTERRUPTED
SUTURING

44. LEFT SUB
CLAVIAN FLAP
LIGATE LT SUB
CLAVIAN
ARTERY
CLOSE
SUBCLAVIAN
ARTERY FLAP
OVERTHE COA
AND SUTURE IN
PLACE

45. PROSTHETIC PATCH
AORTOPLASTY
LONGITUDINAL INCISION
MADE ACROSS COA
AREA ENLARGEDWITH
PATCH

46. BYPASS GRAFT
ATUBE IS SEWN BETWEEN
ASCENDING AND
DESCENDING AORTA

47. BALLOON ANGIOPLASTY

48. STENT
IMPLANTATION

49.  ResidualCOA
 Recurrent COA
 Systemic arterial HTN
 CAD
 PROGRESSIVE VALVE DISEASE
 Bicuspid stenosis
 Bicuspid regurgitation
 Aortic aneurysm
 Bact endocarditis