Coarctation of the aorta

[Phloston]

Is there a difference in symptoms between pre- and post-ductal coarctation?

And is the congenital-type pre-ductal and the adult-type post-ductal?

I had heard that only the adult-type is associated with rib notching, but this confuses me because I would think, based on both coarctations occurring distal to the left subclavian, that both, not just the adult-type, would be associated with this Sx.

Could someone please help clarify? Thanks.

And, yes, I'm very aware that Turner's is pre-ductal. I'm confused because I've encountered a vignette in UWorld that gives a classic Turner's vignette of a girl with rib notching, then it says that she has adult-type coarctation, but I wouldn't expect that in Turner's.

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[thehundredthone]

Pre-ductal/Infantile coarctation is offset by a PDA. Hence there is no significant collateral development required and the features are similar to that of PDA. Post ductal/adult coarctation on the other hand needs collateral vessels and is associated with all the typical coarctation features.

 

[Phloston]

Pre-ductal/Infantile coarctation is offset by a PDA. Hence there is no significant collateral development required and the features are similar to that of PDA. Post ductal/adult coarctation on the other hand needs collateral vessels and is associated with all the typical coarctation features.

Why would pre-ductal be offset by a PDA? Do they necessarily have to occur concurrently?

 

[thehundredthone]

Why would pre-ductal be offset by a PDA? Do they necessarily have to occur concurrently?

Actually, I'm sorry, I seem to have misunderstood the pathophysiology of coarctation.

If it is preductal, there is usually poor collateral development in utero, and closure of PDA will lead to heart failure. If it is postductal, collaterals are better developed at birth. If the child survives, the collaterals will continue to develop. In most cases, a child with preductal coarctation survives because of a PDA, hence the association.

I encountered the same question today, I still haven't got to that explanation yet, maybe I'll add more after I read it.

Here's a very well written page:
http://www.mpoullis.net/aodvd1/anat and embry/coa.htm

EDIT: To clarify, a classical Turner's associated preductal coarctation would present very early and need correction, hence a patient presenting later is more likely to have postductal coarctation.

 

[Transformers]

Same question Phloston...but i have 2 Questions on the association of coarctation and Turners

1.) In FA: Turners is associated with bicuspid valve AND preductal coarctation; preductal (infantile) is associated with Turners and postductal (adult) is associated with bicuspid valve...ahh the dilemma, so what type of coarctation would a patient with Turners and bicuspid valve defect have? If the answer is preductal, then im assuming bicuspid valves are associated with BOTH pre and postductal and is not truly an associative feature.

2.) In UW there was a genetics question, which I'm guessing its an error?: read Phlostons post above...why does UW say Turners is associated with adult type and gives all the sx of rib notching due to collaterals with the intercostals (hence feeling pulses in the chest), diminished femoral pulses??

 

[HSE21]

Is there a difference in symptoms between pre- and post-ductal coarctation?

Pre-ductal (infantile) : Narrowing of aortic lumen classically between the origin of left subclavian artery and Ductus arteriosus --> Pressure in aorta AFTER narrowing is low ---> results in Right to left shunt ---> Lower extremity cyanosis.
Post-Ductal : not associated with PDA (some say it is caused by Fibrosis and contraction of ductus arteriosus), Sx = Hypertension of Upper extremity and Hypotension of lower, development of collateral circulation to deliver blood to lower extremities results in notching of the ribs.

And is the congenital-type pre-ductal and the adult-type post-ductal?
Congenital: Pre-ductal and a/w Turner Syndrome (Often presents in infancy, can present in teenagers)
Adult (post Ductal) : a/w Bicuspid Aortic valve.

- Rib notching Occurs due to development of Shunts to deliver blood to the Abdominal aorta (Subclavian artery --> Internal thoracic artery --> Anterior intercostal ---> Anastomose with posterior intercostal ---> Abdominal Aorta)
- In pre-ductal ---> Right to left shunting through PDA will provide poorly oxygenated blood, which results in lower extremity cyanosis.

 

[Greenbayslacker]

Same question Phloston...but i have 2 Questions on the association of coarctation and Turners

1.) In FA: Turners is associated with bicuspid valve AND preductal coarctation; preductal (infantile) is associated with Turners and postductal (adult) is associated with bicuspid valve...ahh the dilemma, so what type of coarctation would a patient with Turners and bicuspid valve defect have? If the answer is preductal, then im assuming bicuspid valves are associated with BOTH pre and postductal and is not truly an associative feature.

2.) In UW there was a genetics question, which I'm guessing its an error?: read Phlostons post above...why does UW say Turners is associated with adult type and gives all the sx of rib notching due to collaterals with the intercostals (hence feeling pulses in the chest), diminished femoral pulses??

has anyone figured out this discrepancy? i just came across it myself, uworld question 30 [465277]

 

[Greenbayslacker]

according to Goljian RR, it is preductal, so i'll just stick with FA (also says preductal)