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Coarctation of the Aorta - Symptoms, Diagnosis and Treatment

Coarctation of the aorta is congenital heart disease. It means narrowing of the aorta. Narrowing can be before the ductus arteriosus. Which is called preductal coarctation And after the ductal, called postductal coarctation. Preductal coarctation also called infantile type. It Is presented during infancy, and if left untreated, patient will die during his infancy. Preductal coarctation is severe narrowing of aorta. It is associated with Turner syndrome. It is usually associated with patent ductus arteriosus. Patent ductus arteries causes Right ventricular hypertrophy. It is secondary process, Because right ventricle have to blood supply the aorta trough patent ductus arteriosus. Such patients also have congestive heart failure due to high load of the heart caused by coarctation. Cyanosis. Weak pulse on extremities. At this case, prognosis is poor without surgical correction. Post ductal coarctation usually occurs among adults. Sometimes it is asymptomatic. Aortic narrowing is presented after ductus arteriosus. Ductus arteriosus has no function, so it is usually closed. Classical picture: Younger adult comes to doctor’s office. Hypertension on the upper part of the body, upper extremities and lower pressure and weak pulse on lower extremities. To supply blood to lower part of the body, organism develops collateral circulation, with The internal mammary artery and intercostal arteries. Intercostal arteries becomes bigger and they causes notches on the lower border of ribs. So , weak pulse on the feet and via X-ray notches on the ribs its classical for aortic coarctation. Arm/leg systolic blood pressure difference, of 20 mm mercury or more in favor of the arms, may be considered as evidence for aortic coarctation. Coarctation of the aorta can be accurately diagnosed with magnetic resonance angiography. In teenagers and adults, echocardiograms may not be conclusive. Three main problem can arise from coarctation: 1. Heart failure, due to high load. Because of aortic narrowing. 2. High load and high pressure, before coarctation cause atherosclerotic damage of aortic wall, and over time aortic dissection can develop due to atherosclerotic damage 3. Blood pressure is high on upper part of the body. It may cause stroke. If left untreated, 75 % of patients will die out of these, 3 above mentioned reasons. before the age of 45. Treatment is conservative if asymptomatic, but may require surgical resection of the narrow segment if there is arterial hypertension. By Ivan Chang, Margit Heiske, Thierry Letellier, Douglas Wallace, Pierre Baldi - PLoS ONE, CC BY 2.5, https://commons.wikimedia.org/w/index... By Centers for Disease Control and Prevention - Centers for Disease Control and Prevention, CC0, https://commons.wikimedia.org/w/index... By .Koen - eigen werk, original by Mariana Ruiz LadyofHats, CC BY-SA 3.0, https://commons.wikimedia.org/w/index... By Associate Professor Frank Gaillard - https://radiopaedia.org/cases/6279, CC BY-SA 3.0, https://commons.wikimedia.org/w/index... https://s3.amazonaws.com/static.wd7.u... Published in AJR. American journal of roentgenology 2015 CT and MRI of aortic coarctation: pre- and postsurgical findings. A. Karaosmanoglu, R. D. Khawaja, M. Onur, M. Kalra