Aortic coarctation

Clinical severity

1. Mild to moderate

• Collateral blood vessels often enlarge and provide a route for blood to bypass the narrowed segment of the aorta.

• May be asymptomatic or present with hypertension.

2. Severe (critical coarctation)

• Well tolerated during fetal life because 90% of blood is shunted across the ductus arteriosus.

• After birth, the infant will present with low cardiac output and shock once the ductus arteriosus closes.

Criteria for significant coarctation[16]Writing Committee Members, Isselbacher EM, Preventza O, et al. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393. https://www.doi.org/10.1016/j.jacc.2022.08.004 http://www.ncbi.nlm.nih.gov/pubmed/36334952?tool=bestpractice.com

The American College of Cardiology/American Heart Association list the following commonly used criteria for defining significant coarctation in children and adults:

• Evidence of upper extremity hypertension (at rest, on ambulatory blood pressure [BP] monitoring, or with pathologic BP response to exercise) or left ventricular hypertrophy and evidence for one of the following gradient measurements:

  • A noninvasive blood pressure difference of >20 mm Hg between the upper and lower extremities.

  • A peak-to-peak gradient of >20 mm Hg across the coarct by catheterization; or a peak-to-peak gradient of >10 mm Hg across the coarct by catheterization in the setting of decreased left ventricular systolic function or significant collateral flow

  • A mean gradient of >20 mm Hg across the coarct by Doppler echocardiography; or a mean gradient of >10 mm Hg across the coarct by Doppler echocardiography in the setting of decreased left ventricular systolic function or significant collateral flow.