What Is Coarctation of the Aorta?

Symptoms of Coarctation of the Aorta

Symptoms of aortic coarctation depend on how much narrowing occurs. Most people with the condition do not experience symptoms, and mild coarctation is often not diagnosed until adulthood.

Infants with severe aortic coarctation may present with symptoms shortly after birth. Symptoms of aorta coarctation in infants include:

• Difficulty breathing
• Difficulty feeding
• Heavy sweating
• Pale skin
• Irritability

Symptoms of aortic coarctation that occur after infancy can include:

• Chest pain
• Headaches
• High blood pressure
• Leg cramps or cold feet
• Muscle weakness
• Nosebleeds

Depending on the location of the coarctation, blood pressure may be high in the arms and low in the legs and ankles. People with aortic coarctation often have other heart defects. In those individuals, symptoms will depend on the other congenital heart defect or defects they have.

What Causes Coarctation of the Aorta?

The exact cause or causes of aortic coarctation are not fully known. However, genetic changes that happen before birth are often the cause of congenital heart defects (those present at birth) like aortic coarctation. For example, babies with Turner syndrome are at a higher risk of developing aortic coarctation and other congenital defects that affect the left side of their heart. Also, environmental factors related to the mother play a role in causing some heart defects.

Diagnosis of Aortic Coarctation

Severe aortic coarctation is usually diagnosed soon after birth. The condition can also be revealed via ultrasounds done during pregnancy.

Older children and adults with mild aortic coarctation may not present with symptoms. A doctor will check for the following if coarctation of the aorta is suspected:

• High blood pressure in the arms
• Lower blood pressure in the legs than in the arms
• Weak or delayed pulse in the legs
• A whooshing sound made by blood flowing through the narrowed aorta (heart murmur)

Tests to confirm a diagnosis of coarctation of the aorta may include:

• Chest X-ray: Can show a narrowing in the aorta at the site of the coarctation or an enlarged portion of the aorta or both.
• Echocardiogram (Echo): Uses ultrasonic waves to assess your heart’s structure and function. An echocardiogram often shows the location and severity of aortic coarctation. The test can also reveal other congenital heart defects such as a bicuspid aortic valve.
• Electrocardiogram (ECG): Records the electrical activity of your heart over a period of time. If the aortic coarctation is severe, an ECG may reveal thickening of the walls of the lower heart chambers (ventricular hypertrophy).
• Computerized tomography (CT) scan: A CT scan uses X-rays to produces detailed cross-sectional images of the body.
• CT angiogram: In this test, special X-rays show how blood flows through the arteries and veins. A CT angiogram can reveal the location and severity of aortic coarctation and determine whether the condition is affecting other blood vessels in your body. CT angiograms are also used to guide certain aortic coarctation treatments.
• Cardiac magnetic resonance imaging (MRI): A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart and blood vessels. This test can show the location and severity of the aortic coarctation. Your care provider may also use MRI results to guide treatment.
• Cardiac catheterization: A thin tube called a catheter is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye is introduced into your bloodstream through the catheter to help the arteries to show up more clearly on X-ray images and video. Cardiac catheterization can help determine the severity of the aortic coarctation. In addition, catheter procedures may be used to perform certain treatments for coarctation of the aorta.

Treatment of Coarctation of the Aorta

Treatment for aortic coarctation depends on the patient’s age at the time of diagnosis and the severity of the coarctation. If other congenital heart defects are present, they may be repaired at the same time.

Treatment for aortic coarctation may include medication to manage symptoms and procedures and surgeries to repair the aorta.

Medication

Patients with aortic coarctation may be prescribed medication to lower blood pressure before and after the surgery to repair the condition. In addition, many patients must continue to manage their blood pressure with medication even after a successful surgery or procedure.

Often infants with severe aortic coarctation are given a medication that keeps the ductus arteriosus (a blood vessel that connects the aorta to the pulmonary artery) open. This treatment allows blood to flow around the narrowed part of the aorta until surgery is performed.

Surgery & Other Procedures

There are several procedures and surgeries to repair aortic coarctation. Together, you and your healthcare team can discuss which type is most likely to be successful. Options include:

• Balloon angioplasty and stenting: This is often the first treatment for the repair of aortic coarctation. Angioplasty is a procedure in which the surgeon repairs the narrowing of the aorta by inflating a special balloon device inside the artery to widen it. During the procedure, the doctor may also place a stent (a mesh-like device) at the site of the angioplasty to hold the artery open, decreasing the chance of it narrowing again. Sometimes this procedure may be done if narrowing recurs after a previous coarctation surgery.
• Resection with end-to-end anastomosis: This procedure consists of the removal of the narrowed area of the aorta and the connection of the two healthy parts of the aorta (anastomosis).
• Subclavian flap aortoplasty: In this procedure, a part of the left subclavian artery (the blood vessel that delivers blood to the left arm) is used to enlarge the narrowed section of the aorta.
• Patch aortoplasty: Useful when a coarctation involves a long part of the aorta, this procedure involves cutting across the narrowed part of the aorta and attaching a patch of synthetic material to widen the artery.
• Bypass graft repair: In this surgery, a graft (a tube usually made of synthetic material) is used to reroute blood around the shortened area of the aorta.

Following aortic repair surgery, health checkups are needed for life to check blood pressure and monitor for complications.