Because late repair of coarctation of the aorta (COA) is associated wi
th premature cardiovascular disease in adult life, early detection and
treatment is important. Objectives. To determine the timing of referr
al to see whether early detection of COA has improved in the past deca
de, to evaluate the pattern of and reasons for medical center referral
, and to assess the clinical signs relating to the diagnosis of COA. M
ethods. The records of 50 consecutive patients older than 1 year who h
ad surgical repair of COA from 1980 to 1990 were reviewed. The age of
referral, pattern of referral, and presence of standard clinical signs
of COA were analyzed, and data were compared with those from the prev
ious decade. Results. The mean and median ages at referral were 8.4 an
d 5.8 years, respectively. Pediatricians accounted for 64% of the refe
rrals. A specific diagnosis of COA was made in 2 (4%) of 50 patients b
efore referral to a pediatric cardiologist. The most consistent clinic
al findings were a cardiac murmur and a systolic blood pressure gradie
nt between the arms and legs of greater than 10 mm Hg, which were both
present in all patients. Lower-extremity pulses were decreased in 37
(74%) and absent in 9 (18%). Forty-seven children (94%) had upper-extr
emity hypertension (>95th percentile for age); 25 (50%) had systolic b
lood pressure higher than 140 mm Hg. COA would have been missed in 82%
of children if absent lower-extremity pulses were required as a diagn
ostic feature. These findings were similar to those reported by our in
stitution in the previous decade, suggesting that early detection has
not improved. Conclusions. The timing of, reasons for, and sources of
referral for COA in this study, compared with data from the previous d
ecade, indicate no improvement in early detection of COA by pediatrici
ans. Screening all children for COA by routinely measuring upper- and
lower-extremity blood pressures during at least one physical examinati
on after the newborn period is mandatory.