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Radiology
Aortic Coarctation
Built from Obstetric Imaging
What’s inside
9 sections · 69 slides
Overview
- What this topic covers
The defect itself
A narrow segment of aorta, and the duct that sits right next to it
- Start with the pipe, not the name
- Aortic coarctation, defined
- Where the narrowing sits
- Arterial duct and aorta when the duct is open, closed and coarcted
- What the previous picture is telling you
- Why this defect is dangerous
- The headline difficulty
How common, and what travels with it
Numbers, and the company coarctation keeps
- 7%
- It is rarely a lone problem
- The three groups of associated problems
- Shone syndrome
- The genetic company it keeps
- A 45,X karyotype
Why it happens
Unknown cause, two working theories, two anatomical types
- The honest answer on cause
- Two theories of how the narrowing forms
- Two types, named after the duct
- Preductal coarctation
- Postductal coarctation
- How low flow shapes the arch
Why the fetus hides it
The normal shunts of fetal circulation blur the picture
- The fetal short-cuts
- Why the duct masks the defect
- What that forces us to do
- Sensitivity and specificity, in plain words
- What the baby feels, before and after birth
- What happens when the duct closes
- Why suspecting it early is worth so much
The ultrasound signs
Four-chamber view, outflow tracts, three-vessel and trachea view, sagittal arch
- Where the suspicion comes from
- The common thread across the views
- Ventricular disproportion, the classical sign
- Four-chamber view with a dominant right ventricle
- What to notice in that four-chamber view
- Putting a number on the disproportion
- Why ventricular disproportion misleads
- The later you scan, the weaker the sign
- Disproportion of the outflow tracts
- The three-vessel and trachea view
- A small aortic isthmus beside the duct
- Blood running the wrong way
- Reversed flow in the aortic isthmus
- Looking along the arch
- Sagittal views of a hypoplastic aortic arch
- The shelf sign
- It can get worse as pregnancy runs on
- Other findings that travel alongside
- The classic signs, in one list
- 75–80%
- What that timing means in the clinic
What else looks like this
Causes of a right-dominant fetal heart
- Why a differential list is needed
- Vessel and shunt look-alikes
- Heart defects and growth look-alikes
Looking after mother and baby
Before birth, at birth, and in the operating theatre
- What is offered before birth
- What parents are told
- Watching and planning
- The first hours and days after birth
- The babies who look well and are not
- The operation
- Why not simply stretch it open
- The path from scan to repair
Outcomes and take-home points
What the referring physician needs to know
- >90%
- Reading those numbers
- What the referring physician needs to know
- Key points
- If you remember five things
- References
- References (continued)
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition