Coarctation of Aorta
- Discrete stenosis of the upper thoracic aorta, usually just opposite the site of insertion of the ductus arteriosus (juxtaductal). A segment of tubular hypoplasia and/or a remnant of ductal tissue give rise to a prominent posterior infolding (“the posterior shelf”).
- The hemodynamic lesion is most often discrete but may be a long segment or tortuous in nature. It is usually juxtaductal but may occur in other sites (i.e., the abdominal aorta). The prevalence of other associations (bicuspid aortic valve) and long-term complications (hypertension) indicate that this lesion may be part of a broader spectrum arteriopathy and/or endothelial disorder.
- ∼6–8% of patients with congenital heart disease have coarctation.
- Male > female (1.5–4.0:1)
- Multifactorial: occurs in 35% of patients with Turner syndrome (XO)
- Has been described in cases of monozygotic twins
- Many studies document the prevalence of a microdeletion at 22q11 in patients with arch anomalies and ventricular septal defects.
- Decreased systemic blood flow to lower body after ductal closure
- Increased afterload to left ventricle (LV) causes LV hypertrophy. Relative underperfusion of the renal vessels, baroreceptors, and multiple other mechanisms combine to induce compensatory hypertension.
- If the coarctation is severe, LV dysfunction and congestive heart failure (CHF) result, with low cardiac output and increased LV end-diastolic pressure.
- Decreased myocardial perfusion may be present in cases of very low output.
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Cabana, Michael D., editor. "Coarctation of Aorta." Select 5-Minute Pediatrics Topics, 7th ed., Wolters Kluwer Health, 2015. 5-Minute Clinical Consult, www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14107/all/Coarctation_of_Aorta.
Coarctation of Aorta. In: Cabana MDM, ed. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14107/all/Coarctation_of_Aorta. Accessed June 9, 2023.
Coarctation of Aorta. (2015). In Cabana, M. D. (Ed.), Select 5-Minute Pediatrics Topics (7th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14107/all/Coarctation_of_Aorta
Coarctation of Aorta [Internet]. In: Cabana MDM, editors. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. [cited 2023 June 09]. Available from: https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14107/all/Coarctation_of_Aorta.
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TY - ELEC T1 - Coarctation of Aorta ID - 14107 ED - Cabana,Michael D, BT - Select 5-Minute Pediatrics Topics UR - https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14107/all/Coarctation_of_Aorta PB - Wolters Kluwer Health ET - 7 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -