Coarctation of the aorta

Coarctation of the aorta


  1. Congenital narrowing at the junction of the aortic arch and descending aorta, secondary to a fibrous ridge protruding into the aortic lumen.
  2. 80% male.
  3. 50% associated with other congenital anomalies:
  • Bicuspid aortic valve.
  • Turner’s syndrome.
  • PDA, VSD.
  • Cerebral Berry aneurysms.
  1. Second most common cause of cardiac failure in neonates.
  2. May remain undetected well into adult life.

Clinical features

  1. Symptomatic presentation in neonates includes tachypnoea, cyanosis and generalised oedema. Patients require urgent corrective surgery. Most cases are now identified on neonatal screening.
  2. Delayed presentation in adults includes hypertension, headaches, claudication, cardiac failure and renal impairment.
  3. Patients may have cardiac systolic heart murmurs sometimes heard over the back and ‘pistol shot’ femoral pulses.

Radiological features

  1. Neonates – cardiomegaly and pulmonary plethora.
  2. Adults – CXR
  • Inferior rib notching (ribs 3–9), may be unilateral depending on where the right subclavian branches from the aorta. Only visible after 7 years of age.
  • Small aortic knuckle.
  • Figure-3 indentation on the left lateral wall of the aortic arch. The reverse-3 is present on barium studies.
  • Elevated left ventricular apex secondary to hypertrophy.
  1. MRI is very good at characterising the coarctation and associated cardiac anomalies.
  2. The extent of the stenosis is very difficult to assess on imaging.

Differential diagnosis

  1. Pseudo-coarctation – no pressure gradient across a narrowing in the aortic calibre – no obstruction.
  2. Inflammatory conditions such as Takayasu’s arteritis can have similar radiological features.
  3. Chronic SVC, IVC or subclavian artery obstruction may have similar radiological features.


  1. Angioplasty and stenting.
  2. Surgical repair.
  3. Hypertension control.

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