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Chapter-18 Coarctation of the Aorta

BOOK TITLE: Clinical Diagnosis of Congenital Heart Disease

Author
1. Satpathy M
2. Sudhayakumar N
3. Nair BSJ
ISBN
9788184481617
DOI
10.5005/jp/books/10126_18
Edition
1/e
Publishing Year
2008
Pages
10
Author Affiliations
1. Haripur Road, Dolamundai, Cuttack, Odisha, India
2. Kottayam Medical College, Kottayam, Kottayam Medical College, Kottayam, Kerala, India
3. Kottayam Medical College, Kottayam, Kerala, India
Chapter keywords

Abstract

Acyanotic neonates with heart failure where pulses are not felt or are of very low volume, infantile coarctation of aorta (CoA) is strongly suspected. In children and adults CoA is an obstruction in the descending aorta near the attachment of ductus arteriosus or ligamentum arteriosum just distal to the origin of left subclavian artery. There is upper limb hypertension and diminished pulses in lower limbs. Brachio-femoral delay arouses suspicion of CoA. Ejection systolic murmur over right base and interscapular area is audible due to associated bicuspid aortic valve or due to flow of blood in the coarct segment, presence of ejection click indicates associated bicuspid aortic valve. CoA leads to the development of the collateral channels between the pre and post coarct segment of the aorta, designed to favor near normal flow to the lower half of the body. Chest X-ray shows bilateral rib notching in older children and adults involving mainly posterior aspect of 3rd, 4th and 5th rib in the inferior border because of compression by dilated tortuous posterior intercostals arteries due to collateral flow. Figure of ‘3’ sign on left upper cardiac border is due to pre and post coarct dilatation of aorta. ECG shows RVH in neonates, but in children and adults LVH is present. Echo with Doppler demonstrates the site and the degree of narrowing of coarct segment and associated lesions. Cardiac catheterization and angiocardiography is routinely done before surgery. Severe CoA is managed by surgery or by balloon angioplasty.

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