Signs of coarctation of aorta
What is the usual anatomy of coarctation of the aorta, its typical signs, and diagnostic evaluation scheme?
Although congenital localized narrowing of the aorta may occur anywhere between the aortic valve and the abdominal aorta, it most commonly occurs in adults near or at the location of the former ductus arteriosus (ligamentum arteriosum after regression).
It is the fourth leading cause of congenital heart disease, but it is an uncommon cause of hypertension in children and is even less common in adults.
Physical examination nearly always shows a lower blood pressure in the leg (measured supine, with a cuff over the thigh and auscultating in the popliteal fossa), radial-femoral delay, and diminished pulses in the lower extremities. Continuous cardiac murmurs are common in chronic untreated coarctation, as a result of development of collateral blood flow around the narrowing.
The classic chest x-ray findings include rib notching (from dilated intercostal arteries on the inferior surfaces of ribs) and the “3 sign” (consisting of a dilated proximal aorta, the coarctation, and the poststenotic dilatation).
An esophagram (obtained after swallowing barium or other contrast medium) often shows the “reverse 3” sign.
The most useful diagnostic test for patients suspected of having a coarctation is an echocardiogram; some centers prefer magnetic resonance angiograms, although some surgeons still require traditional aortography and a full cardiac catheterization in adults to prove the absence of major coronary heart disease and/or other associated congenital anomalies.