COARCTATION AORTA BUTANOBLOG

CAUSATION

There is localized narrowing of the aortic arch in the region where the ductus arteriosus joins the aorta usually just distal to the origin of the left subclavian artery. The systolic pressure in the aorta and its branches proximal to coarctation is raised but this may not be present in early childhood. Through the obstruction only a small volume of blood passes to the lower limbs, naturally BP in the lower limbs will be low and collaterals will flare up. This develops through the intercostal arteries and branches of subclavian arteries. Associated abnormalities like Bicuspid aortic valve (commonest 20%), VSD,ASD,PDA, transposition of great vessels, abnormalities of mitral valve, subaortic stenosis, aortic regurgitation, aneurysm of circle of willis, etc. may be present. In 20% of cases this remains an isolate anomaly.

COARCTATION AORTA BUTANOBLOG

TEATURES OF COARCTATION AORTA:

  1. Common in males; when occurs in females there may be turner’s syndrome.
  2. Headache, giddiness due to high BP and or aneurysm of circle of willis.
  3. Cramps in the lower limbs due to less blood flow.
  4. BP in the upper limbs is raised and that in the lower limbs is low. Normally systolic BP in the lower limbs is either same or upto 40 mm of Hg higher than the systolic BP in the upper limbs. Pulse pressure in the arms is wide while that in the lower limbs reduced. After exercise the difference in systolic BP between arms and legs is exaggerated.
  5. Carotid pulsations are very prominent with prominent suprasternal pulsation. Femoral pulse are delayed by 0.03 second and weak in volume or absent. Clinically radio femoral delay is present.
  6. Collateral arterial pulsations are present around the scapulae, are better seen if the patient bends forward with arms handing down (suzman’s sing). Sometimes a continuous murmur may develop from this.
  7. Cardiac enlargement of left ventricular type with a systolic murmur over the sternum, loudest at the back may be present. A basal diastolic murmur (for Bicuspid aortic valve) and a mid-diastolic rumble over mitral area (due to fibroelastosis of mitral valve) may also be present.
  8. X-ray of chest shows cardiac enlargement, rid nothing due to enlarged collateral intercostal arteries, dilatation and left ventricular enlargement. (Dock’s sing) and double contour of aorta (Bramwell’s sing), E sing in barium oesophagogram may be present.
  9. ECG shoes left ventricular hypertrophy.
  10. Transoesophageal echocardiography can nicely describe the location, severity and length of coarctation.
  11. Doppler ultrasound will estimate degree of obstruction. MRI is also useful.COARCTATION AORTA BUTANOBLOG

COMPLICATIONS:

  1. Infective endocarditis at the site of coarctation.
  2. LV failure, common in infancy and old age.
  3. Subarachnoid haemorrhage due to rupture of congenital berry aneurysm.
  4. Aortic dissection and aortic rupture.

TREATMENT:

For haemodynamically significant cases resection of coarcted part is required. Now –a-days instead of end to end anastomosis patch aortoplasty or graft insertion is commonly done. operation is easy in children but very difficult in older patients. Percutaneous ballon dilatation is recently introduced but is not without complications. Mortality is 1%-4% during operation. This is highly recommended up to 20 years of age. In spite of operation hypertension persists.COARCTATION AORTA BUTANOBLOG

COARCTATION’S  THE AORTA BUTANOBLOG

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