Aortic coarctation

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Aortic coarctation Microchapters
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Overview
Historical Perspective
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Pathophysiology
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Differentiating Aortic Coarctation from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Electrocardiogram
Chest X-Ray
CT
MRI
Angiography
Echocardiography
Treatment
Medical Therapy
Surgery
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Diagnosis

Symptoms | Physical examination | Electrocardiogram

With severe coarctation, left ventricular hypertrophy LVH may be present.

Chest X Ray

Irregularities or notching of the inferior margins of the posterior ribs results from collateral flow through dilated and pulsatile intercostal arteries. These collaterals appear after 6 years of age if the coarctation is significant.

Post-stenotic dilation of the aorta results in a classic 'reverse 3 sign' on x-ray. The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the aortic wall at the site of cervical rib obstruction, with consequent post-stenotic dilation. This physiology results in the reversed '3' image for which the sign is named.

Chest X-ray below showing 3 sign and arrows pointing to notching of ribs.

Echocardiography

• Useful in determining associated abnormalities.

• Weyman et al were able to visualize this area and make the diagnosis on 2D echo in 16/18 patients.

• Confirmation by cardiac catheterization is unnecessary. Only done when the diagnosis is unclear, which is rare. It is mandatory in the infant to determine preoperative anatomy.

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Angiography

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MRI

Magnetic resonance imaging (MRI) can define the location and severity of a coarctation. MRI can also detect associated cardiac abnormalities and is used for serial follow-up after surgical repair or balloon angioplasty. MR angiography has almost completely replaced invasive catheter based techniques for evaluating re coarctation. In adults with untreated coarctation blood often reaches the lower body through collaterals, eg. internal thoracic arteries via. the subclavian arteries. Those can be seen on MR or angiography.

Schematic drawing of alternative locations of a coarctation of the aorta, relative to the ductus arteriosus. A: ductal coarctation, B: preductal coarctation, C: postductal coarctation. 1: Aorta ascendens, 2: Arteria pulmonalis, 3: Ductus arteriosus, 4: Aorta descendens, 5: Trunchus brachiocephalicus, 6: Arteria carotis communis sinister, 7: Arteria subclavia sinister

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  [Courtesy of RadsWiki and copylefted]

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  [Courtesy of RadsWiki and copylefted]

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  Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

CT

CT images shown below are courtesy of Cafer Zorkun and copylefted

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  Aortic Coarctation

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  Aortic Coarctation

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  Aortic Coarctation

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  Aortic Coarctation

Therapy

Therapy is conservative if the patient is asymptomatic. If symptoms or hypertension are present, treatment for coarctation may be surgical or catheter based. The treatment choice depends on the patients age, the location of the coarctation and other associated anomalies. Recoartctaion after previous surgery is treated percutaneously with either balloon dilation and/or stenting.

External links

• A case of coarctation of the aorta was published in the New England Journal of Medicine in 2007 showing chest X-Rays and MRT Images.
• Aortic Coarctation information from Seattle Children's Hospital Heart Center
• Overview and diagram at childrenscentralcal.org
• Diagram at kumc.edu
• Overview and diagram at umich.edu
• [3]

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