Relevant Physiology

Pathogenesis

• narrowing of the aorta

• R → L shunt as the duct connect the 2 great arteries post-narrowing

  

Prognosis/Disease Course/Complications

• neonate: duct-dependant circulation
  • shock if the duct is closed
  • lower limb cynosis as the duct remains open
  • R-sided hypertrophy
• children/adult: collateral around the narrowing
  • hypertension
  • L-sided hypertrophy

Presentation

Signs and Symptoms

• neonate: duct-dependant circulation
  • Hypertension non-responding to medication
  • Upper and Lower limb BP differential > 20 mmHg
  • Lower limb cyanosis
    • Pre-ductal (R upper limb) vs post-ductal SpO2 difference
  • Decreased femoral pulse
• children/adult: collateral around the narrowing
  • **Hypertension** non-responding to medication

Risk Factor

• Aortic stenosis

Investigation

ECG

• Neonate: RAD, RVH
• Children/adult: LAD, LVH

Management

• Neonate:
  • PGE1 (vasodilator)
  • surgical repair