Coarctation of the Aorta

Background

Coarctation.jpg
  • Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery
    • Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian[1]
  • ~7% of live births with congenital heart disease [2]
  • Associated with bicuspid aortic valve (50%), VSD, PDA

Clinical Features

  • Systolic murmur, often conducted to back
  • Weak or absent femoral pulses, leg claudication, exercise intolerance
  • Upper limb hypertension
  • Usually diagnosed within first year of life, when presentation typically dramatic, particularly after closure of PDA in ductal-dependant critical coarctations.
    • Consider in all critically ill neonates, particularly with poor perfusion to lower extremities
    • Heart failure, shock
  • Less severe coarctations may go undiagnosed for years, but can still lead to complications long-term[3]:

Differential Diagnosis

Sick Neonate

THE MISFITS [4]

Evaluation

Coarctation CXR.jpg
  • CXR
    • Rib notching due to collateral blood vessels
    • "Figure 3" sign seen in 50% of patients
    • Abnormal aortic knob shadow due to coarct and dilation of left subclavian
  • EKG: LVH +/- LA enlargement
  • Echocardiography
  • Cardiac MRI

Management

Neonate in Shock (duct-dependent lesion)

CHF

Disposition

  • Admit

See Also

External Links

References

  1. https://newbp.bmj.com/topics/en-gb/698
  2. Rosenthal E. Coarctation of the aorta form fetus to adult: curable condition or life long disease process? Heart Nov 2005; 91(11): 1495-1502
  3. https://pedemmorsels.com/coarctation-of-the-aorta-in-older-children/
  4. Brousseau T, Sharieff GQ. Newborn emergencies: the first 30 days of life. Pediatr Clin North Am. 2006 Feb;53(1):69-84, vi.

Authors:

Claire