Coarctation of the aorta
Coarctation of the aorta is a congenital narrowing of the aorta, usually just distal to the left subclavian artery, causing upper-limb hypertension with reduced, delayed lower-limb pulses. Critical neonatal coarctation is duct-dependent, while older children and adults present with hypertension; treatment is surgical or catheter-based repair.
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What this article covers
- Overview
Definition: coarctation of the aorta is a congenital narrowing of the aorta, most often just distal to the left subclavian artery near the ductal insertion.
- Epidemiology
A relatively common congenital lesion. More common in males.
- Risk factors
Congenital malformation. Turner syndrome and other genetic syndromes.
- Pathophysiology
Fixed aortic obstruction: narrowing raises proximal (upper-body) pressure and reduces distal (lower-body) perfusion.
- Clinical features
Upper-limb hypertension with weak, delayed femoral pulses (radiofemoral delay) and an arm-leg systolic pressure gradient.
- Differential diagnosis
Essential or other secondary hypertension: elevated pressure without an arm-leg systolic gradient or radiofemoral delay (Secondary hypertension).
- Diagnosis
Establish by an arm-leg blood-pressure gradient with imaging localizing the narrowing: the diagnostic basis is demonstrating upper-limb hypertension with a systolic gradient to the legs and…
- Management
If critical neonatal coarctation, keep the duct open and stabilize: a prostaglandin E1 infusion (0.01 to 0.05 mcg/kg/min) to maintain ductal patency and lower-body perfusion, with supportive care, then urgent repair.
- Complications
Persistent or recurrent hypertension (even after repair).
- Prognosis
Good after timely repair, but lifelong follow-up is needed.
- Prevention
Timely diagnosis and repair (for a peak coarctation gradient above 20 mmHg or significant narrowing) to limit hypertensive damage.
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