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Coarctation of the Aorta
Facts and Terms about Coarctation of the Aorta
7
Medical
Professional
09/23/2013

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Term

Coarctation of the Aorta (COA)

Definition
  • Narrowing of the lumen of the Ao by ductal bump
  • Constriction of the aorta at ductal area due to deformity in the media of the aorta
  • Decreased blood flow through the aortic arch during fetal life

     

     

     

Term

 COA and Echo

Definition
  • Best view: supra sternal notch
  • Look for Bi-leafet AoV
  • Measure narrowing
  • Color doppler 
  • CW across narrowing
  • Diastolic run-off doppler pattern in abdominal Ao
  • PW and CW at Narrowest Point

Term

COA Location

Definition
  • Usually located just past the left subclavian artery and just opposite the PDA (Ao isthmus)

  • Posterior shelf-like obstruction in the ductal region of the Ao
  • Or complete tubular hypoplasia of Ao
  • COA in transverse arch
  • Abdominal Ao COA
  • Rarely can be a part of many other left sided obstructions (Shone’s syndrome) 
Term

COA Symptoms

Definition
  • Symptoms usually begin to occur once the PDA starts to close
  • Obstruction causes an increase afterload of LV:  LVH, LV failure, PHTN
  • 2/3 of cases: Decreased or Impalpable femoral pulses , Systolic thrill (heard in SSN, and back)
  • 46% have Bi-L AoV (make sure you document) 

Term

COA Associated Defects

Definition
  • PDA 
  • VSD
  • Hypoplasia of Ao Arch
  • In infancy: Prostaglandins are given to infants to maintain ductal patency to keep lower body perfused

 

 

 

 

Term

Untreated COA

Definition
  • Higher blood pressures in the upper extremities
  • Lower blood pressures in the lower extremities
  • If PDA is open, adequate lower extremity profusion will be maintained
  • Can have organ failure if COA is severe and there is no perfusion to the organs
  • Adolescents and adults: may have developed prominent collaterals
Term

COA Surgery

Definition
  • Risk of reoccurrence or aneurysms

Resection End-to-End anastomosis

  • The COA portion of the Ao is resected. The two ends of the Ao are then sutured together end to end

Synthetic Patch aortoplasty

  • The coarcted portion of the Ao is resected and replaced with a synthetic patch or homograph
  • Advantage is preservation of LSCA, but there is an elevated risk of aortic aneurysm later in life

Left subclavian artery patch (AKA Subclavian Flap Aortoplasty)

  • A portion of the LSCA is excised and the artery is divided
  • Artery is closed at the proximal end, the tissue resulting from the division of the artery is used to repair the COA
  • Low rate of rejection or recurrence of COA
  • Disadvantage: loss of the LSCA and impaired blood flow to the left arm

 S/P COA

  • Stents can be placed to open up a re-COA area, can re-dilate the stented area as time goes on
  • May balloon to open the narrowed repaired area 
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