Coarctation of aorta

COARCTATION OF AORTA

1. AMRUTHA R 1 st yr MSc nursing 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. CAUSE DUCTUS TISSUE THEORY HEMODYNAMIC THEORY

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

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

7. EMBRYOLOGY

8. EMBRYOLOGY

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

10. RT COMMON CAROTID RT SUB CLAVIAN BRACHIO CEPHALIC LT SUB CLAVIAN LEFT COMMON CAROTID

11. DUCTAL PREDUCTA L POSTDUCTAL TYPES

12. PREDUCTAL

13. DEVELOPMENTAL PATTERNS LOCALISED LESION

14. HYPOPLASTIC SEGMENT

15. SIMPLE

16. COMPLEX

17. GENETIC DISORDERS

18. PATHOPHYSIOLOGY EARLY DAYS PDA ACYNOTIC

19. Post ductal POSTDUCTAL

20. 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

21. CARDINAL FEATURES HTN – Upper body Palpable collaterals Thrill Heave

22. CLINICAL FEATURES PULSES BP MURMUR

23. INFANT DEPENDS ON PATENCY OF PDA ShocK and HF METABOLIC DISTURBANCES Hypothermia Hypoglycemia Hypo perfusion Renal failure

24. Child Upper extrimity HTN Widened pulse pressure Varibility in rt and lt arm pressures Murmurs

25. . 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

26. . 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.

27. Others 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

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

29. cardiomegaly Rib notching 3 sign X RAY

30. RIB NOTCHING

31. ECHO 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

32. ECG MRI BARIUM SWALLOW CARDIAC CATHETERISATION

33. MANAGEMENT MEDICAL Initial stabilisation Ionotropic drugs Prostaglandin E 1 IV .01mcg/kg/ mt

34. SURGICAL REPAIR

35. END TO END ANASTAMOSIS EXCISION OF COA INTERRUPTED SUTURING

36. LEFT SUB CLAVIAN FLAP LIGATE LT SUB CLAVIAN ARTERY CLOSE SUBCLAVIAN ARTERY FLAP OVER THE COA AND SUTURE IN PLACE

37. PROSTHETIC PATCH AORTOPLASTY LONGITUDINAL INCISION MADE ACROSS COA AREA ENLARGED WITH PATCH

38. BYPASS GRAFT A TUBE IS SEWN BETWEEN ASCENDING AND DESCENDING AORTA

39. BALLOON ANGIOPLASTY

40. STENT IMPLANTATION

41. COMPLICATIONS Residual COA Recurrent COA Systemic arterial HTN CAD PROGRESSIVE VALVE DISEASE Bicuspid stenosis Bicuspid regurgitation Aortic aneurysm Bact endocarditis