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Critical Coarctation of the Aorta — RACP Paediatrics MCQ

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ModerateCardiologyCritical Coarctation of the AortaRACP Paediatrics

A 3-week-old infant presents with acute cardiovascular collapse. Examination reveals an absent right femoral pulse, differential SpO2 (right hand 97%, right foot 70%), and hepatomegaly. What is the most important immediate treatment while awaiting definitive management?

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Correct answer: D — IV prostaglandin E1 (alprostadil)

This presentation is consistent with critical coarctation of the aorta or interrupted aortic arch presenting after ductal closure. IV prostaglandin E1 (starting dose 5–10 nanograms/kg/min) is the life-saving treatment to reopen the ductus arteriosus, restoring blood flow to the lower body. Apnoea monitoring is essential as PGE1 can cause respiratory depression.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Duct-Dependent Congenital Heart Disease