Coarctation of the Aorta

Relevant physical signs

• Peripheries
  • Stigmata of infective endocarditis (association with bicuspid aortic valve)
  • Radio-radial delay
    • Coarctation proximal to the left subclavian artery
    • If thoracotomy scar present:
      • Repair of coarctation (left subclavian artery used in repair)
      • Blalock-Taussig shunt
  • Radio-femoral delay
  • Bounding carotid pulsation
  • Jugular venous pulsation – elevated in pulmonary hypertension
• Precordium
  • Apex beat
    • Usually not displaced
    • Heaving in character if left ventricular hypertrophy present
    • May be displaced with thrusting character with concomitant aortic regurgitation
  • Parasternal heave – pulmonary hypertension
  • Palpable thrills
  • Auscultation
    • Ejection systolic murmur over left sternal edge radiating to the back
    • Ejection systolic murmur over the aortic area, radiating to carotids – aortic stenosis
    • Early diastolic murmur over lower left sternal edge – aortic regurgitation
• Underlying Turner’s syndrome
  • Short stature
  • Shield-like chest
  • Wide-spaced nipples
  • Webbed neck
  • High-arched palate

Investigation

• Electrocardiogram: left ventricular hypertrophy
• Chest radiograph
  • Rib notching (collaterals from dilated, tortuous posterior intercostal arteries)
  • Prominent aortic knuckle
  • Cardiomegaly and pulmonary congestion
• Echocardiogram to confirm diagnosis and assess severity, LVEF
  • Look for and assess severity of co-existent valvular heart disease

Complications

• Hypertension
• Hypoplastic limbs (legs if distal to left subclavian artery)
• Left ventricular failure

Management

• Surgical repair with excision of coarctation
• Balloon angioplasty with stent insertion