Aortic coarctation overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Aortic coarctation is a localized narrowing or abrupt constriction of the aortic arch anywhere along its length. It is most common distal to the origin of the left subclavian artery, near the area where the ductus arteriosus (ligamentum arteriosum after its regression) inserts. Less commonly, the obstruction can occur in the abdominal aorta. Coarctation may be associated with bicuspid aortic stenosis.
There is a dilation of the aorta immediately above the narrowing, but especially just below. Therefore the latin term "coarctatus", which means contracted or tightened.
Physical examination
Physical examination acts as an important tool in the diagnosis of coarctation of aorta. Differential hypertension (depending on the location of coarctation)with increased blood pressure in upper limb and hypotension in lower extremities. The difference is usually in systolic blood pressure whereas the diastolic blood pressures are typically similar. Similarly, the pulses in upper extremities are bounding whereas the femoral pulses are often diminished (brachial-femoral delay). There are 3 potential sources of a murmur: multiple arterial collateral (continuous murmur), an associated bicuspid aortic valve (systolic ejection click), and the coarctation itself which can be heard over the left infraclavicular area and under scapula. Murmurs due to associated cardiac abnormalities such as VSD or aortic valve stenosis, may also be detected. Neonates may present with discrepancies in blood pressure and pulses between the limbs, differential cyanosis or reversed differential cyanosis (depending on associated lesions), murmur, congestive heart failure, and shock. Older children and adolescent may be referred due to agitated behavior, headache, vision problem, and hypertension.