Download - Coarctation of aorta
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AMRUTHA R1st yr MSc nursing
COARCTATION OF AORTA
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MORGAGNI in 176040 – 80 % patients have a bicuspid aortic valve.
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There is localised narrowing of the aortic arch, just distal or proximal to the ductus or ligamentum arteriosus
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CAUSE
DUCTUS TISSUE THEORY
HEMODYNAMIC THEORY
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EPIDEMIOLOGY
6-8% OF ALL CHD Male:female is 2:5
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Associations
Turners syndromeBicuspid aortiv valve 30-40%VSDPDAAortic stenosisMitral stenosis Intra cerebral associations
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EMBRYOLOGY
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EMBRYOLOGY
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EMBRYOLOGY
6—8 th week of gest 4th and 6th aortic arches4th arch Connect dorsal to ventral aorta Form aortic arch6th arch Develop distally to DA
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RT COMMON CAROTID
RT SUB CLAVIAN
BRACHIO CEPHALIC
LT SUB CLAVIAN
LEFT COMMON CAROTID
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DUCTAL
PREDUCTAL
POSTDUCTAL
TYPES
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PREDUCTAL
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DEVELOPMENTAL PATTERNS
LOCALISED LESION
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HYPOPLASTIC SEGMENT
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SIMPLE
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COMPLEX
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GENETIC DISORDERS
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PATHOPHYSIOLOGY
EARLY DAYS
PDA
ACYNOTIC
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Post ductal
POSTDUCTAL
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Perfusion of lower body depends upon rt ventricular output
Right to left shunting
Upper extrimities pink and lower blue
Severe pulmonary HTN
LT ventricular hypertrophyHEART FAILURE
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CARDINAL FEATURES
HTN – Upper body
Palpable collaterals
Thrill
Heave
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CLINICAL FEATURES
PULSES
BP
MURMUR
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INFANT
DEPENDS ON PATENCY OF PDA ShocK and HF METABOLIC DISTURBANCES Hypothermia Hypoglycemia Hypo perfusion Renal failure
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Child
Upper extrimity HTN
Widened pulse pressure
Varibility in rt and lt arm pressures
Murmurs
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. Grade 1 refers to a murmur so faint that it
can be heard only with special effort. A grade 2 murmur is faint, but is
immediately audible. Grade 3 refers to a murmur that is
moderately loud, and grade 4 to a murmur that is very
loud
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. A grade 5 murmur is extremely loud and is
audible with one edge of the stethoscope touching the chest wall.
A grade 6 murmur is so loud that it is audible with the stethoscope just removed from contact with the chest wall. In general, murmurs with an intensity of grade 4 or higher are accompanied by a palpable thrill.
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Others
Intermittent claudication (due to a temporary inadequate supply of oxygen to the muscles of the leg)
Pain and weakness of legs and
Dyspnea on running
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Investigations
ANTENATAL Fetal echo 16-18 weeks of gestation Helpful identifiers:
Long segment Small LV Dilated RV
Flow through ductus difficult to detect coarctation
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cardiomegaly
Rib notching
3 sign
X RAY
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RIB NOTCHING
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ECHO
High parasternal, suprasternal long axis
Shelf within lumen of thoracic aorta
Color and pulse wave doppler to locate area
Continuous wave doppler to detect maximum flow velocity
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ECG MRI BARIUM SWALLOW CARDIAC CATHETERISATION
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MANAGEMENT
MEDICAL Initial stabilisation Ionotropic drugs Prostaglandin E 1 IV .01mcg/kg/mt
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SURGICAL
REPAIR
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END TO END ANASTAMOSISEXCISION OF COA INTERRUPTED
SUTURING
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LEFT SUB CLAVIAN FLAP
LIGATE LT SUB CLAVIAN ARTERY
CLOSE SUBCLAVIAN ARTERY FLAP OVER THE COA AND SUTURE IN PLACE
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PROSTHETIC PATCH AORTOPLASTY
LONGITUDINAL INCISION MADE ACROSS COA
AREA ENLARGED WITH PATCH
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BYPASS GRAFT
A TUBE IS SEWN BETWEEN ASCENDING AND DESCENDING AORTA
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BALLOON ANGIOPLASTY
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STENT IMPLANTATION
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COMPLICATIONS
Residual COA Recurrent COA Systemic arterial HTN CAD PROGRESSIVE VALVE DISEASE Bicuspid stenosis Bicuspid regurgitation Aortic aneurysm Bact endocarditis