What is Coarctation of the Aorta?

Coarctation of the aorta is a narrowing of the aorta. The aorta brings blood from the left ventricle of the heart to the body. A narrowing, or coarctation can occur in either a short or long piece of the aorta.  It can occur alone or associated with other heart conditions, typically it occurs with left-sided heart lesions such as ventricular septal defects, mitral or aortic valve abnormalities or hypoplastic left heart syndrome.

Genetic conditions such as Turner’s syndrome can be associated with coarctation of the aorta.

Effects and Symptoms

Effects and symptoms vary with severity of the narrowing. Severe coarctation in newborns and infants can present with poor feeding or weight gain. Some severe cases can cause poor circulation and trouble breathing. 

Infants and children with less severe forms can have no symptoms with normal growth and development.

Diagnosis

Severe coarctation of the aorta can be suspected clinically with a complete physical examination. Pulses in the legs may be weak or absent. A heart murmur may be heard, and signs of poor circulation can be evident.

Infants and children without symptoms can have higher blood pressure in the arms than the legs. Pulses in the legs can also be weaker than the arms. A chest X-ray can provide clues to the presence of coarctation of the aorta, and an echocardiogram is the diagnostic tool for detecting this condition.

Nonspecific changes can be seen in an ECG as well. Rarer forms with narrowing at the level of the abdomen can be detected with a CT scan or an MRI.

Management and Treatment

Prostaglandin E (PGE) can be given to severe cases of coarctation in the newborn to keep the patent ductus arteriosus (PDA) open. This medicine keeps the PDA open to provide adequate blood supply to the body before surgical repair.

Depending on the age of the child, presence of symptoms and the degree, extent and location of the narrowing, coarctation of the aorta can be addressed by cardiac catheterization or surgical repair.

Surgery

Cardiac catheterization can provide widening of the coarctation by balloon dilation +/- implantation of a stent. This is typically offered to older children who are good candidates. Your cardiologist will discuss what treatment options will be best for you.

Surgical repair is required in newborns and infants with symptoms and older children who are not good candidates for cardiac catheterization. There are different types of surgical techniques to repair coarctation of the aorta. The chosen surgical technique will vary according to the degree and extent of coarctation, as well as the presence of other associated lesions. 

Adult and Adolescent Management

Hypertension or elevated blood pressure can persist even after repair of the coarctation. Outcomes of cardiac catheterization and repair are generally very good, but some degree or narrowing can persist or recur in some cases. Regular follow up is done to monitor blood pressure or any changes in the site of intervention or repair.

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