Paediatrics: Coarctation of the aorta

Coarctation of the aorta

Constrictions of the aorta (CoA) may occur at any point. In the majority (98%) of cases, it is usually distal to the origin of the left subclavian artery at the level of the ductus arteriosus.

Most often, this occurs in the neonatal period and the infants present at 48hr old when the duct closes. In older children, the BP is elevated in blood vessels proximal to the obstruction and an extensive collateral circulation develops. CoA is seen more often in boys than girls (2:1), although it is common in Turner syndrome. In ♀, 0% an abnor-mal bicuspid aortic valve is present.

Clinical features

In severe defects a PDA is required to maintain the systemic circulation; heart failure and collapse may occur in the neonatal period. CoA results in a disparity in pulse volume with weak or absent femoral pulses. Mild defects may present later with hypertension (right arm).

Prognosis

Outside the neonatal period, mortality from untreated hypertension is high and usually occurs when aged 20–40yrs. Complications include pre-mature coronary artery disease, congestive cardiac failure, hypertensive encephalopathy, and intracranial haemorrhage.

Treatment 

Neonates require resuscitation and early surgery. Older children or adolescents require stent insertion at cardiac catheter or sur-gical resection.