pediatrics
Coarctation of the Aorta
Diagnosis of Coarctation of the Aorta
Chest x-ray and ECG Echocardiography or CT or MR angiography Diagnosis is suggested by clinical examination (including BP measurement in all 4 extremities and comparing amplitude of brachial and femoral pulses), supported by chest x-ray and ECG, and established by 2-dimensional echocardiography with color flow and Doppler studies or, in older patients with a suboptimal echocardiographic window, with CT or MR angiography. Chest x-ray shows coarctation as a “3” sign in the upper left mediastinal shadow. Heart size is normal unless heart failure supervenes. Dilated intercostal collateral arteries may erode the 3rd to 8th ribs, causing rib notching, but this radiographic sign is seldom seen before age 5 years. ECG usually shows left ventricular hypertrophy but findings may be normal. Because the presence of a coarctation alters fetal circulation by shifting a higher proportion of flow through the right ventricle, neonates and infants with severe coarctation usually have right ventricular hypertrophy rather than left ventricular hypertrophy. 