Coarctation of Aorta Frequently Asked Questions

What are the types of aortic coarctation?
Common:

• Infantile or preductal where the aorta between the left subclavian artery and patent ductus arteriosus is narrowed. It manifests in infancy with heart failure. Associated lesions include patent ductus arteriosus, aortic arch anomalies, transposition of the great arteries, ventricular septal defect.

• Adult type: the coarctation in the descending aorta is juxtaductal or slightly postductal. It may be associated with biscuspid aortic valve or patent ductus arteriosus. It commonly presents between the ages of 15 and 30 years.
  

Rare:
· Localized juxtaductal coarctation.
· Coarctation of the ascending thoracic aort
· Coarctation of the distal descending thoracic aorta.
· Coarctation of the abdominal aorta.
· Pseudocoarctation is of no haemodynamic significance and is a 'kinked' appear-ance of the aorta in the juxtaductal region without stenosis.

Is aortic coarctation more common in men or women?
This condition is two to five times as frequent in men and boys as in women and girls.

What conditions are associated with coarctation of aorta?
It may occur in conjunction with gonadal dysgenesis (e.g. Turner's syndrome), bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus, mitral stenosis or regurgitation, or aneurysms of the circle of Willis.

At what age does the condition manifest?
It is particularly likely to produce significant symptoms in early infancy (presenting as cardiac failure) or between the ages of 20 and 30 years.

What causes rib notching?
Collateral flow through dilated, tortuous and pulsatile posterior intercostal arteries typically causes notching on the undersurfaces of the posterior portions of the ribs. The anterior parts of the ribs are spared because the anterior intercostal arteries do not run in the costal grooves. Notching is seldom found above the third or below the ninth rib and rarely appears before the age of 6 years.

What are the complications of aortic coarctation?
· Severe hypertension and resulting complications:
· Stroke.
· Premature coronary artery disease.
· Left ventricular failure (two thirds of patients over the age of 40 years who have uncorrected aortic coarctatioh have symptoms of heart failure).
· Rupture of aorta.
· Infective endocarditis endarteritis (at the site of the coarctation or on a con-genitally bicuspid aortic valve).
· Intracranial haemorrhage (combination of hypertension and ruptured berry aneurysm).
· Three quarters die by the age of 50, and 90% by the age of 60