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Obstructive lesions

•  LVOT ( Aortic stenosis) •  RVOT (Pulmonary stenosis) •  Coarctation of the aorta •  Characterised by : - increased pressure proximal to obstruction - decreased pressure distal to obstruction - hypertrophy of chamber proximal to lesion -gradient across obstruction

Coarctation of Aorta

•  Narrowing of aorta opposite ductus •  M:F 2:1. 5-7% CHD. Turner’s syn

20-30% •  70-85% associated with Bicuspid AV. •  Associated anomalies MI, AS, VSD, PDA

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Coarctation of the aorta

Coarctation of the aorta

•  Narrowing of the aorta opposite the ductus •  Hypertension proximal to and hypotension

distal to the ductus (systolic pressures primarily affected)

•  Increased afterload on LV, increased wall tension causing LV hypertrophy

•  Femoral pulses delayed, weakened or absent.

Coarctation of aorta clinical

•  Present in CCF in NB, early infancy (with AS, VSD narrowing of proximal aorta)

•  Asymptomatic, on examination at any age abnormal femoral pulses

•  In older child or adult life with hypertension and complications CCF, CVA.

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Coarctation Physical examination

- Normal growth and development - +/- evidence of CCF - ABSENT, WEAK OR DELAYED

FEMORAL PULSES - Abnormal 4-limb BP’s - LVH. Loud S1. Murmur of Bicusp. AV or

collaterals (continuous, L infra-scapular)

Coarctation Investigations

- ECG – NB may show RVH. LVH in child. - Cxray – normal or sl. enlarged heart rib notching 4-8th ribs >5yrs old “3” sign - 2DE – narrowing, Bicusp AV, abnormal

flow on Doppler, assocd anomalies

Rib notching in Coarctation of the aorta

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Coarctation of the aorta

Coarctation Complications

•  CCF in NB and infancy (death) •  Infective endocarditis on Bicusp AV •  Systemic hypertension and its

complications in child and adult •  Rarely rupture of proximal aorta in older

life

Coarctation Treatment

•  Medical for CCF and hypertension •  Surgery is the definitive treatment

•  Post-op may have hypertension needing drug Rx

•  Re-coarctation usually treated with balloon angioplasty