All are true about coarctation of aorta except –
Correct Answer: Boot shaped heart is a feature
Description: Ans. is 'd' i.e., Boot shaped heart is a featureCoarctation of aortao Coarctation of aorta (CoA) is a constriction of aorta due to sharp indentation involving anterior, lateral and posterior wall of aorta.o The medial wall is spared in the narrowing.o 98% of coarctation occur just below the origin of left subclavian occur at the origin of ductus arteriosus (Juxtaductal coarctation). It may occur just proximal to subclav ian A. also,o COA may be a feature of turner syndrome, and is associated with a bicuspid aortic valve,o When COA is associated with mitral valve abnormality and subaortic stenosis, it is referred to as shone complex.o Coarctation of Aorta is a quite common structural abnormality.o Males are affected twice often as females although females with Turner syndrome frequently have a coarctation,o Two classic forms of coarctation of Aorta have been described.1)An infantile form with tubular hypoplasia of the Aortic arch proximal to a PDA that is often asymptomatic in childhod. (This is known as coarctation syndrome).2) An "adult" form in which there is discrete ridge like infolding of the Aorta just opposite to closed ductus arteriosus.Although coarctation of Aorta may occur as a solitary defect it is accompanied by -o Bicuspid aortic valve in 50% cases and may be associated withCongenital Aortic stenosis, ASD, VSD, mitral regurgitation and Berry aneurysm of the circle of willis.Clinical manifestations of COAo Symptoms of coarctation of aorta occurs due to decrease in blood supply distal to aortic obstruction,o If obstruction is distal to left subclavian artery, manifestations are due to arterial insufficiency to lower limbs.Intermittent claudicationPainWeakness of LegDysnea on runningWeak pulses and lower BP in the lowrer extremities - Delayed or weak impalpable femorals compared to strong brachial arteries.o Collateral circulation develops between precoarctation arterial branches and the post coarctation arteries through enlarged intercostal and internal mammary arteries,o This produces radiologically visible erosions (notching) of undersurface (inferior) ofribs.o Hypertension - Headache, dizziness.o If the obstruction is proximal to left subclavian artery - Blood supply to left arm (supplied by left subclavian) is interrupted whereas blood supply to right arm is normal - Pressure difference in two arms.Murmur in coarctation of aortao The blood passing through the narrowed aorta - Midsystolic murmur in anterior part of chest, back and spinous process.o When lumen becomes severlv narrowed the blood flow through it, turns into a high velocity jet - Continous murmur.o COA is associated writh bicuspid aortic valve in 50-80% of patients. The bicuspid valve produce aortic regurgitation - Diastolic murmur.
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