Coarctation of the aorta: a secondary cause of hypertension

Abstract

Coarctation of the aorta is a constriction of the aorta located near the ligamentum arteriosum and the origins of the left subclavian artery. This condition may be associated with other congenital disease. The mean age of death for persons with this condition is 34 years if untreated, and is usually due to heart failure, aortic dissection or rupture, endocarditis, endarteritis, cerebral hemorrhage, ischemic heart disease, or concomitant aortic valve disease in uncomplicated cases. Symptoms may not be present in adults. Diminished and delayed pulses in the right femoral artery compared with the right radial or brachial artery are an important clue to the presence of a coarctation of the aorta, as are the presence of a systolic murmur over the anterior chest,bruits over the back, and visible notching of the posterior ribs on a chest x-ray. In many cases a diagnosis can be made with these findings. Two-dimensional echocardiography with Doppler interrogation is used to confirm the diagnosis. Surgical repair and percutaneous intervention are used to repair the coarctation; however, hypertension may not abate. Because late complications including recoarctation, hypertension, aortic aneurysm formation and rupture, sudden death, ischemic heart disease, heart failure, and cerebrovascular accidents may occur, careful follow-up is required.

Figure 1

A 24‐year‐old patient presents with hypertension and this chest x‐ray. What finding supports a secondary cause of hypertension? The arrows show rib notching.

Figure 2

Postductal coarctation of the aorta

Figure 3

Prevalence of preoperative symptoms (N=61) Data derived from J Thorac Cardiovasc Surg. 1994;108:525–531. ⁹

Figure 4

Surgical survival probability stratified by age (N=252). Data derived from Am J Cardiol. 2002;89:541–547. ¹⁵

Figure 5

Causes of death (n=87) among 571 survivors of coarctation repair Data derived from Circulation. 1989;80:840–845. ¹⁹