Aortic coarctation

Last reviewed: December 2018

Last updated: January 2018

Summary

Characterised by blood pressure differential between upper and lower extremities (upper >lower).

Physical examination may show diminished, absent, or delayed lower extremity pulses compared with upper extremity pulses.

Diagnosis is made by demonstration of aortic arch narrowing, typically by echocardiography.

Treatment may be surgical repair or percutaneous balloon dilation or stent placement.

Long-term complications include persistent hypertension or aneurysm formation at site of surgery or balloon.

Definition

Coarctation of the aorta is defined as a narrowing in the aorta, most commonly at the site of insertion of the ductus arteriosus, just distal to the left subclavian artery. Less commonly, there may be diffuse arch hypoplasia with a long segment of narrowing, proximal to the left subclavian artery, or the obstruction may be in the abdominal aorta. It is often associated with a diffuse arteriopathy and bicuspid aortic valve. It typically presents with upper extremity systolic hypertension or murmur. If the narrowing is severe, it may present in the newborn period once the ductus arteriosus closes as low cardiac output and shock (critical coarctation).

History and exam

Key diagnostic factors

hypertension presenting at a young age or resistant to treatment
diminished lower extremity pulses
differential upper and lower extremity blood pressure (BP)

Full details

Other diagnostic factors

systolic ejection murmur
male gender
genetic syndrome
claudication
headache
systolic ejection click
other cardiac anomalies

Full details

Risk factors

male gender
young age
FHx
Turner's syndrome
DiGeorge's syndrome
hypoplastic left heart syndrome
Shone's complex
PHACE syndrome

Full details

Diagnostic investigations

1st investigations to order

ECG
chest x-ray (CXR)
echocardiogram

Full details

Investigations to consider

computed tomography (CT) angiography
magnetic resonance angiography
cardiac catheterisation

Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL 

Jeffrey Gossett, MD

Director Heart Failure, Heart Transplantation

Professor of Pediatrics

Division of Pediatric Cardiology

University of California, San Francisco

San Francisco

Disclosures

JG declares that he has no competing interests.

Acknowledgements

Dr Jeffrey Gossett wishes to gratefully acknowledge Dr Anna Kamp, a previous contributor to this topic. AK declares that she has no competing interests.

Peer reviewers VIEW ALL 

Ranjit Aiyagari, MD

Clinical Assistant Professor of Pediatrics

University of Michigan

Ann Arbor

Disclosures

RA declares that he has no competing interests.

Sachin Khambadkone, MD, DCH, DNB

Consultant Paediatric Cardiologist and Honorary Senior Lecturer

Great Ormond Street Hospital and Institute of Child Health

London

Disclosures

SK declares that he has no competing interests.

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Aortic coarctation

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

critical coarctation

non-critical coarctationt

recurrent coarctation

Contributors

Authors VIEW ALL 

Jeffrey Gossett, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Ranjit Aiyagari, MD

Disclosures

Sachin Khambadkone, MD, DCH, DNB

Disclosures

Differentials

Guidelines

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