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There are many ways you can help children and their families get the care they need.
At Boston Children's Hospital, we know that the first step to restoring your child’s health is to form an accurate and timely diagnosis.
Your child's doctor may have heard a heart murmur (a noise caused by the turbulence of blood flowing through a narrow region) during a physical exam and referred your child to a pediatric cardiologist* for a diagnosis. The murmur can—but doesn’t usually—result from the coarctation itself; more often, the murmur is the result of secondary defects, such as a bicuspid aortic valve or a VSD.
*A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects—as well as any heart problems that may develop later in childhood.
The first line of diagnosis for COA is the clinical exam, beginning with obtaining the child’s vital signs. The pediatric cardiologist obtains a four-limb blood pressure—measuring the blood pressure in both arms and both legs.
The doctor may suspect a coarctation if the blood pressure in the child’s legs is lower than the pressure in his arms. The baby’s femoral (thigh) or foot pulses will be weak and therefore very difficult for the doctor to feel. (Part of the newborn discharge exam is to be able to feel four good pulses.)
Other tests that help with the diagnosis—or with treatment planning—may include:
COA can sometimes be detected prenatally through cardiac ultrasound: The test can pick up the size discrepancy between the left heart and the right heart, as well as the narrowing of the aortic arch. The aortic arch may not be obstructed in the fetus because of the ductus arteriosus, which is open (patent) in the fetus. But the obstruction can show up in the newborn after his ductus arteriosus closes.
So, while knowing in advance that the newborn will have COA can help doctors and families to be prepared for treatment after birth, there’s really no need to treat the fetus in utero.
Mild or moderate cases of COA may not be diagnosed until school-age, adolescence or even adulthood—whenever symptoms appear (sometimes it’s detected because of elevation on routine blood pressure measurement). As a child with COA grows, his aorta will not grow at the same rate; so with a relative narrowing later in life, signs and symptoms can appear, such as:
With the onset of symptoms, cardiologists will diagnose COA through physical examination and the use of advanced diagnostic tools.
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The Heart Center at Boston Children’s is the largest pediatric heart program in the United States. Our staff of more than 80 pediatric cardiac specialists cares for thousands of children and adults with congenital and acquired heart defects each year. We have experience treating rare heart problems—with results that are among the best in the world.
Boston Children’s Hospital pioneered interventional catheterization for many congenital heart defects.
Learn more about Boston Children's history of innovation.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”