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18 Cards in this Set
- Front
- Back
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def
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presnt
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ds
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tx/ complications
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Coarctation of aorta most commonly found in:
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Coarctation of aorta most commonly found in:Turner syndrome(45,X).
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Bicuspid aortic valve:
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Bicuspid aortic valve: found in coarctation of aorta (70% ofcases) and in Turner syndrome <33-50% of cases).
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Most common site of coarctation
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Most common site of coarctation: just below origin of (L) subclavian artery found in 98% of cases (juxtaductal coarctation).
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Most serious complications of coarctation of aorta
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Most serious complications of coarctation of aorta: cardiac failure, premature coronary artery disease, hypertensive encephalopathy, or iruracranlal hemorrhage. All complications are due to hypertension. Infants with severe coarctation appear with heart failure and hypoperlusion.
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Classic sign of coarctation of aorta:
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Classic sign of coarctation of aorta: reduced pulse and blood pressure more in lower extremities than upper extremities. Pulses maybe absent up to 40%ofcases) in lower extremities.A delay in palpation of femoral pulses when both femoral and radial pulses palpated simultaneously. (Normally lower extremities BP is 10-20 of Hg higher than upper extremities. Normally femoral pulses are palpated earlier than radial pulses.)
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A case presentation of coarctation of aorta(important):
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A case presentation of coarctation of aorta(important):a child shows signs and symptoms of weakness(or pain)in both legs after exercise. Examination reveals more diminished pulse and blood pressure in lower extremities than upper extremities; a systolic ejection click or thrill is heard in suprasternal notch indicates presence of bicuspid aortic valve; a short systolic murmur is heard along sternal border at 300 and 4th intercostal spaces and murmur is transmitted to left infrascapular area.
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examination
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MOST LIKELY DIAGNOSIS: coarctation of aorta. Some older children are asymptomatic. However,a routine physical examination reveals high BP in upper extremities. Newborn may present with cardiac failure, lower body hypoperfusion, metabolic acidosis, systolic murmur along left sternal border with loud 2nd heart sound. Please remember, murmur is always present in coarctation of aorta. In newborns, lower extremities may be more cyanotic than upper extremities
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CHEST X-RAY:
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CHEST X-RAY: notching of inferior border of ribs due to enlarged collateral blood vessels is commonly found in late childhood, and a prominent shadow in left superior mediastinum is due to enlarged left subdavian artery. Newborns have cardiomegaly and pulmonary congestion.
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EKG:
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EKG: normal in young children or (L) ventricular hypertrophy in older children, right or biventricular hypertrophy in neonates and young infants.
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Preferred diagnostic method:
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Preferred diagnostic method: echocardiography
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TREATMENT:
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TREATMENT:
(a) NEWBORN WITH ACIDOSIS, HYPOPERFUSION: medical treatment (PGEj) , surgical repair is done when a patient is stabilized. (b) OLDER PATIENTS WITH CHF, NORMAL PERFUSION: anticongestive therapy before surgical repair. (c) OLDER CHILDREN WITH SIGNIFICANT COARCTATION: surgical repair without delay. Procedures are excision of coarctation with a primary anastomosis, patch aortop!asty, or repair coarctation with left subclavian artery flap. (d) PATIENT WITH PREVIOUS SURGICAL REPAIR:balloon angio plasty is procedure of choice because to repeat operationis very difficult. |
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Key words:
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Key words: diminished pulse and blood pressure in lower extremities, short systolic murmur which is transmitted to left infrascapular area.
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Most common postoperative complication of coarctation of aorta (important):
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Most common postoperative complication of coarctation of aorta (important): rebound hypertension needs antihypertensive therapy for a period of time, residual murmurs due to associated cardiac anomaly, flow disturbance in repaired area, and collateral blood flow. Apatient with left subclavian flap has diminished or absent left arm radial pulse and BP.
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Postcoartectomy syndrome (important for Board examination
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