Dr Mahak Bhasin, Dr. Vinitha Prasad, Dr. Stephy, Dr. C Jayakumar, Department of Pediatrics, AIMS, Kochi
Twelve year old male child known case of reactive airway disease on controller inhalers developmentally normal and thriving well presented with 1 episode of dizziness lasting 20 minutes associated with mild head ache while he was attending class.
No history of vomiting/migraine/breathing difficulty/palpitations/claudication of extremities with cold ness
No history of previous hospital admissions. No family history or migraine/heart disease present.
As outside clinical examination recorded elevated blood pressure he was brought at AIMS for further management.
At presentation, he was tired looking with elevated BP. Right upper limb BP- 184/121 mmHg, Right lower limb BP-122/73 mmHg, Left upper limb- 168/111mmHg, Left Lower Limb- 117/73mmHg. Saturation was maintained on room air. Systemic examination revealed Grade 3/6 Ejection Systolic Mumur and bilateral wheezing. Peripheral pulses were all felt with no perceivable radio radial or radio -femoral delay ,but decreased volume of pulsations in femoral artery.
ECG was done which was normal. Echo done showed Mitral Valve Prolapse with mild Mitral Reguritation. CT Aortogram done which showed severe coarctation of the aorta distal to the left SCA with collaterals from bilateral SCA.
Child was started on Tab Metoprolol and the family was counselled to henceforth keep him under regular follow up. Stenting of Coarctation of Aorta is also planned for him.
Coarctation of Aorta
Diagnosis is often delayed as most children remain asymptomatic. Clinical examination reveals lower systolic blood pressure in lower limbs compared to upper limbs and radioradial/radiofemoral delay. The complications in unoperated cases are systemic hypertension, accelerated coronart artery diaease, stroke, aortic dissection and heart failure. Origin of left subclavian artery procimal to the coarctation results in hypertension in all 4 limbs. Patients with CoA gradient >20mmHg, systemic hypertension, heart failure, radiologic evidence of collateral development must undergo surgical intervention. Regular follow up with blood pressure monitoring, aortic imaging to look for complications of recoarctation post surgery, periodic Echocardiographies, neuroimaging to evaluate for aortic aneurysms must be undertaken. While ten year survival rate is >90%, long term survival is reduced compared to general population.