Transthoracic echocardiographic (TTE) images with Doppler assessment in a patient with coarctation of the aorta

(A) Two-dimensional suprasternal TTE image demonstrating severe narrowing in the descending thoracic aorta (arrow).
(B) Color-flow Doppler demonstrating marked flow acceleration at the narrowed site.
(C) Parasternal short axis TTE image showing a bicuspid aortic valve (double asterisk), which frequently is seen in patients with coarctation.
(D) Pulsed-wave Doppler of the abdominal aorta demonstrating a low antegrade systolic velocity with persistent flow in diastole (arrow).
(E) Continuous-wave Doppler demonstrating severe obstruction at the site of coarctation with a peak systolic gradient of 65 mmHg and a mean gradient of 33 mmHg. Note persistent forward flow during diastole, consistent with persistent pressure gradient across the obstruction.