bluestar
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what are the different presentations of pre- and post- ductal coarctation? and what are the routes of collateral circulation in post- ?
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| Bela
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Pre ductal coarctation:
1) infantile form
2) a/w Turner's
3) coarctation is proximal to subclavian A
4) pt presents w/ HTN in upper extremities and low pulses in lower extremities
Post ductal coarctation:
1) adult form
2) coarctation is distal to subclavian A.
3) notching of the ribs
Route of collateral circulation is from the subclavian :arrow: internal thoracic A. or the intercoastals????
What's the answer bluestar b/c I think this is high yield and this is the max I can recall rite now.
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| Idiopathic
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The prominent radiographical finding is notching of the ribs, due to collateral circualtion from the intercostals. Maybe this is what the OP is referring to.
I think you have them backwards. Pre-ductal coarctation will have low pulses everywhere, while post-ductal will have HTN in arms and low pulses in legs.
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| Alina T
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idiopathic, in preductal coarctation u'll actually have HTN somewhere: in ur right arm. low BP in left arm and low pulses in legs. correct? :wink:
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| Bela
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Here is some additional explanation from Kaplan:
Aortic Coarctation, infantile type is a/w PDA. The stenotic segment is localized proximal to a PDA. Since BP drops distal to PDA, blood will shunt from the Pulmonary A. to the AORTA through the PDA. Thus cyanosis develops in the lower part of the body only.
***Aortic Coarctation, adult type is NOT a/w PDA. This is more common than infantile type and leads to HTN proximal to the stenosis (ie. in the head and upper limbs) and HypoT in the lower half of body. There is no cyanosis.
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| Idiopathic
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Yes, you are right. Brachiocephalic comes off before the ductus, so the arm pulses will be unequal. But in postductal you will have upper/lower extremity inequality.
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| bluestar
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Thank you guys for the discussion. just for additional info about the collateral circulation:
1, subclavian A :arrow: internal thoracic A :arrow: ant. intercostal A :arrow: post. intercostal A. :arrow: thoracic aorta
2, subclavian A :arrow: internal thoracic A :arrow: sup. epigastic A :arrow: inf. epigastic A. :arrow: external iliac A.
I think the notching of rib comes from higher than normal pressure of intercosal A on the rib? correct me pls if I am wrong on this.
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| waqastariq
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yups you are correct budy
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| ts97
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A postductal lesion allows good collateral circulation from proximal to distal portions of the aorta via the anterior intercostals from internal thoracic artery anastomosing with posterior intercostal branches of descending aorta.
A preductal lesion presents a life threatening situation early in infancy. The distal aorta is initially filled via a patent ductus arteriosus, but as the ductus closes blood flow to the distal aorta diminishes, and the infant's survival may be threatened.
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