Coarctation of the aorta

Question 1

What is CoA?

Answer 1

CoA is a congenital condition where there is narrowing of the aortic arch usually around the ductus arteriosus. The severity can vary from mild to severe.

Question 2

What is CoA often associated with?

Answer 2

CoA is often associated with an underlying genetic condition, particularly Turner’s syndrome.

Question 3

What does CoA lead to?

Answer 3

• narrowing of the aorta reduces the pressure of blood flowing to the arteries that are distal to the narrowing
• it increases pressure in the areas proximal to the narrowing eg. the heart and the first 3 branches of the aorta

Question 4

What is found on examination for CoA?

Answer 4

• often the only indication of coarctation in a neonate may be weak femoral pulses
• performing a four limb BP will reveal high BP in the limbs supplied from the arteries that come before the narrowing and low BP in the limbs distal to the narrowing
• systolic murmur heard below the left clavicle (left infraclavicular area) and below the left scapula

Question 5

What are the symptoms of CoA in infancy?

Answer 5

• tachypnoea and increased work of breathing
• poor feeding
• heart failure**
• shock

Question 6

What signs may develop over time with CoA?

Answer 6

• left ventricular heave due to left ventricular hypertrophy
• underdeveloped left arm where there is reduced flow to the left subclavian artery
• underdevelopment of legs

Question 7

What is the management for CoA?

Answer 7

• in mild cases, patients can live symptoms free until adulthood without requiring surgical input
• severe cases - emergency surgery shortly after birth
• in critical cases where there’s risk of heart failure and death shortly after birth, prostaglandin E is used to keep the ductus arteriosus open while waiting for sugery
• this allows some blood flow through the ductus arteriosus into the systemic circulation distal to the coarctation
• surgery is then performed to correct the coarctation and ligate the ductus arteriosus