Coarctation of the Aorta

ExitCare ImageCoarctation of the Aorta is usually a congenital defect affecting the aorta. Congenital means that it starts to develop before birth. The aorta is the main artery (blood vessel) that delivers blood from the heart to the rest of the body. When part of the aorta is too narrow, this is called coarctation. The narrowed aorta acts like a bottleneck and makes it hard for blood to pass to the rest of the body. As a result, the heart has to pump harder than usual. This can cause high blood pressure in the upper part of the body and low blood pressure in the legs. Some important points to know about Coarctation of the Aorta are:

  • It is most often discovered in babies or children, but it can be detected at any age.

  • It occurs 2-5 times more frequently in boys than girls.

  • A small number of patients develop brain aneurysms. This can cause bleeding into the brain, especially if high blood pressure is left untreated.

  • There is an increased risk of having an abnormal heart valve when a diagnosis of Coarctation of the Aorta is made.

  • It is important to get treatment for this condition. If it is not treated, the heart muscle can deteriorate. Over time, this can cause heart failure and eventual death.

CAUSES

The cause of Coarctation of the Aorta is not always known.

  • When it is diagnosed in young children:

  • The condition usually is present at birth.

  • Many children who have Coarctation of the Aorta also have other heart problems, such as heart valve disease or they may have a hole in the wall between the heart's upper or lower chambers.

  • Girls with the condition sometimes have a condition called Turner syndrome. This is a genetic condition when girls do not have two X chromosomes.

  • When Coarctation of the Aorta is diagnosed later in life:

  • The narrowing might not have been severe enough to cause symptoms earlier. Another possibility is that the narrowing developed slowly over time, and extra blood vessels formed that helped deliver blood to the lower part of the body. These extra blood vessels are usually only seen in older patients with coarctation.

  • It can also rarely develop in people with Takayasu's Arteritis. In this rare chronic condition, the aorta and the rest of the blood vessels are inflamed and can become narrowed.

SYMPTOMS

Symptoms depend on the age and how severe the narrowing is. In babies, if the coarctation is mild, there might not be any symptoms.

  • In infants and very young children, severe symptoms can include:

  • Skin color changes such as cyanosis (bluish skin color) or mottled (patchy or blotchy) skin.

  • Rapid or difficult breathing.

  • Poor eating.

  • Sweating while eating.

  • Poor weight gain.

  • Cold feet or legs.

  • In older children and adults, symptoms can include:

  • Dizziness or fainting.

  • Shortness of breath or rapid breathing.

  • Pounding headache.

  • Chest pain.

  • Cold feet or legs.

  • Nosebleed.

  • Leg cramps with exercise.

  • Hypertension (high blood pressure) with or without exercise.

  • Decreased ability to exercise.

DIAGNOSIS

  • Tests during routine physical exams can reveal signs of aortic coarctation in children and adults.

  • Blood pressure readings maybe different between the right arm and left arm. The blood pressure may also be high in the arms and low in the legs.

  • Heart sounds. A murmur may be heard if there is an abnormal heart valve.

  • Pulse checks. The pulse in the legs may be weak or delayed compared with the pulse in the arms. This is how the condition is often discovered in infants. Other symptoms might not show up until the child is older.

  • If Coarctation of the Aorta is suspected, other tests can confirm it. They include:

  • Chest X-ray.

  • Cardiac echocardiogram. This is an ultrasound scan of the heart.

  • EKG (electrocardiogram). This records electrical activity in the heart.

  • CT (computed tomography). This is a scan that uses radiation to create pictures of the body's internal parts.

  • MRI (magnetic resonance imaging). This is a scan that uses a large magnet and radio waves to produce images of the heart.

  • Cardiac catheterization. This involves inserting a catheter (a long, thin, flexible tube) into a blood vessel and guiding it into the heart. A cardiologist can then check the pressures in the heart and on either side of narrowing to check the significance the coarctation. They can also take pictures of the coarctation with special catheters and a small injection of X-ray dye.

TREATMENT

Coarctation of the Aorta must be treated. Different treatment options involve:

  • Medication. Newborns may need medicine to keep the heart working until the condition can be corrected. Other medicines can be used to bring high blood pressure to a normal level.

  • Surgery. This is the most common treatment in infants and is done to remove the narrowed part of the aorta.

  • If a small part of the aorta is removed, the two free ends can be reconnected.

  • If a large part of the aorta is removed, a graft (a patch) is used to fill the gap. The graft is commonly a piece of synthetic fabric.

  • Balloon angioplasty. This procedure can be done if the artery becomes narrow again after surgery (recoarctation) or if the person is older when they are diagnosed with coarctation. A special catheter is threaded through a blood vessel to the narrow point in the artery. Then a balloon on the end of the tube is quickly inflated and then deflated and removed. This widens the narrowed spot in the artery so blood can flow more freely again.

  • Stenting. A metal mesh tube is placed on a balloon catheter and positioned in the narrow part of the artery. The stent stays inside the aorta and supports the artery walls and props the artery open so blood can flow more normally. This is usually done only in adolescents and adults.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.