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COARCTATION OF

THE AORTA
Diane D. Sosa

Case
Miss Sathi, 24 years old, admitted into
the hospital with the complaints of 1) Headache, dizziness and fatigue-2
years
2) Shortness of breath- 2 years.
3) Pain in leg after prolong walking- 2
years.
B.P- 180/90mmHG ( in arm)
Leg- not recordable.

Pulses
Radial
Brachial
Axillary
Carotid
Femoral
Popliteal
Post. Tibial
Dorsalis pedis

Right
+
+
+
+
-

Left
+
+
+
+
-

AuscultationAn ejection systolic


murmur over left
sternal border, more
prominent over
infrascapular region.
Provisional
diagnosisCoarctation of
aorta

What is Coarctation of the


Aorta
A congenital
narrowing of upper
descending thoracic
aorta adjacent to the
site of attachment of
ductus arteriosus.

This narrowing
restricts the
amount of
oxygen-rich
(red) blood
that can travel
to the lower
part of the
body.

Coarctation of aorta
8-10% of CHDs
M:F ratio 2:1
Pathology: indentation involving anterior,
lateral & posterior wall of aorta

Types

PREDUCTAL TYPE
1. PDA is patent and large
and provide blood flow
to lower extremity.
2. Tubular narrowing of
isthmus
3. No shelf like narrowing
in aorta.
4. Minimal post stenotic
dilatation of aorta.
5. Minor enlargement of
intercostal arteries.

POSTDUCTAL TYPE
1. The ductus is closed and
no longer acts as a shunt.
2. No narrowing of isthmus.
3. Shelf like narrowing with
in the aorta in juxtaductal
position.
4. Post stenotic and
prestenotic aorta is
dilated.
5. Intercostal arteries are
grossly dilated.

Preductal type(infantile)

Adult type CoA

Shortness of breath, especially when


exercising
Intermittent claudication
Fatigue
Frequent nose bleeds
Dizziness or fainting
Chest pain, especially when exercising
Very cold legs and feet
Strong, throbbing headache

High blood
pressure
Abnormal
differences of
blood pressure and
arterial pulses in
upper and lower
extremities
Murmur

Collateral Circulation

Pressure

Volume

CXR PA View

Chest X ray

Chest X RAY

Echocardiogram

MRI

MANAGEMENT

Balloon Dilatation Angioplasty

Management
Treatment in patients with congestive heart failure
(CHF) includes the use of diuretics and inotropic
drugs.
Prostaglandin E1 (0.05-0.15 mcg/kg/min) is infused
intravenously to open the ductus arteriosus.
Ventilatory assistance is provided to patients with
markedly increased work of breathing.

Thank you!