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Although present at birth coarctation of the aorta

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Although present at birth, coarctation of the aorta may not cause symptoms until early childhood and sometimes not until latechildhood, depending on the severity of the coarctation, and the presence of associated cardiac lesions.If a ventricular septal defect is alsopresent and is large, the coarctation of the aorta will cause increased left to right shunting across the defect, producing congestive heartfailure within the first few months of life as the pulmonary resistance decreases after birth.A patent ductus arteriosus located proximal to
Page - 273the coarctation would likewise increase pulmonary shunting through the ductus resulting in congestive heart failure.If the ductus islocated distal to the coarctation, signs and symptoms may be delayed.Other anomalies associated with aortic coarctation include a bicuspid aortic valve (85%) (3) that may obstruct left ventricularoutput, and an aberrant origin of the right subclavian artery distal to the coarctation (1%) (4).The latter will cause the blood pressure ofthe right arm to be equal to the leg, and may mislead one from the correct diagnosis.It is important to measure the blood pressure in botharms and at least one leg in order to detect the blood pressure differential caused by an aortic coarctation.If coarctation of the aorta is an isolated lesion, the typical symptoms may include:shortness of breath with exertion, leg pain withexercise, and rarely, chest pain with exercise.Physical findings include:upper extremity hypertension with a blood pressure differentialbetween arm and leg (obtain BP in both arms and one leg), a systolic murmur heard along the left sternal border and especially well overthe back between the scapulae, and diminished and delayed pulses in the lower extremities when compared with the upper extremities.Achest x-ray may display cardiomegaly with a left ventricular hypertrophy configuration.In long standing cases, rib notching due to erosionof the lower anterior portion of the rib by dilated collateral arteries can be appreciated.The echocardiogram demonstrates narrowing of thedistal aortic arch with increased velocities on pulsed and color Doppler.The pulsed Doppler waveform has a typical prolonged systolicphase extending throughout systole.The MRI produces a static but clearer picture, than the echocardiogram, of the anatomy of thecoarctation.An angiogram is sometimes necessary to clarify associated cardiac lesions.There are several surgical techniques used to repair a coarctation of the aorta. Each technique has had its own proponents at onetime or another.If the coarcted segment is short and discrete, resection and end to end anastomosis of the proximal and distal ends ispossible.If the coarctation is a long tubular obstruction, resection with interposition of a tube graft would be necessary.Some surgeonsfavor a longitudinal incision with insertion of a synthetic graft to enlarge the diameter.In the young infant, sacrificing the left subclavianartery, and using the transected blood vessel as a graft by turning it down and sewing it into the aortic wall was popular at one time (5).

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Nursing, Pediatrics, Physician, John A Burns, Hawaii John A

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