pediatrics
Coarctation of the Aorta
Key Points
Coarctation of the aorta is a localized narrowing of the lumen, typically in the proximal thoracic aorta just beyond the left subclavian artery and adjacent to the opening of the ductus arteriosus. Manifestations depend on severity of coarctation but typically involve pressure overload proximal to the coarctation, leading to heart failure, and hypoperfusion distal to the coarctation. Severe coarctation can manifest in the neonatal period with acidosis, renal insufficiency, and shock, but mild coarctation may not be apparent until an adolescent or adult is evaluated for hypertension or diminished femoral pulses. There is typically a blood pressure gradient between upper and lower extremities, an easily distinguished amplitude differential between the upper and lower extremity pulses, and a grade 2 to 3/6 ejection systolic murmur, sometimes most prominent in the left interscapular area. For symptomatic neonates, infuse prostaglandin E1 to reopen the constricted ductus arteriosus. Correct coarctation surgically or using balloon angioplasty with or without stent placement. 