VI. COARCTATION OF THE AORTA
Coarctation of the aorta is a congenital narrowing of the aorta as the artery winds its way from the top of the heart. The condition may be discovered when the child is an infant if the coarctation is severe or if an astute physician correctly interprets the signs. About 80% of children with coarctation have a mild coarctation or develop an extensive corollary system of vessels that carry blood past the coarctation. These children may have no symptoms until they reach adolescence; some children have no symptoms until they reach the age of 15–30.
Early diagnosis of coarctation of the aorta is essential to ensure timely surgical or nonsurgical correction. Although there are remarkable specific physical signs that make diagnosis straightforward in the doctor’s office, it is one of the most commonly overlooked diagnoses in children. A diagnosis can be made within minutes if the physician feels the femoral pulses and finds them absent or weak. There is also accompanying high blood pressure in the arms and low pressure in the legs. More than 80% of coarctations are situated just beyond the ductus arteriosus and, fortunately, beyond the beginning of the left subclavian artery, which supplies blood to the left upper limb.