Coarctation of the Aorta Differential Diagnoses

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
  • Print
DDx

Diagnostic Considerations

Important considerations

Do not fail to diagnose coarctation of the aorta (CoA). Hypertensive patients may be treated well into adolescence or adulthood without consideration of the diagnosis of coarctation by physicians. When these patients exhibit complications of coarctation, such as a ruptured cerebral aneurysm, significant repercussions may ensue.

Patients may refuse the administration of blood products and yet need repair. This may be particularly true of infants whose parents refuse the use of blood products. In these patients, consider balloon dilation of a native coarctation to achieve temporary or even permanent relief of obstruction.

Physicians may reduce the risk of paralysis by careful attention to documenting the extent of arterial collateral flow prior to surgical repair in patients with native or recurrent coarctation. Multiple precautionary measures, including Gott shunt, may be used if the status of collateral vessels is uncertain.

Cardiac catheterization, if necessary to document the extent of collateral vessels, allows intraoperative measures to protect the spinal cord and to avoid paralysis.

Special concerns

After successful repair of coarctation of the aorta, pregnancy should be well tolerated. [31] Prenatal care should include careful monitoring of blood pressure (BP), since hypervolemia in pregnancy may contribute to worsening hypertension, especially in patients with some degree of residual obstruction or preexisting hypertension. The presence of other associated lesions, such as aortic valve disease, may further complicate obstetrical management. Anecdotal cases document aortic rupture during pregnancy.

Differential Diagnoses