Coarctation of the Aorta

Coarctation (narrowing)

Aorta (the great artery arising form the left ventricle,
being the main trunk from which the systemic arterial system proceeds)

Coarctation of the aorta:  This narrowing of the
aorta occurs usually just below the left subclavian artery, near the site
where the ligamentum arteriosum (the remnant of the ductus arteriosus,
a fetal blood vessel) joins the pulmonary artery to the aorta.  The
obstructive process causes hypertension in the aortic branches above the
constriction (arteries that supply the arms, neck, and head) and diminished
pressure in the vessels below the constriction.

Prognosis depends on the severity of associated cardiac anomalies. 
Corrective surgery for isolated coarctation is required and prognosis is
good (before his condition induces severe systemic hypertension or degenerative
changes in the aorta).

Cause:  This disorder may develop as a result of spasm and
constriction of the smooth muscle in the ductus arteriosus as it closes.


Cardinal signs include resting systolic hypertension, absent or deminished
femoral pulses, and widened pulse pressure.

In infants:  Tachypnea (very rapid respiration), dyspnea (difficulty
breathing), pallor, tachycardia (abnormally rapid heart rate), cardiomegaly
(hypertrophy of the heart), hepatomegaly (hepatomegaly (enlargement of
the liver), and failure to thrive.

In adolescent:  may have dyspnea, claudication (limping), headache,
and epistaxis (hemorrhage from the nose).  Inspection and palpation
may reveal a visible aortic pulsation in the suprasternal notch. 
Auscultation may reveal a continuous systolic murmur with an accentuated
S2 and S3.


For infant with CHF caused by coarctation of the aorta, treatment consist
of digoxin and diuretics.  If drug therapy fails, surgery may be necessary.

Note:  this disorder may not be detected until adolescence and
that it can recur after initial surgery.