Coarctation of the aorta: Difference between revisions
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==Background== | ==Background== | ||
[[File:Coarctation.jpg|thumb|]] | [[File:Blausen 0243 CoarctationofAorta CloseUp.png|thumb|Coarctation of the aorta.]] | ||
[[File:Coarctation.jpg|thumb|Coarctation of the aorta.]] | |||
*Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery | *Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery | ||
**Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian<ref>https://newbp.bmj.com/topics/en-gb/698</ref> | **Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian<ref>https://newbp.bmj.com/topics/en-gb/698</ref> | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Coarctation CXR.jpg|thumb|]] | [[File:Coarctation CXR.jpg|thumb|Chest x-ray showing classic findings for coarctation of the aorta.]] | ||
[[File:1440px-Co.A. 01- 4 M Kind - Z. n. End-zu-End.jpg|thumb|Coarctation of the aorta on cath.]] | |||
*[[CXR]] | *[[CXR]] | ||
**Rib notching due to collateral blood vessels | **Rib notching due to collateral blood vessels | ||
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==External Links== | ==External Links== | ||
*[https://www.acep.org/how-we-serve/sections/pediatric-emergency-medicine/pedemmorsels/coarctation-of-the-aorta-in-the-older-child/ ACEP - Coarctation of the Aorta in the Older Child] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] [[Category:Cardiology]] | [[Category:Pediatrics]] [[Category:Cardiology]] | ||
Latest revision as of 16:55, 13 November 2024
Background
- Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery
- Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian[1]
- ~7% of live births with congenital heart disease [2]
- Associated with bicuspid aortic valve (50%), VSD, PDA
Clinical Features
- Systolic murmur, often conducted to back
- Weak or absent femoral pulses, leg claudication, exercise intolerance
- Upper limb hypertension
- Usually diagnosed within first year of life, when presentation typically dramatic, particularly after closure of PDA in ductal-dependant critical coarctations.
- Consider in all critically ill neonates, particularly with poor perfusion to lower extremities
- Heart failure, shock
- Less severe coarctations may go undiagnosed for years, but can still lead to complications long-term[3]:
Differential Diagnosis
Sick Neonate
THE MISFITS [4]
- Trauma
- Heart
- Congenital heart disease
- Hypovolemia
- Endocrine
- Metabolic
- Sodium
- Calcium
- Glucose
- Inborn errors of metabolism
- Seizure
- Formula / feeding problems
- Intestinal Disasters
- Toxin
- Sepsis
Evaluation
- CXR
- Rib notching due to collateral blood vessels
- "Figure 3" sign seen in 50% of patients
- Abnormal aortic knob shadow due to coarct and dilation of left subclavian
- EKG: LVH +/- LA enlargement
- Echocardiography
- Cardiac MRI
Management
Neonate in Shock (duct-dependent lesion)
- PGE1 0.1mcg/kg/min IV/IO
- Side Effects:
- Apnea (intubate)
- Hypotension
- Bradycardia
- Flushing
- Apnea (intubate)
- Side Effects:
- NS 10cc/kg
- Dobutamine
CHF
- O2 (give only if SpO2 <95%)
- Furosemide 1-2mg/kg IV
- Dopamine 5-10mcg/kg/min
- Dobutamine 5-10mcg/kg/min
Disposition
- Admit
See Also
External Links
References
- ↑ https://newbp.bmj.com/topics/en-gb/698
- ↑ Rosenthal E. Coarctation of the aorta form fetus to adult: curable condition or life long disease process? Heart Nov 2005; 91(11): 1495-1502
- ↑ https://pedemmorsels.com/coarctation-of-the-aorta-in-older-children/
- ↑ Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.