Cardiovascular Medicine Book

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Aortic CoarctationAka: Coarctation of the Aorta

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  1. See also
    1. Congenital Heart Disease
    2. Congenital Heart Disease Causes
  2. Epidemiology
    1. Incidence: 6% of Congenital Heart Disease
    2. More common in Males by a ratio of 1.7 to 1
  3. Associated Conditions
    1. Turner's Syndrome
    2. Bicuspid aortic valves (50%)
    3. Aortic Coarctation Syndrome
      1. Patent Ductus Arteriosus (PDA)
      2. Tubular hypoplasia the aortic isthmus
      3. Ventricular Septal Defect (VSD)
      4. Congestive Heart Failure
  4. Pathophysiology
    1. Constriction of aorta near isthmus
      1. Ductus arteriosus insertion
      2. Occurs below origin of left subclavian
  5. Etiology
    1. Congenital malformation
    2. Atherosclerosis
    3. Thrombosis
    4. Aortic aneurysm
    5. External compression
  6. Symptoms (May be asymptomatic)
    1. Epistaxis
    2. Intermittent Claudication
    3. Dizziness
    4. Headaches
    5. Tinnitus
  7. Signs
    1. Arterial Hypertension
    2. Diminished femoral pulses
    3. Femoral pulses lag brachial pulses
    4. Palpable pulsating arteries about scapula and axilla
  8. Radiology: Chest XRay
    1. Older Children
      1. Notching of the lower rib borders
      2. Displaced esophageal shadow rightward
    2. Infants with Congestive Heart Failure signs
      1. Cardiomegaly
      2. Pulmonary venous congestion
  9. Radiology: Echocardiogram
    1. Dilated Right Ventricle
    2. Hypoplastic Left Ventricle (Infants)
    3. Coarctation site
  10. Diagnostics: Electrocardiogram
    1. Right Ventricular Hypertrophy (Infants)
    2. Left Ventricular Hypertrophy (older child and adults)
  11. Management
    1. Infant with Congestive Heart Failure
      1. PGE1 to open ductus arteriosus (Neonates)
      2. Surgical Repair
  12. Management: Surgical Repair
    1. Indications
      1. Routine repair between ages 2 and 4
      2. Urgent repair
        1. Circulatory shock
        2. Cardiomegaly
        3. Severe Hypertension
        4. Severe Congestive Heart Failure
    2. Techniques
      1. Subclavian flap repair
      2. End to end anastomosis with resection
      3. Balloon Angioplasty (for recoarctation)
  13. References
    1. Saenz (1999) Am Fam Physician 59(7):1857
    2. Cyran (1998) PREP review lecture, October, Phoenix
    3. Merenstein (1994) Pediatrics :

Aortic coarctation (C0003492)

Definition (MSH)A birth defect characterized by the narrowing of the AORTA that can be of varying degree and at any point from the transverse arch to the iliac bifurcation. Aortic coarctation causes arterial HYPERTENSION before the point of narrowing and arterial HYPOTENSION beyond the narrowed portion.
Definition (CSP)congenital constriction of the aorta just distal to the left subclavian artery; causes upper body hypertension but few other symptoms; may present as headache or dyspnea on exertion.
ConceptsCongenital Abnormality (T019)
ICD9747.1, 747.10
MSHD001017
Englishaorta coarctation, Aortic Coarctation, Aortic Coarctations, Coarctation, COARCTATION OF AORTA, COARCTATION OF THE AORTA
Spanishcoartacion aortica, coartacion de aorta
Parent ConceptsCardiovascular Abnormalities (C0243050), Cardiac and circulatory congenital anomalies (C0810060), aorta obstruction (C0596118), Aortic coarctation (C0003492), Other congenital circulatory system anomalies (C0158625), Congenital Heart Defects (C0018798), Congenital stenosis of aorta (C0265890), Congenital anomaly of aortic arch AND/OR descending aorta (C1444210), Duplicate concept (C1274013)
SourcesAOD, CCS, COSTAR, CSP, CST, DXP, ICD9CM, LCH, MSH, MTH, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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