Coarctation of the aorta

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Coarctation of the aorta is a significant cause of secondary hypertension.
• It accounts for 5-8% of congenital heart defects.
• Infants may present with heart failure, while older children are often diagnosed due to hypertension or murmurs.

Purpose of the Study:

• To review the diagnosis, treatment, and outcomes of coarctation of the aorta.
• To highlight diagnostic methods including physical examination, echocardiography, and cardiac catheterization.
• To discuss surgical and interventional treatment options and their associated complications.

Main Methods:

• Physical examination focusing on pulse deficits (brachial vs. femoral).
• Blood pressure measurement differences between arms and legs.
• Non-invasive imaging: echocardiography with Doppler.
• Invasive imaging: cardiac catheterization and aortography.

Main Results:

• Diagnostic indicators include diminished/delayed femoral pulses and a >20 mm Hg arm-leg blood pressure gradient.
• Echocardiography shows narrowing and increased flow velocity; catheterization reveals pressure gradients.
• Both surgical repair (resection, flap, bypass) and balloon angioplasty can relieve obstruction.
• Potential complications include mortality, recoarctation, aneurysms, and paraplegia.

Conclusions:

• Coarctation of the aorta is treatable, with interventions typically recommended between ages 2-5 for asymptomatic cases.
• While immediate results of surgery and angioplasty are often good, long-term prognosis remains uncertain.
• Long-term survival may be impacted by age at intervention and pre-existing hypertension severity and duration.