Coarctation of Aorta in Children

Abstract

Coarctation of aorta (CoA) is a discrete narrowing in aorta causing obstruction to the flow of blood. It accounts for 6-8% of all congenital heart diseases. With advances in fetal echocardiography rate of prenatal diagnosis of coarctation of aorta has improved but it still remains a challenging diagnosis to make prenatally. Transthoracic echocardiography is mainstay of making initial diagnosis and routine follow-up. Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) are great advanced imaging tools for two-dimensional and three-dimensional imaging of aortic arch in complex cases. Based on type of coarctation, size of patient, severity of lesion, and associated abnormalities various management options like surgical treatment, transcatheter balloon angioplasty and transcatheter stent implantation are available. There is significant improvement in long-term survival from pre-surgical era to post-surgical era. But, among the postsurgical era patients, the long-term survival has not significantly changed between older and contemporary cohort. Patients with coarctation of aorta need lifelong follow-up event after successful initial intervention.

Keywords: aortic coarctation; cardiac imaging; coarctation of aorta; pediatric coarctation.

Figure 1. Transthoracic echocardiographic views of coarctation of aorta. (A) Suprasternal sagittal two-dimensional view showing narrowing in the aortic lumen at the isthmus (arrow). (B) Suprasternal sagittal color Doppler imaging showing turbulent flow across the coarctation site (arrow). (C) Continuous wave spectral Doppler imaging across the coarctation segment in suprasternal view. Doppler shows increased flow velocity in systole with continuation of flow in diastole (diastolic run-off). (D) Abnormal Doppler pattern in abdominal aorta in coarctation of aorta. Spectral Doppler shows blunted velocity and systolic upstroke with continuous forward flow.

Figure 2. Computed tomography scan imaging of coarctation or aorta. (A) Two-dimensional sagittal reconstruction showing site of discrete narrowing at the level of aortic isthmus (arrow). (B) Three-dimensional reconstruction of computed tomographic angiography showing site of discrete narrowing in the same patient when viewed from posterior aspect (arrow).