Adult-type Coarctation of the Aorta (CoA)

Coarctation of the aorta is a narrowing of the aorta.

coarctation

Clinical presentation

Symptoms
  • Asymptomatic
Physical signs
  • Systemic hypertension
  • Ejection systolic murmur at upper sternal edge
  • Collaterals heard with continuous murmur at the back
  • Radio-femoral delay. This is due to blood bypassing the obstruction via collateral vessels in the chest wall and hence the pulse in the legs is delayed

Investigations

Chest radiograph
  • Rib-notching due to the development of large collateral intercostal arteries running under the ribs posteriorly to bypass the obstruction
ECG
  • Left ventricular hypertrophy

Management

The approach to native coarctation varies across centers. Most centers recommend surgical correction of a native coarctation. Others perform balloon angioplasty with or without placement of a stent to relieve coarctation in the adult.