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Aorta Coarctation

Aortic coartation consists of narrowing or constriction of the lumen of the aorta, which may occur anywhere along its length. The narrowing is most common distal to the origin of the left subclavian artery near the insertion of the ligamentum arteriosum. Coarctation occurs in about 7 percent of patients.

Most children and young adults with isolated, discrete coarctation are asymptomatic. Headache, epistaxis, cold extremities, and claudication with exercise may occur, and attention is usually directed to the cardiovascular system when a heart murmur or hypertension in the upper extremities and absence, marked diminution, or delayed pulsations in the femoral arteries are detected on physical examination. Enlarged and pulsatile collateral vessels may be palpated in the intercostal spaces anteriorly, in the axillae, or posteriorly in the interscapular area. The upper extremities and thorax may be more developed than the lower extremities. A midsystolic murmur over the anterior part of the chest, back.

The chief hazards result from severe hypertension and include the development of cerebral aneurysms and hemorrhage, rupture of the aorta, left ventricular failure, and infective endocarditis.


Treatment is usually surgical; resection and end-to-end anastomosis or subclavian flap angioplasty are employed commonly, although it may be necessary to use a tubular graft, patch, or bypass conduit if the narrowed segment is coartation.