Coarctation of the Aorta
Coarctation of the aorta is typically asymptomatic in older children and adults, however, presents with cardiac shock in severe cases in the neonatal period. Higher blood pressure in upper extremities when compared to blood pressure in lower extremities is diagnostic of coarctation of the aorta. ECG in older children show left ventricular hypertrophy and possible left ventricular strain pattern (ST, T changes in V4–V6), while in neonates right ventricular hypertrophy pattern is noted due to in utero pressure overload of the right ventricle which is the chamber pumping blood to the narrow area of aortic arch through the ductus arteriosus. Repair of coarctation of the aorta is surgical in early childhood and through balloon dilation with or without stent placement in older children. Recoarctation of the aorta is almost always managed through balloon dilation in the cardiac catheterization laboratory unless associated with hypoplasia of the aortic arch which would require repeat surgical intervention.