Aortic coarctation

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Última revisão: 30 May 2025

Última atualização: 10 Dec 2024

Aortic coarctation is characterized by a blood pressure differential between upper and lower extremities (upper >lower).

In neonates, may present with shock if there is inadequate systemic perfusion once the ductus arteriosus closes.

Physical exam 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.

Definição

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).

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

male sex
young age
family history
Turner syndrome
DiGeorge syndrome
hypoplastic left heart syndrome
Shone complex
PHACE syndrome

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

electrocardiogram (ECG)
chest x-ray (CXR)
echocardiogram

Detalhes completos

Investigações a serem consideradas

computed tomography (CT) angiography
magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA)
cardiac catheterization

Detalhes completos

Algoritmo de tratamento

AGUDA

critical coarctation

CONTÍNUA

noncritical coarctation

recurrent coarctation

Colaboradores

Autores

Jeffrey Gossett, MD

Vice President and System Chief of Pediatric Cardiology

Professor of Pediatrics

Division of Pediatric Cardiology

Cohen Children’s Medical Center, Northwell Health

New Hyde Park

Declarações

JG declares that he has no competing interests.

Agradecimentos

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

Declarações

AK declares that she has no competing interests.

Revisores

Sheba John, MD, FAAP

Associate Professor

Pediatric Cardiology/Adult Congenital Cardiology

University of Utah

Salt Lake City

Declarações

SJ declares that she has no competing interests.

Daniel A. Cox, DO, FACC, FAAP, FAHA

Associate Professor

Adult Congenital and Pediatric Cardiology

University of Utah/Primary Children's Hospital

Salt Lake City

Declarações

DAC 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

Declarações

SK declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Erbel R, Aboyans V, Boileau C, et al; Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J. 2014 Nov 1;35(41):2873-926.Texto completo

Writing Committee Members, Isselbacher EM, Preventza O, et al. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393.Texto completo Resumo

Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2020 Aug 29;ehaa554.Texto completo

Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2019 Apr 2;73(12):e81-192.Texto completo

Writing Committee; Riambau V, Böckler D, Brunkwall J, et al. Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017 Jan;53(1):4-52.Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Aortic stenosis (AS)
- Interrupted aortic arch
- Left ventricular outflow tract obstruction
Mais Diagnósticos diferenciais
Guías de práctica clínica
- ACR appropriateness criteria: congenital or acquired heart disease
- Guidelines for cardiovascular intervention in adults with congenital heart disease
Mais Guías de práctica clínica
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Aortic coarctation

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

critical coarctation

noncritical coarctation

recurrent coarctation

Colaboradores

Autores

Jeffrey Gossett, MD

Declarações

Agradecimentos

Declarações

Revisores

Sheba John, MD, FAAP

Declarações

Daniel A. Cox, DO, FACC, FAAP, FAHA

Declarações

Sachin Khambadkone, MD, DCH, DNB

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Guías de práctica clínica

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice