Guide to Coarctation of the Aorta
Coarctation of the aorta is a birth defect in which a section of the aorta (the major artery that carries oxygen-rich blood from the heart to the rest of the body) is abnormally narrow. Depending on how narrow the section of the aorta is, symptoms can be mild to severe. Treatment is typically needed to widen the aorta and resume normal blood flow.
Key Facts
- Children born with a mild narrowing (or coarctation) may not be diagnosed or require treatment until later in life. Those with a more severe narrowing may be diagnosed before birth and receive treatment shortly after.
- The most common treatment is angioplasty, a minimally invasive procedure that uses a thin, flexible tube called a catheter to insert a balloon or stent (a wire mesh device) into the aorta, widening the narrow section so blood can flow normally.
- Recurrence can occur in children under 3 but becomes less common as they get older. However, regular follow-ups to manage blood pressure and other complications will be necessary over the long-term.
Causes
The exact causes of coarctation of the aorta are unknown. Most likely, it is a combination of risk factors, including:
- Genetic disorders, such as Turner syndrome
- Male biological sex (coarctation is twice as common in males)
- Viral infection during pregnancy
- The presence of other heart abnormalities, such as defects in the heart valves or walls
Symptoms
Symptoms of coarctation of the aorta can range from mild to severe depending on how narrow the aorta is.
Young children with a mild coarctation may not show any symptoms until later in life, while babies with more serious cases can develop the following symptoms early on:
- Difficulty breathing
- Heavy sweating
- Irritability
- Pale skin
- Problems with feeding
For older children and adults, symptoms may include:
- Chest pain
- Exercise intolerance
- Headaches
- High blood pressure
- Leg cramps or cold feet
- Muscle weakness
- Nosebleeds
Diagnosis
Diagnosing coarctation of the aorta will often depend on how serious it is. Patients with mild coarctation may not receive a diagnosis until they are adults. More severe cases may be detected with a routine ultrasound during pregnancy and diagnosed shortly after birth.
Coarctation of the aorta can be diagnosed using a number of methods:
- Cardiac catheterization: This procedure can be used to detect blockages in blood vessels, as well as determine their severity. It involves inserting a catheter into a blood vessel and up into the heart so different measurements can be taken.
- Chest X-ray: This test creates a detailed picture of the heart and lungs, allowing doctors to check for signs of coarctation.
- Echocardiogram: This technique uses sound waves to produce an image of the heart. Doctors can use it to see the heart beating and pumping blood while they look for defects.
- Electrocardiogram: This test measures the electrical activity of the heart. Sensors called electrodes are attached to the patient’s arms, legs, and chest to measure how well the heart is beating.
- Magnetic resonance imaging (MRI): This test uses magnetic fields to create detailed images of the heart and blood vessels. Doctors can use it to locate the coarctation, determine its severity, and guide treatment.
Treatment
Treatment options for coarctation of the aorta will depend on the severity of the condition, the presence of any other heart defects, and the patient’s age. If other heart defects exist, they will likely need to be repaired at the same time, which may mean more invasive types of surgery.
Treatment methods for coarctation of the aorta include:
- Balloon angioplasty: A catheter is inserted into an artery in the groin then guided up into the aorta using X-rays. Once it reaches the narrowed section, a balloon at the end of the catheter is inflated, widening the area and allowing blood to flow more easily. This is the most common method for treating aortic coarctation of the aorta.
- Stenting: A small wire mesh tube is expanded inside a blood vessel. Stents are often used in combination with a balloon angioplasty to help keep the artery open and decrease the chances of it narrowing again.
- Anastomosis: A surgical procedure to remove the narrowed section of the aorta and then connect the two remaining ends back together.
Outlook
The long-term outlook for coarctation of the aorta after corrective surgery is excellent. The overwhelming majority of patients who receive treatment for the condition go on to lead normal, healthy lives. However, as with any surgery, complications are possible. These may include:
- Re-stenosis: Occasionally, the aorta becomes narrow again. This is more common in infants and small children and very rarely happens after 3 years old.
- High blood pressure: Hypertension (high blood pressure) is typical after surgery and can be treated with medication. But if the problem continues, long-term treatment may be necessary.
Anyone who has received treatment for coarctation of the aorta should regularly follow up with a cardiologist to check for additional complications and heart problems.
Next Steps
If your child has a congenital heart issue such as coarctation of the aorta, the Congenital Heart Center can help. Our team can offer personalized treatment plans delivered with a level of quality that could only come from one of the most experienced programs in the country.
Call us at 212-305-2688 or use our online form to schedule an appointment.