AMRUTHA R1st yr MSc nursing

COARCTATION OF AORTA

MORGAGNI in 176040 – 80 % patients have a bicuspid aortic valve.

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

CAUSE

DUCTUS TISSUE THEORY

HEMODYNAMIC THEORY

EPIDEMIOLOGY

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

Associations

Turners syndromeBicuspid aortiv valve 30-40%VSDPDAAortic stenosisMitral stenosis Intra cerebral associations

EMBRYOLOGY

EMBRYOLOGY

EMBRYOLOGY

6—8 th week of gest 4th and 6th aortic arches4th arch Connect dorsal to ventral aorta Form aortic arch6th arch Develop distally to DA

RT COMMON CAROTID

RT SUB CLAVIAN

BRACHIO CEPHALIC

LT SUB CLAVIAN

LEFT COMMON CAROTID

DUCTAL

PREDUCTAL

POSTDUCTAL

TYPES

PREDUCTAL

DEVELOPMENTAL PATTERNS

LOCALISED LESION

HYPOPLASTIC SEGMENT

SIMPLE

COMPLEX

GENETIC DISORDERS

PATHOPHYSIOLOGY

EARLY DAYS

PDA

ACYNOTIC

Post ductal

POSTDUCTAL

Perfusion of lower body depends upon rt ventricular output

Right to left shunting

Upper extrimities pink and lower blue

Severe pulmonary HTN

LT ventricular hypertrophyHEART FAILURE

CARDINAL FEATURES

HTN – Upper body

Palpable collaterals

Thrill

Heave

CLINICAL FEATURES

PULSES

BP

MURMUR

INFANT

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

Child

Upper extrimity HTN

Widened pulse pressure

Varibility in rt and lt arm pressures

Murmurs

. 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

. 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.

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

Investigations

ANTENATAL Fetal echo 16-18 weeks of gestation Helpful identifiers:

Long segment Small LV Dilated RV

Flow through ductus difficult to detect coarctation

cardiomegaly

Rib notching

3 sign

X RAY

RIB NOTCHING

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

ECG MRI BARIUM SWALLOW CARDIAC CATHETERISATION

MANAGEMENT

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

SURGICAL

REPAIR

END TO END ANASTAMOSISEXCISION OF COA INTERRUPTED

SUTURING

LEFT SUB CLAVIAN FLAP

LIGATE LT SUB CLAVIAN ARTERY

CLOSE SUBCLAVIAN ARTERY FLAP OVER THE COA AND SUTURE IN PLACE

PROSTHETIC PATCH AORTOPLASTY

LONGITUDINAL INCISION MADE ACROSS COA

AREA ENLARGED WITH PATCH

BYPASS GRAFT

A TUBE IS SEWN BETWEEN ASCENDING AND DESCENDING AORTA

BALLOON ANGIOPLASTY

STENT IMPLANTATION

COMPLICATIONS

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