Aortic coarctation

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.

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).