Coarctation of the aorta

Secondary hypertension is much more common in children than in adults. Kidney disease (e.g., pyelonephritis, glomerulonephritis) is the most common cause of secondary hypertension in children. Coarctation of the aorta can also produce secondary hypertension. Medical or surgical management of the underlying disorder usually restores normal BP. 

A specific cause of hypertension can be established in only 10-15% of patients. Patients in whom no specific cause of hypertension can be found are said to have essential or primary hypertension. Patients with a specific etiology are said to have secondary hypertension. It is important to consider specific causes in each case, however, because some of them are amenable to definitive surgical treatment renal artery constriction, coarctation of the aorta, pheochromocytoma, Cushing s disease, and primary aldosteronism. 

Tenderness of the branches of the external carotid artery (occipital, facial, superficial temporal) points towards giant cell arteritis. Tenderness of the common carotid artery in the neck can occur in acute carotid occlusion but is more Ukely to be a sign of dissection, or arteritis. Absence of several neck and arm pulses in a young person occurs in Takayasu s arteritis (Ch. 6). Delayed or absent leg pulses suggest coarctation of the aorta or, much more commonly, peripheral vascular disease. Other causes of widespread disease of the aortic arch are atheroma, giant cell arteritis, syphihs, subintimal fibrosis, arterial dissection and trauma. 

Spinal subarachnoid hemorrhage is very rare. It is caused by a vascular malformation, hemostatic failure, coarctation of the aorta, inflammatory vascular disease, mycotic aneurysm or a vascular tumor such as ependymoma. Accumulating hematoma may compress the spinal cord. Suspicion is aroused if the cerebral angiogram is negative and the patient develops spinal cord signs. 

In a fatal case, a massive overdose of 340 ml Renigrafin 76 was injected into a 7-year-old child with coarctation of the aorta, and computed tomography showed the presence of contrast agent in the brain (98). 

A newborn girl is found to have marked swelling of the dorsal areas of her feet along with a broad (webbed) neck, a broad chest, and a heart murmur that is due to coarctation of the aorta. Her physician suspects a chromosomal disorder and orders a karyotype. Which of the results pictured below is most likely ... 

Chronic kidney disease Cushing s syndrome Coarctation of the aorta Obstructive sleep apnea Parathyroid disease Pheoc h ro mocyto ma Primary aldosteronism Renovascular disease Thyroid disease... 

The most common secondary causes of hypertension are fisted in Table 13-1. A complete medical evaluation may provide clues for diagnosing secondary hypertension. For example, patients with coarctation of the aorta may have diminished or even absent femoral pulses, and patients with renal artery stenosis may have an abdominal systohc-diastolic bruit. 

Cardiac abnormalities that are associated with IE are classified into three groups ffigh-risk conditions Previous IE, aortic valve disease, rheumatic heart disease, prosthetic heart valve, coarctation of the aorta, and complex cyanotic congenital heart diseases... 

A. Compensatory hypertension, for example, in patients with increased intracranial pressure (eg, hemorrhage or mass lesion) or in patients with coarctation of the aorta. If nitropmsside is required in such patients, use with extreme caution. 

Various hereditary connective tissue disorders have been associated with formation of aneurysms, most likely as a result of the weakening of the vessel wall. Intracranial aneurysms may develop in 10%-15% of patients with polycystic kidney disease, an autosomal dominant disorder. Although Marfan syndrome was previously identified as a risk factor for aneurysms, a recent study did not find any significant relationship (Conway et al. 1999). Coarctation of the aorta, fibromuscular dysplasia and pheochromocytoma are associated with intracranial aneurysms, most likely because of the elevated blood pressure that occurs in these conditions. 

Clinical data NB was the third child of apparently healthy non-related parents. At four days he was admitted with congestive cardiac failure for repair of coarctation of the aorta. Two previous male siblings had died within the first two years of life. Both the child and his mother have a high tone hearing deficit. 

There also has been an explosion of therapeutic possibilities both medical and surgical. Witness the growth of closed heart surgery from closure of a patent ductus arteriosus and repair of coarctation of the aorta and mitral valvulotomy, profound hypothermia for atrial septal defect closure and pulmonary stenosis, open heart surgery, with cross-circulation and later extracorporeal circulation for valve repair and replacement, repair of complex congenital malformations and coronary artery bypass surgery and more recently the development of less invas-... 

Tabbutt S, Nicolson SC, Adamson PC, Zhang X, Hofhnan ML, Wells W, Backer CL, McGowan FX, Tweddell JS, Bokesch P, Schreiner M. The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and... 

Coarctation of the aorta greater muscular development of the upper extremities than the lower extremities. 

Renovascular disease (RVD) is an important but uncommon cause of hypertension in children, accounting for about 10% of cases (Gill et. al 1976 Deal et al. 1992 Wyszynska et al. 1992). Renal pathology is the cause of hypertension in over 90% of children after 1 year of age under 1 year of age, coarctation of the aorta is more common. The more severe the hypertension and the younger the child, then the more likely it is to be secondary hypertension. RVD is now well recognized in paediatrics, but... 

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