Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 273-

Author's reply

Anita Saxena, Jay Relan 
 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Anita Saxena
Department of Cardiology, All India Institute of Medical Sciences, New Delhi

How to cite this article:
Saxena A, Relan J. Author's reply.Ann Pediatr Card 2020;13:273-273

How to cite this URL:
Saxena A, Relan J. Author's reply. Ann Pediatr Card [serial online] 2020 [cited 2022 Dec 10 ];13:273-273
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Full Text


We thank the authors for their letter and appreciate their effort in bringing the issue to our notice. We agree with the authors and hereby clarify that the gradient of 20 mmHg mentioned in points “i” to “v” under the subheading “Indications for intervention” in coarctation of the aorta in the guideline document[1] refers to the gradient between upper and lower limb systolic blood pressure, instead of Doppler gradient, as per the European Society of Cardiology guidelines.[2]

Point “v” should be read as follows:

v. Intervention is not indicated if gradient between upper and lower limb systolic blood pressure is <20 mmHg with normal left ventricular function and no upper limb hypertension (Class III).

We agree that Doppler peak gradients tend to be overestimates, as they reflect the peak instantaneous pressure gradient instead of the peak-to-peak pressure gradient, and hence are not recommended to decide intervention in coarctation of the aorta.


We express thanks to Children's HeartLink Group (Ms. Bistra Zheleva, Ms. Adriana Dobrzycka, and Ms. Veera Rajasekhar), Pediatric Cardiac Society of India and Dr. Arun Singh, National Advisor, Rashtriya Bal Swasthya Karyakram, Ministry of Health and Family Welfare, Government of India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, et al. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the working group on management of congenital heart diseases. Ann Pediatr Card 2019;12:254-86.
2Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873-926.