Aortic coarctation

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Aortic coarctation
ICD-10 Q25.1
ICD-9 747.10
OMIM 120000
DiseasesDB 2876
eMedicine med/154 
MeSH D001017
Sketch showing heart with coarctation of the aorta. A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:pulmonary artery, 10:Aorta

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WikiDoc Resources for Aortic coarctation

Articles

Most recent articles on Aortic coarctation

Most cited articles on Aortic coarctation

Review articles on Aortic coarctation

Articles on Aortic coarctation in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Aortic coarctation

Images of Aortic coarctation

Photos of Aortic coarctation

Podcasts & MP3s on Aortic coarctation

Videos on Aortic coarctation

Evidence Based Medicine

Cochrane Collaboration on Aortic coarctation

Bandolier on Aortic coarctation

TRIP on Aortic coarctation

Clinical Trials

Ongoing Trials on Aortic coarctation at Clinical Trials.gov

Trial results on Aortic coarctation

Clinical Trials on Aortic coarctation at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Aortic coarctation

NICE Guidance on Aortic coarctation

NHS PRODIGY Guidance

FDA on Aortic coarctation

CDC on Aortic coarctation

Books

Books on Aortic coarctation

News

Aortic coarctation in the news

Be alerted to news on Aortic coarctation

News trends on Aortic coarctation

Commentary

Blogs on Aortic coarctation

Definitions

Definitions of Aortic coarctation

Patient Resources / Community

Patient resources on Aortic coarctation

Discussion groups on Aortic coarctation

Patient Handouts on Aortic coarctation

Directions to Hospitals Treating Aortic coarctation

Risk calculators and risk factors for Aortic coarctation

Healthcare Provider Resources

Symptoms of Aortic coarctation

Causes & Risk Factors for Aortic coarctation

Diagnostic studies for Aortic coarctation

Treatment of Aortic coarctation

Continuing Medical Education (CME)

CME Programs on Aortic coarctation

International

Aortic coarctation en Espanol

Aortic coarctation en Francais

Business

Aortic coarctation in the Marketplace

Patents on Aortic coarctation

Experimental / Informatics

List of terms related to Aortic coarctation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.


Overview

History

Epidemiology and demographics

Classification

Anatomy

Pathophysiology

Natural History

Genetics

Complications

Associated conditions

Diagnosis

Symptoms

Patients may complain of a headache most likely due to the presence of hypertension.

Physical Examination

Vital Signs

Blood Pressure

Arterial hypertension in the right arm with normal to low blood pressure in the lower extremities is classic. The blood pressure is higher in the upper extremities than in the lower extremities. The patient may complain of a headache due to hypertension.

Pulses

Femoral pulses are often diminished in strength. Exercise exacerbates this gradient.

If the coarctation is situated before the left subclavian artery, the left pulse will be diminished in strength and asynchronous radial pulses will be detected in the right and left arms. A radial-femoral delay between the right arm and the femoral artery may be apparent, while no such delay may be observed with left arm radial-femoral palpation.

A coarctation occurring after the left subclavian artery will produce synchronous radial pulses, but radial-femoral delay will be present under palpation in either arm.

Neck

There may be "webbing" of the neck in patients with Turner syndrome, 10% of whom have aortic coarctation.

Heart
  • A systolic ejection click is present when there is an associated bicuspid aortic valve.
  • An S4 may be present secondary to LVH
  • There are 3 potential sources of a murmur: arterial collaterals, an associated bicuspid aortic valve, and the coarctation itself which can be heard over the spine.
Extremities

Cyanosis of the lower extremities may be present.

Occasionally adults may have narrow hips and thin legs or have an undeveloped left arm (in those patients in which the coarctation compromises the origin of the subclavian artery).

Laboratory Findings

Electrocardiogram

With severe coarctation, left ventricular hypertrophy LVH may be present.

Chest X Ray

Irregularities or notching of the inferior margins of the posterior ribs results from collateral flow through dilated and pulsatile intercostal arteries. These collaterals appear after 6 years of age if the coarctation is significant.

Post-stenotic dilation of the aorta results in a classic 'reverse 3 sign' on x-ray. The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the aortic wall at the site of cervical rib obstruction, with consequent post-stenotic dilation. This physiology results in the reversed '3' image for which the sign is named.[1][2][3]

Chest X-ray below showing 3 sign and arrows pointing to notching of ribs.

Echocardiography

  • Useful in determining associated abnormalities.
  • Weyman et al were able to visualize this area and make the diagnosis on 2D echo in 16/18 patients.
  • Confirmation by cardiac catheterization is unnecessary. Only done when the diagnosis is unclear, which is rare. It is mandatory in the infant to determine preoperative anatomy.

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Angiography

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MRI

Magnetic resonance imaging (MRI) can define the location and severity of a coarctation. MRI can also detect associated cardiac abnormalities and is used for serial follow-up after surgical repair or balloon angioplasty. MR angiography has almost completely replaced invasive catheter based techniques for evaluating re coarctation. In adults with untreated coarctation blood often reaches the lower body through collaterals, eg. internal thoracic arteries via. the subclavian arteries. Those can be seen on MR or angiography.

Schematic drawing of alternative locations of a coarctation of the aorta, relative to the ductus arteriosus. A: ductal coarctation, B: preductal coarctation, C: postductal coarctation. 1: Aorta ascendens, 2: Arteria pulmonalis, 3: Ductus arteriosus, 4: Aorta descendens, 5: Trunchus brachiocephalicus, 6: Arteria carotis communis sinister, 7: Arteria subclavia sinister

CT

CT images shown below are courtesy of Cafer Zorkun and copylefted

Therapy

Therapy is conservative if the patient is asymptomatic. If symptoms or hypertension are present, treatment for coarctation may be surgical or catheter based. The treatment choice depends on the patients age, the location of the coarctation and other associated anomalies. Recoartctaion after previous surgery is treated percutaneously with either balloon dilation and/or stenting.

References

  1. Sabatine, Marc (February 15, 2000). Pocket Medicine. Lippincott Williams & Wilkins. pp. 256 pages. ISBN 0781716497.
  2. Blecha, Matthew J. (August 30, 2005). "General Surgery ABSITE and Board Review (Pearls of Wisdom)". McGraw-Hill. ISBN 978-0071464314.
  3. Brady Pregerson (October 1, 2006). "Quick Essentials: Emergency Medicine, 2nd Edition". ED Insight Books. ISBN 0976155273.

External links

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Template:Link FA de:Aortenisthmusstenose it:Coartazione dell'aorta no:Koarktasjon av aorta nn:Koarktasjon sr:Коарктација аорте uk:Коарктація аорти


Template:WikiDoc Sources

  1. Quiros-Lopez R, Garcia-Alegria J (2007). "A medical mystery -- high blood pressure". N Engl J Med. 356 (25): 2630. PMID 17582073.