Post on 10-Apr-2016
description
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Obstructive lesions
• LVOT ( Aortic stenosis) • RVOT (Pulmonary stenosis) • Coarctation of the aorta • Characterised by : - increased pressure proximal to obstruction - decreased pressure distal to obstruction - hypertrophy of chamber proximal to lesion -gradient across obstruction
Coarctation of Aorta
• Narrowing of aorta opposite ductus • M:F 2:1. 5-7% CHD. Turner’s syn
20-30% • 70-85% associated with Bicuspid AV. • Associated anomalies MI, AS, VSD, PDA
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Coarctation of the aorta
Coarctation of the aorta
• Narrowing of the aorta opposite the ductus • Hypertension proximal to and hypotension
distal to the ductus (systolic pressures primarily affected)
• Increased afterload on LV, increased wall tension causing LV hypertrophy
• Femoral pulses delayed, weakened or absent.
Coarctation of aorta clinical
• Present in CCF in NB, early infancy (with AS, VSD narrowing of proximal aorta)
• Asymptomatic, on examination at any age abnormal femoral pulses
• In older child or adult life with hypertension and complications CCF, CVA.
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Coarctation Physical examination
- Normal growth and development - +/- evidence of CCF - ABSENT, WEAK OR DELAYED
FEMORAL PULSES - Abnormal 4-limb BP’s - LVH. Loud S1. Murmur of Bicusp. AV or
collaterals (continuous, L infra-scapular)
Coarctation Investigations
- ECG – NB may show RVH. LVH in child. - Cxray – normal or sl. enlarged heart rib notching 4-8th ribs >5yrs old “3” sign - 2DE – narrowing, Bicusp AV, abnormal
flow on Doppler, assocd anomalies
Rib notching in Coarctation of the aorta
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Coarctation of the aorta
Coarctation Complications
• CCF in NB and infancy (death) • Infective endocarditis on Bicusp AV • Systemic hypertension and its
complications in child and adult • Rarely rupture of proximal aorta in older
life
Coarctation Treatment
• Medical for CCF and hypertension • Surgery is the definitive treatment
• Post-op may have hypertension needing drug Rx
• Re-coarctation usually treated with balloon angioplasty