• 98% are located near aortic isthmus (proximal to ductus arteriosus)
• Occurs in 3 contexts
• Associated anomalies (occur in 70% of neonates, 15% of older children): patent foramen ovale (PFO), ductus arteriosus, VSD, bicuspid aortic valve (40%), and Shone syndrome
• Obstruction leads to systolic and diastolic hypertension in upper extremities
• Collaterals eventually develop
• Patent ductus arteriosus maintains distal flow
• Type A (35%): Absence of arch distal to left subclavian artery
• Type B (60%): Between left carotid and left subclavian artery
• Type C (5%): Between innominate and left carotid artery
• Ductus arteriosus maintains distal flow
• Almost always has associated VSD, truncus arteriosus, aortopulmonary window, subaortic stenosis, or transposition of great vessels
• Type B associated with aberrant right subclavian artery
• Occurs in 0.2-0.6 per 1000 live births
• 5-8% of congenital cardiovascular anomalies
• 2-5 times more common in males
• 15-30% of patients with Turner syndrome have aortic coarctation
• In neonate, alprostadil (PGE1
) to maintain ductus patency, mechanical ventilation, and HCO3
• Surgical options: Resect with end-to-end anastomosis, subclavian flap aortoplasty ± resection, patch aortoplasty, interposition graft, percutaneous balloon
• Repair performed via left thoracotomy
• Median sternotomy if concomitant intracardiac anomaly repair
• Neonate: Primary repair or subclavian flap preferred
• Child: Primary repair or interposition graft preferred
• Recoarctation (gradient > 20 mm Hg), consider balloon or patch aortoplasty
• Once diagnosis of aortic coarctation is made, correct when stabilized
• Repair interrupted aortic arch early
• Operative: Hemorrhage, damage to recurrent laryngeal nerve, Horner syndrome, chylothorax, paraplegia
• Postoperative mesenteric vasculitis can be minimized with good blood ...
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