Coarctation.png|thumb|right|Sketch showing heart with coarctation of the aorta. A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:pulmonary artery, 10:Aorta ]]

Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.

Types

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There are three types (Valdes-Cruz 1998):

1. Preductal coarctation: The narrowing is proximal to the ductus arteriosus. If severe, blood flow to the aorta distal (to lower body) to the narrowing is dependent on a patent ductus arteriosus, and hence its closure can be life-threatening.
2. Ductal coarctation: The narrowing occurs at the insertion of the ductus arteriosus. This kind usually appears when the ductus arteriosus closes.
3. Postductal coarctation: The narrowing is distal to the insertion of the ductus arteriosus. Even with an open ductus arteriosus blood flow to the lower body can be impaired. Newborns with this type of coarctation may be critically sick from the birth.

Signs, symptoms and diagnosis

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(Depending on different types of aortic coarctation,) Arterial hypertension in the left arm with normal to low blood pressure in the right arm (should be "in the upper extremities with normal to low blood pressure in the lower extremities) is classic. Poor peripheral pulses, especially of (right carotid artery?) and the femoral arteries, may be found in severe cases.

If the coarctation is situated before the left subclavian artery, asynchronous radial pulses will be detected in the right and left arms. A radial-femoral delay between the right arm and the femoral artery would be apparent, whilst no such delay would occur under left arm radial-femoral palpation.

A coarctation occurring after the left subclavian artery will produce synchronous radial pulses, but radial-femoral delay will be present under palpation in either arm.

On chest X-ray, resorption of the lower part of the ribs may be seen, due to increased blood flow over the neurovascular bundle that runs there. Coarctation of the aorta can be accurately diagnosed with magnetic resonance angiography. In teenagers and adults echocardiograms may not be conclusive.. In adults with untreated coarctation blood often reaches the lower body through collaterals, eg. internal thoracic arteries via. the subclavian arteries. Those can be seen on MR or angiography. An untreated coarctation may also result in hypertrophy of the left ventricle.

Therapy

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Therapy is conservative if asymptomatic, but may require surgical resection of the narrow segment if there is arterial hypertension. In some cases angioplasty can be performed to dilate the narrowed artery. If the coarctation is left untreated, arterial hypertension may become permanent due to irreversible changes in some organs (such as the kidney).

Reference

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• Valdes-Cruz LM, Cayre RO: Echocardiographic diagnosis of congenital heart disease. Philadelhia, 1998.

External links

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• Aortic Coarctation information from Seattle Children's Hospital Heart Center
• Overview and diagram at childrenscentralcal.org
• Diagram at kumc.edu
• Overview and diagram at umich.edu

Cardiology | Pediatrics

Aortenisthmusstenose | Coartazione dell'aorta | Koarktasjon | Koarktacja aorty | Коарктација аорте