Saturday, November 13, 2010

Coarctation of aorta

Coarctation of the Aorta
Narrowing of aorta causing elevation of pressure proximally and decreased pressure distally.

1 - pinched or coarcted aorta
Flow patterns are normal but are reduced below
the coarctation. Blood pressure is increased in
vessels leaving the aorta above the coarctation.
The broken white arrow indicates diminished
blood flow through the aorta.

Obstructive defect... Generally, severe stenoses in the neonatal period are associated with CHF symptoms and/or cyanosis depending on the location of the lesion.

Constriction of aorta either discrete or significant in length.

Almost always at the junction of the ductus and aorta just distal to the left subclavian artery.

Most severe form of coarctation is the interrupted aortic arch which is a congenital absence of a portion of the aorta.

Young patients may present in the first 3 weeks of life with poor feeding, tachypnea, and lethargy and progress to overt CHF and shock.

Keys to the diagnosis include blood pressure discrepancies between the upper and lower extremities as well as reduced or absent lower extremity pulses to palpation.

Differential cyanosis (pink upper extremities with cyanotic lower extremities) may occur when right-to-left flow across a PDA provides lower body flow. Although often not obvious to the eye, this may be documented by preductal and postductal pulse oximetry.

IV, O2, Monitor.

3cc/kg/hr D10W  for infants under 1 year of age, D5W if over 1 year.

Check pulse ox pre-ductal and post-ductal.

Severe CHF may benefit from intubation with positive pressure ventilation and Lasix

Prostaglandins to open Ductus

Foley catheter insertion to follow renal perfusion and urine output.

ABG to follow acidosis.

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