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Sunday, February 20, 2011

COARCTATION OF THE AORTA

Narrowing of the aorta most commonly occurs in the region where the ductus arteriosus joints the aorta, i.e. just below the origin of the left subclavian artey. The condition is more common in males, and is sometimes associated with other abnormalities, Of which the most frequent is a bicuspid aortic valve.
 Acquired coarctation of the aorta is rare; it may follow trauma, or be complication of a progressive arteritis.

Clinical features
Aortic caorctation is an important cause of cardiac failure in new born, but symptoms are often absent in older children or adults. Headaches may occur from hypertension on the upper part of the body, and occasionally weakness or cramps in the legs may result from decreased circulation in the lower part of the body. The blood pressure is raised in the arms normal or low in the legs. Unduly large arterial pulsations may be seen in the neck. The femoral pulses are weak, and delayed after the radial. Asystolic murmur may sometimes be heard over the coarctation posteriorly. There may also be an ejection systolic murmur in the aortic area. Evidence of a collateral circulation may be detectable in older children and adults in the form of visible or palpable dilated and tortuous arteries around the scapulae and  below the ribs posteriorly.
Radiological examination in early childhood is often normal but at a later age may show changes in the contour of the aorta and notching of the under surfaces of the ribs from tortuous loops of enlarged intercostal arteries. The ECG may show left ventricular hypertrophy.

Management
In untreated severe cases, death may occur from left ventricular failure, dissection of the aorta or cerebral hemorrhage. Surgical correction is advisable in all but the mildest cases. If this is done early enough in childhood the risk of persistent hypertension may be avoided, but patients operated on in late childhood or adult life often remain hypertensive or become hypertensive again. Coexistent aortic valve disease is another reason for long-term follow-up.

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