Aortic Coarctation
A narrowing of the body's main artery, the aorta
Quick Facts
- Type: Congenital heart and blood vessel condition
- What it is: Narrowing of the aorta
- Common sign: High blood pressure in the arms
- Treatment: Surgery or catheter-based repair
Overview
Aortic coarctation is a narrowing of the aorta, the large artery that carries oxygen-rich blood from the heart to the rest of the body. The narrowing is usually present from birth (a congenital heart condition) and most often occurs in the part of the aorta just beyond where the arteries to the head and arms branch off.
The narrowed segment forces the heart to pump harder to push blood through, which can raise blood pressure in the upper body and reduce blood flow to the lower body. The condition ranges from severe forms that cause serious problems in newborns to milder forms that are not found until childhood or adulthood, sometimes when high blood pressure is discovered. With treatment, most people do well, though lifelong heart follow-up is important.
Symptoms
Symptoms depend on how narrow the aorta is and the person's age. Severe coarctation in a newborn can cause serious illness soon after birth, while milder cases may cause few symptoms for years.
- In newborns (severe): Poor feeding, fast or labored breathing, sweating, pale or gray skin, and trouble thriving
- In children and adults: High blood pressure in the arms, headaches, cold feet or leg pain with exercise, nosebleeds, and weaker pulses in the legs
- Chest pain or shortness of breath in some cases
A newborn who is feeding poorly, breathing hard, or has pale or gray skin needs emergency care. In older children and adults, unexplained high blood pressure, especially with weaker leg pulses, should be evaluated.
Causes
Aortic coarctation is usually a congenital condition, meaning the narrowing develops as the heart and aorta form before birth. The exact cause is often unknown.
- Congenital development: The aorta forms with a narrowed segment.
- Associated heart conditions: Coarctation often occurs alongside other heart problems, such as a two-leaflet (bicuspid) aortic valve.
- Genetic conditions: It is more common in some genetic conditions, such as Turner syndrome.
- Acquired causes: Rarely, narrowing of the aorta later in life results from injury or certain inflammatory conditions.
Risk Factors
- Other congenital heart defects, especially a bicuspid aortic valve
- Certain genetic conditions, such as Turner syndrome
- A family history of congenital heart disease
- Being assigned male at birth, in whom coarctation is somewhat more common
Diagnosis
Diagnosis involves a physical exam and imaging of the heart and aorta.
- Blood pressure and pulse check: Comparing blood pressure and pulses in the arms and legs; weaker leg pulses or lower leg blood pressure is a key clue.
- Echocardiogram: An ultrasound of the heart that can show the narrowing and any associated defects.
- CT or MRI: Detailed imaging of the aorta to define the narrowing and plan treatment.
- Other tests: Such as an ECG or chest X-ray to assess the heart's response.
Treatment
Treatment aims to relieve the narrowing, lower blood pressure, and protect the heart. The approach depends on the severity, the person's age, and any associated conditions.
- Surgical repair: An operation to remove or widen the narrowed segment and restore normal blood flow.
- Catheter-based treatment: A procedure using a balloon to stretch the narrowing, sometimes with a stent to keep the aorta open, performed through a blood vessel without open surgery.
- Medications: To control blood pressure before and sometimes after the procedure, and to stabilize newborns.
- Lifelong follow-up: Regular checks for re-narrowing, high blood pressure, and other heart issues.
Most people do well after treatment, but ongoing cardiology care is important because problems can develop years later.
Prevention
Because aortic coarctation is usually congenital, it cannot generally be prevented. The focus is on early detection and careful long-term care:
- Newborn screening and prompt evaluation of suspicious symptoms
- Investigating unexplained high blood pressure in children and young adults
- Lifelong cardiology follow-up after treatment to catch any re-narrowing or blood pressure problems early
When to See a Doctor
See a doctor if a child or young adult has unexplained high blood pressure, headaches, or leg pain with exercise. Seek emergency care immediately for:
- A newborn who feeds poorly, breathes hard, or has pale or gray skin
- Severe chest pain or sudden severe shortness of breath
- Fainting or collapse
Frequently Asked Questions
What is aortic coarctation?
Aortic coarctation is a narrowing of the aorta, the main artery carrying blood from the heart to the body. It is usually present from birth and makes the heart work harder, often raising blood pressure in the upper body.
How is aortic coarctation found?
Doctors may notice a difference in blood pressure or pulses between the arms and legs, often with high blood pressure in the arms. An echocardiogram and detailed imaging such as CT or MRI confirm the narrowing.
How is it treated?
Treatment relieves the narrowing through surgery or a catheter-based procedure that uses a balloon and sometimes a stent. Medications help control blood pressure, and lifelong cardiology follow-up is important.
Can aortic coarctation come back after treatment?
Yes, the aorta can re-narrow over time, and high blood pressure can persist or return. This is why regular, lifelong heart follow-up is recommended even after successful treatment.
When is aortic coarctation an emergency?
A newborn who feeds poorly, breathes hard, or has pale or gray skin needs emergency care. In older patients, severe chest pain, sudden severe shortness of breath, or fainting are emergencies.
References
- American Heart Association. Coarctation of the Aorta.
- Mayo Clinic. Coarctation of the aorta.
- MedlinePlus, U.S. National Library of Medicine. Coarctation of the aorta.
- Centers for Disease Control and Prevention (CDC). Congenital Heart Defects.