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Coarctation of the aorta is a narrowing of the aorta, the large blood vessel that delivers oxygen-rich blood throughout the body. Usually, the narrowing occurs near the ductus arteriosus, a blood vessel that was important in the fetus. This narrowing can cause increased blood pressure in your arms, and decreased blood pressure in your legs. The extra pressure in the heart can cause the heart muscle to thicken, which may cause it to weaken over time. If the narrowing is severe, symptoms are present in infancy. If it is not treated, heart failure or death can occur. Treatment for coarctation of the aorta often requires surgical repair.
Even after repair, patients with coarctation can develop high blood pressure or coronary artery problems at an earlier age than patients who have not had a coarctation. This may occur regardless of the amount of narrowing at the coarctation. Therefore, it is very important that patients who have had a coarctation repair have lifelong cardiology follow-up to monitor for any long-term complications.
Coarctation of the aorta occurs during fetal development or in the first week of life. In most cases, the cause is unknown.
Symptoms vary depending on the degree of narrowing. Symptoms in infants include:
Sometimes the narrowing may be mild and the body will make new arteries around the narrowing. This may result in coarctation being diagnosed later in childhood or adulthood. The most common presenting symptom in older children or adults is high blood pressure.
Adolescents and adults who have the condition often do not have symptoms because their narrowing is usually less severe. If they do have symptoms, they may include:
Coarctation of the aorta may be detected by a physician who notices:
Re-narrowing can occur without symptoms. If you had your condition repaired in childhood and narrowing has recurred, you may be a candidate for an additional cardiac catheterization procedure.
Ohio State’s Wexner Medical Center offers a team approach to congenital heart disease (CHD), which means each patient is evaluated by an adult congenital heart disease (ACHD) specialist, and when appropriate, a cardiac surgeon, an imaging specialist and an interventional cardiologist with training in CHD. This integrated approach means that each patient’s disease is treated individually, with that particular patient’s needs and physical condition in mind.
Anyone who has ever been diagnosed with or treated for coarctation of the aorta should have lifelong care from a cardiologist who specializes in congenital heart defects. We provide this care from birth to adulthood; we partner with Nationwide Children’s Hospital to provide the resources necessary for the care of adult congenital cardiac patients through the Columbus Ohio Adult Congenital Heart Disease Program (COACH).
The COACH program focuses on:
Because of improvements in technology, some congenital heart defects can be detected before a baby is born. In other cases, severe heart defects are detected shortly after birth. Some cases of less-severe disease may not be detected until childhood, late adolescence or even adulthood.
Tests used to diagnose coarctation of the aorta include:
Ankle-brachial index (ABI) – A test that measures blood pressure in the affected extremity
Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart
Echocardiogram (also called echo) – A test that uses sound waves to assess the function and structure of the heart muscle and valves
Chest X-ray – A radiograph or picture of the heart and lungs, including blood vessels, ribs, and bones of the spine
Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating
Cardiac catheterization – A procedure to measure pressures in the heart and blood vessels and to check for problems in the coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, and then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
Medication may be prescribed to help regulate blood pressure before surgery. It is not used to repair coarctation of the aorta.
Surgical procedures to treat coarctation of the aorta involve relieving the narrowing of the aorta to improve blood flow to the lower half of the body. This can be done by bypassing the narrowing, removing the narrowed segment and reattaching the aorta, or by making a patch from Gortex or another artery.
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