Cardiovascular

INDEX:

• Aortic coarctation
• Tetralogy of Fallot

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AORTIC COARCTATION

Congenital. Eccentric narrowing and infolding of the aorta.

Two forms:
(1) Infantile form: Long segmental narrowing after left subclavian artery
(2) Adult form: Short segmental narrowing near the ligamentum arteriosum.

Clinical features:
- Headache - d/t HT
- Lower limb claudication - d/t poor perfusion

Association:
- Bicuspid aortic valve. Seen in infantile form.
- Aortic aneurysm
- Aortic dissection
- Congenital heart disease

CXR:
- Inferior rib notching
-- Development of the collateral arteries supplied by the arteries proximal to the narrowing
-- Often the middle 1/3 and lateral 1/3 of the posterior ribs
-- Most at 3rd and 4th ribs. 1st and 2nd ribs are spared.
-- Rib notching can be unilateral if presence of of aberrant subclavian artery

CT:
- Coronal: Figure '3' appearance

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TETRALOGY OF FALLOT

Tetralogy
1. Pulmonary infundibular stenosis
2. Over-riding of the aorta
3. Ventricular septal defect (VSD)
4. Right ventricular hypertrophy

Clinical features:
Cyanosis - the over-riding aorta receive deoxygenated blood from RV via the VSD

Association:
25% have right-sided aortic arch

Chest radiograph:
1. Decreased pulmonary vascular markings - remember there is pulmonary infundibular stenosis
2. NO cardiomegaly - it's RV hypertrophy, not LV hypertrophy
3. +/- Rt sided aortic arch
4. Boot shaped heart (in moderate to severe patients)

MRI:
- To assess degree of pulmonary artery / aorta stenosis / hypoplasia

Keys:
Cyanosis, no cardiomegaly, little pulmonary markings +/- right aortic arch

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