Coarctation of Aorta
Basics
Description
- Discrete stenosis of the upper thoracic aorta, usually just opposite the site of insertion of the ductus arteriosus (juxtaductal). A segment of tubular hypoplasia and/or a remnant of ductal tissue give rise to a prominent posterior infolding (“the posterior shelf”).
- The hemodynamic lesion is most often discrete but may be a long segment or tortuous in nature. It is usually juxtaductal but may occur in other sites (i.e., the abdominal aorta).
- The prevalence of other associations (bicuspid aortic valve) and long-term complications (hypertension) indicate that this lesion may be part of a broader spectrum arteriopathy and/or endothelial disorder.
Epidemiology
Prevalence
- ~6–8% of patients with congenital heart disease have coarctation.
- More common in males
Risk Factors
Genetics
- Occurs in 35% of patients with Turner syndrome (XO)
- Has been described in cases of monozygotic twins
- Mutations of several genes, including NOTCH1 and MCTP2, have been identified in some patients.
- Many studies document the prevalence of a microdeletion at 22q11 in patients with arch anomalies and ventricular septal defects.
Pathophysiology
- Decreased systemic blood flow to lower body after ductal closure
- Increased afterload to left ventricle (LV) causes LV hypertrophy. Relative underperfusion of the renal vessels, baroreceptors, and multiple other mechanisms combine to induce compensatory hypertension.
- If the coarctation is severe, LV dysfunction and congestive heart failure (CHF) result, with low cardiac output and increased LV end-diastolic pressure.
- Decreased myocardial perfusion may be present in cases of very low output.
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Citation
Cabana, Michael D., editor. "Coarctation of Aorta." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617111/all/Coarctation_of_Aorta.
Coarctation of Aorta. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617111/all/Coarctation_of_Aorta. Accessed October 15, 2024.
Coarctation of Aorta. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617111/all/Coarctation_of_Aorta
Coarctation of Aorta [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 October 15]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617111/all/Coarctation_of_Aorta.
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