Recognition of Coarctation of Aorta

Sir.—We read with interest the article by Thoele and colleagues¹ relating their experience in the prereferral diagnosis of coarctation of the aorta (CoA). We agree with them that in the asymptomatic child, the most important reason for a lack of diagnosis is an incomplete physical examination. Several recommendations were made. Palpation of the peripheral pulses and measurement of blood pressures were the most important of these suggestions. However, in our opinion, misleading emphasis was placed on palpation and blood pressure measurement in the right arm, almost to the exclusion of palpation and measurement on both upper extremities. Although Thoele and colleagues are correct in emphasizing that a left subclavian artery arising near or distal to the site of coarctation is not uncommon, an aberrant right subclavian artery can and does occur in a similar fashion. We recently encountered a child first referred at 5½ years of age (the