Coarctation of the aorta

Coarctation of the aorta is a congenital narrowing of the aorta. It is most often localized distal to the left subclavian artery near the ductus arteriosus. This narrowing leads to a pressure drop behind the obstruction and a pressure rise in front of it. In young infants, the pressure gradient may mask left ventricular failure, persistent patency of the ductus arteriosus, and in older development of the collateral circulation.

Classification

 * According to the location in relation to the ductus arteriosus
 * preductal,
 * juxtaductal,
 * postductal.
 * According to the hemodynamic picture
 * With an open ductus arteriosus,
 * With closed ductus arteriosus.

Clinical signs
The basic symptom is the absence of femoral pulsation. Severe coarctation manifests in early infancy as non-palpable femoral pulsation, anuria, metabolic acidosis. Less severe defects are sometimes not detected until school age, due to a murmur heard on the back between the shoulder blades, or even later with the finding of hypertension and atherosclerotic changes in the surrounding area.

Diagnosis
We look for a history of other congenital heart defects (CHD) and arterial hypertension (especially in children and younger patients). On physical examination, both pressure and pulse should be examined in both upper and lower extremities.

Echocardiography is nowadays the basic diagnostic method, it can also be used prenatally. Of the non-invasive examinations, ECG is the key, which may be normal or show signs of hypertrophy and left ventricular load. CT angiography or MRI to view the anatomy before intervention or surgery. Invasive catheterisation is important where coronary angiography needs to be supplemented or to clarify the significance of associated CHD's.

Treatment
Coarctation surgery is indicated in all cases. It is indicated electively in toddler or preschool age. Critical defects are operated on immediately. The functional outcome of the operation is usually excellent. There is a risk of recoarctation, which can be removed with balloon angioplasty.

Related articles

 * Congenital heart defects
 * Acquired heart disease

External link

 * Aortic coarctation - Shelter - Audio recordings (TECHmED)