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Coarctation of the aorta (CoA) (Clinical presentation (Asymptomatic …
Coarctation
of the aorta (CoA)
Definition
Congenital narrowing
of the aorta
Epidemiology
Rare, 5% congenital heart disease
Commonest cause of LV
outflow obstruction and collapse
Pathophysiology
Defect
Arterial duct tissue encircles aorta at point of insertion into the duct; when duct closes, aorta also constricts
Can result in complete or partial narrowing of aorta
Mechanism
Becomes more severe over time,
with symptoms often not apparent until
adulthood
If severe, may be duct dependent and
so present on day 1-2 of life
Clinical
presentation
Asymptomatic
(adult type)
Cyanosis
(if duct dependent)
Acute HF
(if duct dependent)
Shock
(if duct dependent)
Diagnosis
Examination
Cardio
HTN in R arm (due to minimal reaching left)
Radio-femoral delay (bypasses via collaterals in chest)
Absent femoral pulses (neonate)
Murmur (ejection systolic at ULSE; continuous radiating to back)
Investigations
Bloods
Cap blood gas (metabolic acidosis),
FBC, U+E, LFT
Imaging
CXR: rib notching (collateral intercostal arteries);
notch in descending aorta (3 sign); cardiomegaly (HF)
Bedside
Obs (HTN R arm)
ECG (normal or LVH if longstanding)
History
PMH
Growth and development
Known medical conditions
FH
Cardiac disorders
Cosanguinuity
POH
Antenatal: scans, bloods, growth
Perinatal: gestation, delivery, weight
Postnatal: growth, complications
SH
Living arrangements
School/occupation
PC/HPC
Asymptomatic
Cyanosis day 1-2
DH
Meds, allergies
Management
Definitive
Conservative
Information, advice, support
Referral cardio/paeds ASAP
Medical
Prostaglandins
Indication: asap in cyanosed neonate
E.g. aloprostil
MOA: inhibits DA closure, preserving duct
Surgical
Repair surgery
Indication: ASAP in neonates; adults if stent not suitable
MOA: surgical repair of coarctation
Stent
Indication: adults with severe disease per ECHO
MOA: stent inserted in coarctation
Initial ABCDE
