Correction of coarctation of the aorta
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
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The audio recording shown in this video is from a patient who is 18 years of age and who had undergone surgery for correction of coarctation of the aorta. The recording is taken from the left sternal border area. All of the following are correct except: (A) The S1 is split and the second component is sharp and suggestive of an ejection click, (B) There is a mild tachycardia noted, (C) There is a mid-diastolic rumble getting louder and ending in a loud split S1, (D) There is a decrescendo blowing diastolic murmur starting with the S2. The likely cause of the auscultatory findings is: (A) Aortic dissection as a result of surgical complication of the coarctation repair, (B) Aortic valve disease of rheumatic origin, (C) Bicuspid aortic valve, (D) Dilated aortic root and ascending aorta secondary to coarctation. The audio recordings clearly show a split S1, the second component of the split being quite sharp and suggestive of an aortic ejection click. This is commonly noted with a bicuspid aortic valve which is most commonly an associated lesion with the coarctation of aorta. Often bicuspid aortic valves are accompanied by aortic regurgitation. The decrescendo diastolic blowing murmur in this patient is characteristic of the same.

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