COARCTATION OF THE AORTA

Aortic constriction just distal to the origin of the left subclavian artery is a surgically correctable form of hypertension . Usually asymptomatic, but may cause headache, fatigue, or claudication of lower extremities. Often accompanied by bicuspid aortic valve.

Physical Examination 

Hypertension in upper extremities; delayed femoral pulses with decreased pressure in lower extremities. Pulsatile collateral arteries can be palpated in the intercostal spaces. Systolic (and sometimes also diastolic) murmur is best heard over the mid-upper back at left interscapular space.



ECG 

LV hypertrophy.

CXR 

Notching of the ribs due to collateral arteries;  appearance of distal aortic arch.

Echocardiography 

Can delineate site and length of coarctation, and Doppler determines the pressure gradient across it. MR or CT angiography also visualizes the site of coarctation and can identify associated collateral vessel formation.


Coarctation of the Aorta TREATMENT


Surgical correction (or percutaneous transcatheter stent dilation in selected pts), although hypertension may persist. Recoarctation after surgical repair may be amenable to percutaneous balloon dilatation.