Introduction
Coarctation of the aorta is the narrowing of the aorta where the ductus arteriosus (ligamentum arteriosum after regression) inserts
Preductal: identified in infancy; early presentation of symptoms
Postductal: identified in early adulthood; later presentation of symptoms
-Most common site of coarctation is distal to the left subclavian artery
-Poses high risk for aortic aneurysm, dissection, rupture, CHF, stroke
-Associations: Turner’s syndrome, Berry aneurysms, Bicuspid aortic valve
Symptoms & Signs
Infants: pale skin, difficulty feeding, difficulty breathing, irritability
Adults: Exertional dyspnea, headache, epistaxis and leg fatigue,
-Hypertension in the arms, with low or normal pressure in the legs
-Absent or weak and delayed femoral pulsations in comparison with the brachial or radial pulse
-A continuous murmur loudest at left infrascapular region, posterior inter scapular area,
-Lower blood pressure in the legs than in the arm
-Cyanosis in lower half of the body
Diagnosis
Radiography
Rib notching: scalloping of the inferior portion of the ribs due to enlarged intercostal arteries
3 sign: aortic arch and dilated left subclavian artery forming the upper curvature and poststenotic dilation of the descending aorta forming the lower
ECG: left ventricular hypertrophy, left atrial enlargement
Echocardiography, CT, MRI
Treatment
balloon angioplasty, Endovascular stenting, or surgery