Aortic Coarctation Workup
- Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Park W Willis IV, MD more...
No specific laboratory tests are necessary for coarctation of the aorta.
See the list below:
- 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.
- 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.
See the list below:
- 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.
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