# Acyanotic Congenital Heart Diseases & Coarctation of Aorta
> Deep dive into Acyanotic CHD, Coarctation of Aorta (CoA), duct-dependent lesions, and emergency neonatal management for MD, DNB, and MRCPCH exams.

Tags: pediatric-cardiology, congenital-heart-disease, coarctation-of-aorta, neonatology, medical-education, pge1, acyanotic-chd
## Fundamentals of Cyanosis
* Definition: Bluish-purple discoloration from deoxygenated hemoglobin (>5 g/dL).
* Central vs. Peripheral: Central affects tongue/lips (SpO2 <85%); Peripheral/Acrocyanosis is normal in the first 24-48 hours.

## Classification of Acyanotic CHD
* Left-to-Right Shunts: VSD (32%), ASD, PDA, AVSD (Down syndrome), PAPVR.
* Obstructive Lesions: Coarctation of Aorta (CoA), Pulmonary Stenosis (PS), Aortic Stenosis (AS), Hypoplastic Left Heart Syndrome (HLHS).

## Coarctation of Aorta (CoA)
* Primary site: Juxtaductal (near ligamentum arteriosum).
* Clinical Signs: Radio-femoral delay, upper limb hypertension with lower limb hypotension, weak femoral pulses.
* Radiography: Rib notching (older children), '3' sign on CXR.

## Duct-Dependent Lesions
* Systemic Flow Dependent: Critical CoA, HLHS, Interrupted Aortic Arch. Present with shock when PDA closes.
* Pulmonary Flow Dependent: Pulmonary Atresia, Tetralogy of Fallot. Present with severe cyanosis when PDA closes.
* Emergency Care: Start Prostaglandin E1 (PGE1) at 0.05-0.1 mcg/kg/min IV; avoid high-flow oxygen.

## Surgical Management
* Neonates: Resection and end-to-end anastomosis (Gold Standard).
* Other techniques: Subclavian flap aortoplasty, patch aortoplasty, balloon angioplasty (recoarctation).
* Timing: Urgent for symptomatic neonates (within 24-48h); elective at 3-6 months for asymptomatic infants.

## CHD Epidemiology in India
* 240,000 new babies born with CHD annually in India.
* 1 in 100 newborns affected; 25-30% die before age 1 without intervention.
* Critical CHD contributes to 9.8% of all infant deaths in India.

## Exam Preparation High-Yield Facts
* Most common CHD: VSD.
* Association: Turner Syndrome ➔ CoA.
* Association: Down Syndrome ➔ AVSD.
* Association: Williams Syndrome ➔ Supravalvular AS.
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