Author's reply.

Abstract

Sir, We thank the authors for their letter and appreciate their effort in bringing the issue to our notice. We agree with the authors and hereby clarify that the gradient of 20 mmHg mentioned in points “i” to “v” under the subheading “Indications for intervention” in coarctation of the aorta in the guideline document[1] refers to the gradient between upper and lower limb systolic blood pressure, instead of Doppler gradient, as per the European Society of Cardiology guidelines.[2] Point “v” should be read as follows: v. Intervention is not indicated if gradient between upper and lower limb systolic blood pressure is <20 mmHg with normal left ventricular function and no upper limb hypertension (Class III). We agree that Doppler peak gradients tend to be overestimates, as they reflect the peak instantaneous pressure gradient instead of the peak-to-peak pressure gradient, and hence are not recommended to decide intervention in coarctation of the aorta. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments We express thanks to Children's HeartLink Group (Ms. Bistra Zheleva, Ms. Adriana Dobrzycka, and Ms. Veera Rajasekhar), Pediatric Cardiac Society of India and Dr. Arun Singh, National Advisor, Rashtriya Bal Swasthya Karyakram, Ministry of Health and Family Welfare, Government of India.