Coarctation of the aorta means
a narrowing of the aorta.
If this takes place, then normally, you might
expect to see a congestive heart failure between
two and six weeks after birth. The heart will
show unusual murmurs and thrills. Now, these
are sounds and sensations caused by the blood
attempting to go through a narrow area of
the aorta and reflecting back from it. So
the normal flow of the blood can be quite
seriously disturbed by one of these coarctations
or narrowings. One of the consequences is
that you may, again, get right ventricular
hypertrophy. In other words, the muscle of
the wall of the right ventricle is enlarged
and thickened because it’s having to work
harder to try and pump blood against this
resistance of the part that’s become narrow.
Again, there may be a reduction in femoral
pulses because blood is not moving around
the arcs of the aorta in the normal way, not
getting to the lower part of the body.
Then, there may be a lower body cyanosis and a reduction
of the femoral pulses. A is marked as a preductal
coarctation. So, coming just before the point
where the ductus arteriosus would be.
And B marked as a postductal one. So those are the
two varieties you could find of this coarctation
of the aorta. So initially, we began by presenting
a problem, our six-week-old male baby with
the following signs. This, in fact, corresponds
to what we described as a ventricular septal
defect, and I trust you spotted that during
the course of the lecture. And there are some
very interesting clues that you can detect from
the scenario itself. Almost nothing that
happens in the clinical scenario is irrelevant.
You have to be alert for a variety of different
kinds of things. So for spotting a VSD, a
ventricular septal defect, the time period
is fairly typical; six weeks after birth, perhaps
not necessarily immediately at birth.
Male sex is also a clue because this is more
common in male babies than in female babies.
The poor weight gain and slow feeding is a
consequence of the oxygenation levels, and
that also causes the possibility of persistent
infection of the lungs as another consequence
of the condition. Finally, cyanosis is always
a clue that there’s something interrupting
the normal process of circulation development
in the baby. So, those are some of the things
that you might look for. These are common
defects, as we said. Therefore, these are
things that you may well encounter clinically.
So we looked through the ventricular septal
defect, atrial septal defect, tetralogy of
fallot, patent ductus arteriosus,
and coarctation of the aorta. Thank you very much.