Coarctation of Aorta

Types
1- Infantile type:

  • incompatible with life.
  • proximal to Lt. Pr** very high pr. in
  • subclavian head & neck
  • cerebral hge.


2- Adult type
pr*distal to Lt. subclavian.
Pr¯

Heamodynamics

  • Pr* collaterals
  • intecostal anastomosis
  • Vs around
  • pr¯scapula.
  • Upper ½ pr. *
  • Lower ½ pr. ¯ collaterals to by pass obstruction


C/P
associations aneurysm of the circle of
willis.(Berry An)
bicuspid Aortic valve
1. Bl. Pr
** in upper limbs – radiofemoral delay
2. Headache, epistaxis
3. L.L. ischaemia. claudication pain.
4. Suzman sign pulsating intercostal Vs in the back
5. Murmur 3
late systolic murmur back early diastolic machinery murmur 3rd Lt. interscapular murmur d.t. over the collaterals due to coarctation. A. I.
d.t. associated dilated Aorta. bicuspid Aortic valve
with A.I A.I

Investigations (MRI)
1. X-ray double Aortic knuckle
2. Aortography.
3. Catheter Pr. gradient across the coarctation
4. Rosler’s sign.
notches in the lower parts of ribs d.t. dilated intercostal vs

Treatment
resection & anastomosis
In severe cases prosthetic vascular graft

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)