What is Coarctation of Aorta ?

More common in males (3:l). Narrowing of aorta typically located near aortic attachment of ligamenturn arteriosum or PDA. It can be a localized narrowing or associated with long segment tubular hypop1asia:In older children ESM is present over descending aorta, distal to obstruction (in left inter-scapular region).

Figure: Coarctation of aorta

Sometimes, continuous murmur of collaterals between vessels arising from pre and post Coarctation segment present. Depending severity of obstruction the femoral pulses are both weak and delayed (due to delayed upstroke of arterial pulse in lower extremity sites) or absent. Minor symptoms are headache, epistaxis and leg fatigue.

Two types of presentations - (a) symptomatic infants with LV failure, (b) Asymptomatic adolescent or young adults. High incidence of Hypertension with significant difference in upper and lower limb systolic BP (>20 mm Hg), which exaggerates on exercise. Major symptoms includes congestive heart failure, especially in infants, rupture or dissection of para-coarctation aorta, infective endarteritis, and cerebral hemorrhage due to rupture of aneurysm of circle of Willis. ECG in symptomatic infant shows RVH while LVH is present in older children and adult.