coarctation

Coarctation of the aorta is a congenital narrowing of a segment of the aorta, most often just distal to the left subclavian artery near the ligamentum arteriosum. The constricted area creates high pressure proximal to the lesion and reduced perfusion distal to it. It can occur in isolation or with other heart defects, most commonly a bicuspid aortic valve.

Forms of the condition are commonly described by age of presentation. Infantile or preductal coarctation refers to constriction before the ductus arteriosus and may present with heart failure in the newborn. Postductal or adult-type coarctation presents later in life with hypertension and leg claudication. The condition may be associated with collateral vessel development that can contribute to rib notching on chest imaging.

Clinical features include a difference in blood pressure between the arms and legs, diminished or delayed femoral pulses, and a systolic murmur heard on the back. Some patients experience headaches, epistaxis, fatigue, or growth issues in infancy due to elevated proximal pressure.

Diagnosis typically begins with echocardiography to assess anatomy and function, followed by cross-sectional imaging such as CT angiography or MRI to define the exact location and extent of narrowing. Cardiac catheterization may be used for hemodynamic assessment or when intervention is planned.

Management depends on age and anatomy. Neonates often require urgent or early repair, while older children and adults may undergo surgical options (resection with end-to-end anastomosis, patch aortoplasty, or interposition graft) or balloon angioplasty with or without stenting. Prostaglandin E1 may be used to maintain ductal patency in newborns before definitive treatment.

Prognosis after repair is generally favorable, but there remains a risk of recoarctation and long-term hypertension. Lifelong follow-up with periodic imaging and blood pressure monitoring is recommended.