Internal Medicine

P1: SBT

0521779407-03a CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:18

Aortic Coarctation 139

■Murmur mid systolic at anterior chest, back and spinous process,

may progress to continuous

■Occasionally poor lower extremity development

tests

Specific Diagnostic Tests:

■ECG: LVH

■chest x-ray: rib notching and “3” sign of aortic notch

Other Imaging Tests

■MRI/MRA offers good anatomic definition

■Echocardiography useful to assess gradient

■In adults, angiography remains gold standard to allow assessment

of coronaries before coarctation repair

differential diagnosis

■Takayasu’s or related aortitis, pseudocoarctation

management

What to Do First

■surgery

General Measures

■R/O CAD by coronary angiography if any suspicion

specific therapy

Indication for surgical therapy: detection of significant coartation

Treatment Options

■Surgical repair (usually excision with end-to-end anastomosis)

Side Effects & Contraindications

■Side effects: bleeding, infection, pneumothorax, death

➣Contraindications

Absolute: Contraindication to thoracotomy

follow-up

■Complications, residua and sequelae are frequent, require indefinite

follow-up.

complications and prognosis

■Complications: residual hypertension and increased risk of CAD, MI,

CHF, bicuspid aortic valve, re-coarctation

■Prognosis: generally good but CHF, MI are major causes of death at

11–25 years of follow-up