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Infants with coarctation of the aorta often come to medical attention due to congestive heart failure. Although heart failure can develop any time during the first six months of life, it typically develops during the first six weeks of life. Major features associated with heart failure include: 

• Rapid heart rate
• Rapid respiratory rate
• Poor weight gain

The infant in uncontrolled heart failure needs immediate diagnosis and treatment, since shock and death can rapidly develop.

In contrast to infants, most children with coarctation have no symptoms. If symptoms are present they are usually nonspecific and could be: 

• High Blood Pressure (hypertension) in the upper part of the body
• Headaches
• Frequent nose bleeds
• Reduced blood supply to the lower extremities resulting in exercise induced leg pain, claudication 

The hallmarks of coarctation of the aorta are: 

• Absent leg pulses and a difference in blood pressure between the arms and legs (high blood pressure in the arms and low to normal blood pressure in the legs)
• The typical heart murmur that is associated with a coarctation is a systolic murmur that is loudest in the back below the left shoulder blade (scapula).
• If a prominent back murmur is not heard and the child has a blood pressure difference between arms and legs, a coarctation located in the abdomen should be considered.

The diagnosis of coarctation of the aorta is typically made through a combination of medical tests and clinical/physical findings. Here are the primary diagnostic tools used to confirm the condition:

• Chest X-ray: This can be very helpful in suggesting the presence of coarctation of the aorta
• Echocardiogram: This is the primary tool for confirming the diagnosis.
• Heart Catheterization: This is used as an alternative diagnostic tool and performed if the coarctation cannot be adequately documented by the echocardiogram or to treat the coarctation with the use of balloon angioplasty.

These tests are essential for accurately diagnosing coarctation of the aorta and planning the appropriate treatment strategy.

Treatment for coarctation of the aorta is tailored to each individual's needs. Here's an overview of the common treatment approaches:

For children without symptoms:

• Timing: If diagnosed during a routine examination, the recommended treatment, either surgical repair or balloon angioplasty, is typically performed by the age of 18-24 months.

For newborns or infants with congestive heart failure:

• Initial Stabilization:
  • Medications: To increase the strength of the heartbeat (inotropic agents) and to help remove excess fluids (diuretics).
  • Prostaglandin E1: If the infant is less than 2 weeks of age the baby will receive a medicine to open the ductus arteriosus
  • Ventilator Support: Provided for the most critically ill infants to assist with breathing
• Surgical Repair: After stabilization, surgery is required to correct the coarctation by removing the narrowed segment and reconnecting the ends of the aorta. Occasionally, a piece of artificial material (Dacron or Gore-Tex) may be used to enlarge or bypass the narrowed area.
• Balloon Angioplasty: Performed during a heart catheterization, this involves placing a special balloon catheter across the narrowed area and inflating it to stretch open the aorta.

These treatment strategies ensure that the condition is managed effectively, allowing for improved heart function and overall health.