1. Coarctation of Aorta
Dr. Kalpana Malla
MBBS MD (Pediatrics)
Manipal Teaching Hospital
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2. Coarctation of aorta
• 8-10% of CHDs
• M:F ratio 2:1
• Pathology: indentation involving anterior, lateral &
posterior wall of aorta
 Postductal type: distal to ductus/ ligamentum
arteriosum or subclavian artery -adult type
 Preductal-proximal (infantile)

3. Coarctation of the Aorta
• Localized narrowing of the aorta
• M>F
• Associated with Turner’s Syndrome
• Most common clinical sign: weak pulses &
decreased blood pressure in the lower extremities

5. Hemodynamics:
• Preductal type: very high load on left ventricle
elevation of both systolic & diastolic pressures
absence of collaterals immediately symptomatic
with CCF from birth
• Postductal type: development of collaterals
connecting branches of subclavian artery to arteries
arising from aorta from in-utero life distal level of
coarctation spares infant from LVF

6. Clinical manifestations:
• Symptomatic infants-
H/O poor feeding, dyspnea, poor weight gain,
signs of acute circulatory shock in first 6 weeks
of life
• Weakness or pain in legs after exertion

7. Clinical manifestations:
• Intermittent claudication
• Dyspnea on running
• Physical examination: pale, respiratory
distress, weak femoral pulses, radio-femoral
delay, BP in arms more than in legs

8. Precordial examination
Heart size N – apex normal site but heaving
• Systolic thrill in suprasternal notch
• S1 – accentuated with constant ejection click
• S2 – normally split with loud A2
• Murmur - ejection systolic murmur grade 2-4/6
at URSB & mid or lower left sternal border,
systolic murmur at interscapular area (left)

9. Diagnosis:
• CXR: heart size N with prominent ascending
aorta and aortic knuckle
“3” sign on over-penetrated films
rib notching between 4th and 8th ribs
• “E” sign on barium swallow
• ECG: left axis deviation, LVH
• Echo: coarctation visualized

10. Management:
• Medical: control of CCF in infancy
dental hygiene
Infective endocarditis prophylaxis
Treat HTN
Balloon angioplasty
• Surgical: resection of coarctation and end-to-end
anastomosis at any age but lowest risk at 1-10yrs

11. Thank you
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