[The clinical diagnosis of aortic isthmus stenosis]

Unfortunately, congenital coarctation of the aorta (CoA) is in many cases not diagnosed until adulthood., even though this defect is known to cause serious complications if treated too late. This retrospective study of patients was undertaken to ascertain whether early, exclusively clinical, diagnosis would have been possible.

The case notes of 61 patients with native CoA (n = 45) or restenosis in adulthood after earlier surgical repair (n = 16) were analysed with regard to the findings on physical examination and the patients' symptoms.

The patients' age ranged from 15 to 54 years (mean 23 +/- 15.5 years). 48 of 58 patients (83%; incomplete data excluded three patients) had hypertension in the brachial arteries and 50 of 58 (86%) had a pressure difference between the arms. 51 of 53 patients (96%) had a heart murmur, while a pressure gradient between the arms and legs was recorded in in 49 of 51 patients (96%). Notching of the ribs was noted in the chest radiogram of 47 of the 58 patients in whom it was taken. 35 patients had reported one, 23 more than one symptom.

In all patients (with native CoA or restenosis after surgical repair) it would have been possible to make the correct diagnosis of CoA on the basis of hypertension in the arms, a difference in pulse amplitude and/or a pressure gradient between arms and legs, as well as a cardiac murmur. Normal pressures in ten patients could be explained by marked collateral circulation (rib notching), but even in these patients their symptoms plus at least two other main signs could have provided the correct diagnosis at an earlier time.