Coarctation of aorta is an abnormal narrowing in the aorta that is usually seen proximal to the attachment of the ductus arteriosus. It is a cause for hypertension and is characterized by weak pulses and the presence of a radio-femoral delay (this means the radial pulse is felt ever so slightly before the femoral artery when they are palpated simultaneously).
Continuous wave doppler using a suprasternal approach provides valuable information and demonstrates forward flow during diastole. In other words, while measuring systolic flow across the coarctation, the forward flow will continue through diastole and will demonstrate a ‘diastolic tail’ as is seen in the figure below. When a number of recordings are taken with consecutive heartbeats, a ‘saw tooth’ pattern emerges.
The flow jet is eccentric as seen in the figure, and this can result in the underestimation of the flow velocity. Once repaired, there may still be evidence of elevated systolic peak velocities, but the diastolic flow will disappear.
Just remember, coarctation of the aorta can be associated with bicuspid aortic valve.
A few other points to remember with regards to this question:
Marfans syndrome is associated with a dilated aortic root, and there may be aortic regurgitation as a consequence. Mitral valve prolapse and a redundant anterior mitral valve leaflet may occur as well. Patent foramen ovale may be associated with migraines, and this is due to effect of serotonin. This association, however, has been questioned by different groups.
Atrial septal aneurysms are seen in patients with patent foramen ovale and are characterized by abnormally high mobility of the interatrial septum. The atrial septum appears to move > 10 mm from its normal plane. It has been associated with a higher incidence of stroke.
References
1. L Bruno, S Tredici, M Mangiavacchi, V Colombo, G F Mazzotta, C R Sirtori Cardiac, skeletal, and ocular abnormalities in patients with Marfan's syndrome and in their relatives. Comparison with the cardiac abnormalities in patients with kyphoscoliosis. Br Heart J. 1984 February; 51(2): 220–230.
2. Reisman, Mark, Christofferson, Ryan D., Jesurum, Jill, Olsen, John V., Spencer, Merrill P., Krabill, Kimberly A., Diehl, Lance, Aurora, Sheena, Gray, William A. Migraine headache relief after transcatheter closure of patent foramen ovale J Am Coll Cardiol 2005 45: 493-495
3. A.V Mattioli, M Aquilina, A Oldani, C Longhini, G Mattioli Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study Eur Heart J (2001) 22 (3): 261-268.
Continuous wave doppler using a suprasternal approach provides valuable information and demonstrates forward flow during diastole. In other words, while measuring systolic flow across the coarctation, the forward flow will continue through diastole and will demonstrate a ‘diastolic tail’ as is seen in the figure below. When a number of recordings are taken with consecutive heartbeats, a ‘saw tooth’ pattern emerges.
The flow jet is eccentric as seen in the figure, and this can result in the underestimation of the flow velocity. Once repaired, there may still be evidence of elevated systolic peak velocities, but the diastolic flow will disappear.
Just remember, coarctation of the aorta can be associated with bicuspid aortic valve.
A few other points to remember with regards to this question:
Marfans syndrome is associated with a dilated aortic root, and there may be aortic regurgitation as a consequence. Mitral valve prolapse and a redundant anterior mitral valve leaflet may occur as well. Patent foramen ovale may be associated with migraines, and this is due to effect of serotonin. This association, however, has been questioned by different groups.
Atrial septal aneurysms are seen in patients with patent foramen ovale and are characterized by abnormally high mobility of the interatrial septum. The atrial septum appears to move > 10 mm from its normal plane. It has been associated with a higher incidence of stroke.
References
1. L Bruno, S Tredici, M Mangiavacchi, V Colombo, G F Mazzotta, C R Sirtori Cardiac, skeletal, and ocular abnormalities in patients with Marfan's syndrome and in their relatives. Comparison with the cardiac abnormalities in patients with kyphoscoliosis. Br Heart J. 1984 February; 51(2): 220–230.
2. Reisman, Mark, Christofferson, Ryan D., Jesurum, Jill, Olsen, John V., Spencer, Merrill P., Krabill, Kimberly A., Diehl, Lance, Aurora, Sheena, Gray, William A. Migraine headache relief after transcatheter closure of patent foramen ovale J Am Coll Cardiol 2005 45: 493-495
3. A.V Mattioli, M Aquilina, A Oldani, C Longhini, G Mattioli Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study Eur Heart J (2001) 22 (3): 261-268.
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