Outflow Obstruction in the Sick Infant

Coarctation of the aorta presenting in infancy

CoA is due to arterial duct tissue encircling the aorta just at the point of insertion of the duct. When the duct closes, the aorta also constricts causing severe obstruction to the left ventricular outflow. These children usually present as ill with heart failure and shock in the neonatal period.


Clinical presentation

  • Examination on the first day of life is usually normal. These neonates usually present with acute circulatory collapse at 2 days of age when the duct closes
Physical signs
  • A sick baby, with severe heart failure and absent femoral pulses
  • Severe metabolic acidosis


Chest radiograph
  • Cardiomegaly from heart failure and shock
  • Normal


  • Management is to stabilize first (ABC).
  • Maintain adequate tissue perfusion and oxygenation
  • Prostaglandin E1 should be administered if there is clinical suspicion for a ductal-dependent lesion (dose 0.05- 0.1 mcg/kgper minute; maximum 0.1 mcg/kgper minute). Beware of complications of prostaglandin E1 infusion such as hypotension, tachycardia, and apnea. Protect the airway by intubation and mechanical ventilation before transporting the patient to another medical facility.
  • Referral is made to a cardiac Centre for early surgical intervention
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