What is the role of echocardiography in the workup of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Echocardiography delineates intracardiac anatomy and allows assessment of associated significant intracardiac anomalies. The suprasternal notch 2-dimensional echocardiographic view allows evaluation of the aortic arch to assess the transverse aortic arch, isthmus, and severity of coarctation. Doppler echocardiography is used to measure the gradient at the site of coarctation and to identify the pattern of diastolic runoff typically seen in patients with severe obstruction.

Instantaneous peak pressure gradients across the aortic coarctation can be estimated with a modified Bernoulli equation, as follows:

ΔP = 4 (V22 – V12)

ΔP is the peak instantaneous gradient, and V2 and V1 are the peak flow velocities in the descending aortic, distal to coarctation (continuous-wave Doppler) and proximal to the coarctation (pulsed Doppler), respectively. The calculated gradient usually overestimates the measured blood pressure gradient. Presence of pan-diastolic flow indicates significant obstruction. Inclusion of duration-related Doppler flow parameters in the gradient calculation may improve the accuracy of Doppler prediction of coarctation gradient. [32]

When aortic arch cannot be adequately evaluated, abdominal aortic Doppler parameters may help in the diagnosis. [33] Absence of early diastolic reversal along with corrected pulse delay of 2.8 microseconds1/2 or more may best predict significant obstruction.


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