The challenge in diagnosing coarctation of the aorta

Abstract

Critical coarctation of the aorta in neonates is a common cause of shock and death. It may be the most difficult of all forms of critical congenital heart disease to diagnose because the obstruction from the coarctation does not appear until several days after birth (and after discharge from the hospital), and because there are no characteristic murmurs. Some of these patients may be detected by neonatal screening by pulse oximetry, but only a minority is so diagnosed. Older patients are usually asymptomatic but, although clinical diagnosis is easy, they are frequently undiagnosed.

Fig. 1

Basic anatomy of coarctation of the aorta. Asc: ascending; IA: innominate artery; LCA: left carotid artery; LSA: left subclavian artery; PA: main pulmonary artery; PDA: patent ductus arteriosus.

Fig. 2

A: At birth, the ductus (PDA) is wide open, so that despite the coarctation shelf (Coa), flow is not obstructed. Dashed line with arrow shows unimpeded flow. B: Ductus closes at its connection to the main pulmonary artery, but its ampulla still provides a detour for flow. Dashed line with arrow shows unimpeded flow. C: Narrowing of the ductus ampulla leads to severe flow obstruction. Heavy dashed line shows obstructed flow. AA: ascending aorta; DA: descending aorta.