Coarctation of the Aorta

Coarctation (narrowing)

Aorta (the great artery arising form the left ventricle, being the main trunk from which the systemic arterial system proceeds)

Coarctation of the aorta:  This narrowing of the aorta occurs usually just below the left subclavian artery, near the site where the ligamentum arteriosum (the remnant of the ductus arteriosus, a fetal blood vessel) joins the pulmonary artery to the aorta.  The obstructive process causes hypertension in the aortic branches above the constriction (arteries that supply the arms, neck, and head) and diminished pressure in the vessels below the constriction.

Prognosis depends on the severity of associated cardiac anomalies.  Corrective surgery for isolated coarctation is required and prognosis is good (before his condition induces severe systemic hypertension or degenerative changes in the aorta).

Cause:  This disorder may develop as a result of spasm and constriction of the smooth muscle in the ductus arteriosus as it closes.

Symptoms:

Cardinal signs include resting systolic hypertension, absent or deminished femoral pulses, and widened pulse pressure.

In infants:  Tachypnea (very rapid respiration), dyspnea (difficulty breathing), pallor, tachycardia (abnormally rapid heart rate), cardiomegaly (hypertrophy of the heart), hepatomegaly (hepatomegaly (enlargement of the liver), and failure to thrive.

In adolescent:  may have dyspnea, claudication (limping), headache, and epistaxis (hemorrhage from the nose).  Inspection and palpation may reveal a visible aortic pulsation in the suprasternal notch.  Auscultation may reveal a continuous systolic murmur with an accentuated S2 and S3.

Treatment:

For infant with CHF caused by coarctation of the aorta, treatment consist of digoxin and diuretics.  If drug therapy fails, surgery may be necessary.

Note:  this disorder may not be detected until adolescence and that it can recur after initial surgery.

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