eMedicine Specialties > Cardiology > Congenital Heart Disease in the Adult

Aortic Coarctation: Differential Diagnoses & Workup

Author: Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Coauthor(s): Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Contributor Information and Disclosures

Updated: Oct 2, 2008

Workup

Laboratory Studies

No specific laboratory tests are necessary for coarctation of the aorta.

Imaging Studies

  • Radiograph
    • Radiograph findings vary with the clinical presentation of the patient. In coarctation diagnosed early in life, chest radiograph shows cardiac enlargement and pulmonary venous congestion. Associated cardiac defects may mask these findings.
    • In older children, chest radiograph findings are usually normal. The study typically shows a prominent aortic knob, and the stenotic region may be observed as an indentation of the proximal thoracic descending aorta in the shape of a number 3.
    • Rib notching is observed as irregularities and scalloping on the undersurface of the posterior ribs. This finding is unusual in children younger than 5 years and is observed more frequently in patients with significant gradient across coarctation of long standing.
  • Barium esophagram: Barium esophagram shows the classic "E sign," representing compression from the dilated left subclavian artery and poststenotic dilatation of the descending aorta.
  • Echocardiography
    • Diagnosis of coarctation of the aorta is made by 2-dimensional echocardiography, pulsed-wave Doppler, and color flow mapping. Classic findings are narrowing of the isthmus and posterior indentation or shelf. Blood flow velocities proximal and distal to obstruction, measured by Doppler tracings, can be used to estimate pressure gradient across the coarctation by a modified Bernoulli equation. Color flow mapping shows changes in color at the site of obstruction due to increases in blood velocity and turbulence.
    • In older patients, coarctation may be difficult to diagnose by surface echocardiography. For these patients, MRI, transesophageal echocardiography, or cardiac catheterization with angiogram may be necessary to make the diagnosis.
  • Fetal echocardiography
    • Detection of coarctation in utero is a difficult task for the echocardiographer.
    • Some features suggest the presence of coarctation: enlargement of right ventricle compared to left ventricle, isthmus and transverse aortic diameters less than 3% for gestational age, hypoplasia of left-sided structures, and decrease or reversal of flow in the foramen ovale.
  • Magnetic resonance imaging
    • MRI is a sensitive test for location and extent of coarctation as well as involvement of adjacent vessels and presence of collaterals. However, it is expensive, time consuming, and not universally available.
    • MRI is seldom used as a primary diagnostic tool. It is a useful tool for detecting and monitoring aneurysms and restenosis.
  • Cardiac catheterization
    • If the peak gradient across the coarctation is less than 20 mm Hg, the coarctation is mild.
    • A gradient of greater than 20 mm Hg across the coarctation is suggestive of the need for intervention.

Other Tests

  • Electrocardiogram
    • Newborns and older children with milder forms of coarctation may have a normal electrocardiogram (ECG) finding. If associated cardiac defects present, then ECG finding may be abnormal.
    • In older patients, long-standing coarctation of the aorta or a higher gradient across the coarctation stimulates left ventricular hypertrophy.

More on Aortic Coarctation

Overview: Aortic Coarctation
Differential Diagnoses & Workup: Aortic Coarctation
Treatment & Medication: Aortic Coarctation
Follow-up: Aortic Coarctation
References
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References

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Further Reading

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Keywords

aorta coarctation, coarctation of aorta, cardiac lesion, juxtaductal coarctation, preductal coarctation, postductal coarctation, vascular malformation, coarctated aortic segment, infective endarteritis, cystic medial necrosis, coarctation of the aorta, narrowing of the aorta, ductus tissue theory, hemodynamic theory, ventricular septal defect, bicuspid aortic valve, left ventricular outflow obstruction, tubular hypoplasia of the transverse aortic arch, congenital cardiac lesions, XO Turner syndrome, aortic arch hypoplasia, extracardiac vascular anomalies

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Contributor Information and Disclosures

Author

Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Sandy N Shah, DO, MBA is a member of the following medical societies: American College of Cardiology, American Heart Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Dawn M Calderon, DO is a member of the following medical societies: American College of Cardiology and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center
Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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