Coarctation of the Aorta

Coarctation of the aorta is narrowing of the aorta, the major blood vessel carrying highly
oxygenated blood from the left ventricle of the heart to the rest of the body
It occurs three times more often in males than in females

Pathophysiology-
1. Coarctation of the aorta occurs most often in the area near the ductus arteriosus.
2. The narrowing can be preductal (between the subclavian artery and ductus
arteriosus) or postductal (after the ductus arteriosus).
3. As a result of the narrowing, blood flow is impeded, causing pressure to increase
in the area proximal to the defect and to decrease in the area distal to it.
4. Thus, blood pressure is increased in the heart and upper portions of the body and
decreased in the lower portions of the body.
5. Left ventricular afterload is increased, and in some children this may lead to heart
failure.
6. Collateral circulation also may develop as the body attempts to ensure adequate
blood flow to the descending aorta.
7. Due to the elevation in blood pressure, the child is also at risk for aortic rupture,
aortic aneurysm, and cerebrovascular accident (CVA)

Clinical Manifestations-

 Irritability
 Frequent epistaxis.
 Reports of leg pain with activity
 Dizziness
 Fainting
 Headaches.
 Full, bounding pulses in the upper extremities
 Weak or absent pulses in the lower extremities.
 Notching of the ribs
 On auscultation of the heart a soft or moderately loud systolic murmur, most often
heard at the base of the heart
 Poor weight gain
 Pale skin
 Sweating
 Cold feet or legs
 B/P in arms higher than B/P in feet
 Enlarged Liver
  Grouchiness
Diagnostic Test-

 Chest X-ray- May show an enlarged heart or other changes caused by COA.
 Electrocardiogram (ECG). It can find abnormal rhythms (arrhythmias) and heart
muscle damage.
 Echocardiogram.  Most aortic coarctations are diagnosed by echocardiography.
 Cardiac catheterization. A thin, flexible tube (catheter) is moved through the blood
vessels into the heart. Dye is used to get a clear picture of the heart and aorta. A
catheterization may also be used to treat the narrowing.
 CT scan. This can make detailed pictures of the aorta and show the area of
narrowing.
 MRI. This makes detailed pictures of the heart and aorta. It can clearly show where
the narrowing is and how large it is.