Coarctation of the aorta: A call for early detection

Abstract

Background: Early repair of coarctation of the aorta (COA) is associated with few perioperative complications and better long-term outcome. Therefore, early detection and treatment of COA patients is extremely desirable. The aim of this study was to review our referral system, the effectiveness of neonatal screening examination, and orient physicians about this abnormality, the mode and age of presentation, differences in presentation between cases with isolated COA, and cases associated with other cardiac lesions.

Patients and methods: This was a retrospective study of 61 inpatients admitted to our hospital between January 1989 and December 1996, who were found to have COA. Referral data was analyzed and compared to hospital cardiac evaluation findings.

Results: All the patients were referred after being symptomatic, but there was no suspicion of COA in any of the cases. One of the patients was referred by a pediatrician from a private clinic, and the rest by hospital pediatricians. Femoral pulse and cardiac murmur were commented upon in only three of the referral letters. Systolic pressure gradient (SPG) between upper and lower limbs and systolic hypertension were not commented on in any of the referral letters. SPG >/=10 mm Hg and systolic hypertension were found in 100% and 58% of the patients, respectively, upon evaluation in our center. SPG in patients with COA associated with other cardiac lesions was significantly lower than in patients with isolated COA (P=0.02).

Conclusion: Increased awareness in our primary health physicians of the importance of the neonatal screening examination and of measuring blood pressure in the limbs to detect COA early is needed. Timing of the neonatal screening examination between the third day and the third week is recommended. Systolic pressure gradient is a reliable method to detect COA, and in the lower significant range (>/=10 mm Hg) is associated with complex cardiac lesion rather than isolated COA.