Practice Easily Missed?

Coarctation of the aorta in the newborn

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6838 (Published 16 November 2011) Cite this as: BMJ 2011;343:d6838
  1. Mallika Punukollu, general practitioner1,
  2. Anthony Harnden, university lecturer in general practice2,
  3. Robert Tulloh, consultant, reader in paediatric cardiology3
  1. 1Kershaw Unit, Gartnavel Royal Hospital, Glasgow G12 0XH, UK
  2. 2Department of Primary Health Care, University of Oxford, Oxford OX3 7LF, UK
  3. 3Bristol Congenital Heart Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8BJ, UK
  1. Correspondence to: M Punukollu mpunukollu{at}gmail.com
  • Accepted 7 September 2011

Key points

  • Suspected congenital heart disease in the newborn is a medical emergency

  • Coarctation of the aorta is the most commonly missed congenital heart disease

  • Remain alert for the possibility of coarctation of the aorta, especially in an infant presenting with poor feeding, failure to thrive, or signs of heart failure

  • Specific physical findings include a systolic murmur, weak or absent femoral pulses, and upper body hypertension

  • However, a normal result on examination of a newborn does not rule out congenital heart disease

  • Detection and treatment of coarctation of the aorta reduces morbidity and mortality from heart failure and improves long term outcome

Case scenario

A 14 day old infant presented with poor feeding, sleepiness, and loss of weight. He was born at term with normal vaginal delivery and was discharged within 24 hours after a newborn check was normal. Examination showed mild tachycardia, tachypnoea, weak femoral pulses, and a soft systolic murmur at the left sternal edge. The lungs were clear and the liver was enlarged by 3 cm. He was immediately referred to a specialist paediatric cardiology centre, where, after further investigation, a diagnosis of coarctation of the aorta was confirmed, prostaglandin was started, and the patient had successful surgical correction.

What is coarctation of the aorta?

Congenital heart disease is the commonest group of congenital diseases. It affects 19 in 1000 live births worldwide1 and accounts for 9% of infant deaths in the United Kingdom.2 Coarctation of the aorta is a discrete narrowing of the proximal descending aorta and accounts for 7% of congenital heart defects (figs 1 to 3 ).1 3

Top: Normal heart. Bottom: Heart with coarctation of the aorta (arrows indicate direction of all blood flow)

Coarctation of the aorta is a narrowing of the aorta, the major artery leading from the heart to the body. Blood pressure …

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