Congenital Disease of the Aortic Arch: Coarctation and Arch Anomalies

Abstract

Coarctation ■ Evaluation of upper versus lower extremity blood pressure is an important diagnostic tool in the evaluation of coarctation. Systolic blood pressure of upper extremities greater than that of lower extremities merits further diagnostic workup (limited to moderate evidence). ■ Associated cardiovascular anomalies are common in patients with coarctation and impact the presenting clinical symptoms, the age of clinical presentation, and the clinical outcome (moderate evidence). ■ In newborns and infants with appropriate acoustic window, echocardiogram is the study of choice with sensitivity >90% (limited to moderate evidence). ■ In older children, contrast-enhanced MR angiography (MRA) is superior to transthoracic echocardiography and other MR imaging techniques for the diagnosis of congenital coarctation and obstructive aortic arch anomalies (moderate to strong evidence). ■ CT angiography (CTA) offers comparative performance to MRA and can be used for the diagnosis and surgical planning when MRA is not available or is contraindicated (limited evidence). ■ Conventional angiography is no longer routinely used for diagnosing coarctation but is reserved for endovascular treatment with balloon angioplasty or stent placement (limited evidence).