Coarctation of the aorta commonly results from an abnormality of the aortic media (1). A discrete infolding of the posterolateral wall of the aorta in the region of the ligamentum or ductus is typically noted. This abnormality can occur in either the preductal or postductal location which modulates the age and severity of presentation.

Coarctation proximal to the ductus presents shortly after birth and is usually associated with hypoplasia of the arch between the left subclavian artery and the ductus (2). The preductal location limits the blood volume load needed for normal aortic development.

Postductal coarctation is more common than the preductal form and often is not symptomatic in the neonatal period.

Typically, there is dilatation of the descending aorta distal to the coarctation with collateralization of vessels into the aorta primarilly via the intercostal arteries (2). This finding can result in rib notching. An abberant right subclavian artery that originates distal to the coarctation can serve as a major collateral to the right and rib notching occurs only on the left. If the left subclavian artery arises distal to the coarctation, then the rib notching is unilateral on the right (3).


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