Coarctation of the Aorta
A narrowing of the body's main artery, the aorta
Quick Facts
- Type: Congenital heart defect
- What it is: Narrowed segment of the aorta
- Key sign: High blood pressure in the arms
- Treatment: Surgery or catheter procedure
Overview
Coarctation of the aorta is a narrowing of part of the aorta, the large artery that carries oxygen-rich blood from the heart to the rest of the body. The narrowed section restricts blood flow, so the heart must pump harder to push blood past it. This is a congenital heart defect, usually present from birth, though it is sometimes not found until later in childhood or adulthood.
Because the narrowing typically lies beyond the vessels supplying the arms and head, blood pressure is often high in the upper body and lower in the legs. Coarctation can occur on its own or alongside other heart defects, and it is treatable with surgery or a catheter procedure.
Symptoms
Symptoms vary with the severity of the narrowing and the age at which it is found.
- In newborns with severe narrowing: poor feeding, fast breathing, irritability, pale or gray skin, and difficulty within days of birth
- High blood pressure, especially in the arms
- Weak or delayed pulses in the legs or groin compared with the arms
- Headaches, nosebleeds, or cold feet
- Leg pain or cramping with exercise
- Chest pain in some cases
Severe coarctation in a newborn can cause sudden, serious illness as a fetal blood vessel closes, and this is a medical emergency.
Causes
Coarctation develops as the aorta forms before birth. The precise cause is usually unknown, but several factors are linked.
- Abnormal development of the aorta: The vessel narrows during fetal growth.
- Genetic conditions: It occurs more often in people with certain syndromes, such as Turner syndrome.
- Associated heart defects: It frequently accompanies a two-leaflet (bicuspid) aortic valve and other defects.
In most cases coarctation is present at birth, though milder forms may not cause noticeable problems until later in life.
Risk Factors
- Certain genetic conditions, such as Turner syndrome
- A bicuspid aortic valve
- Other congenital heart defects
- A family history of heart defects
- Male sex, which is somewhat more often affected
Diagnosis
Coarctation may be suspected when blood pressure differs between the arms and legs or when pulses in the legs feel weak. Tests confirm and map the narrowing.
- Echocardiogram: The main test, showing the narrowed area and its effect on blood flow.
- Blood pressure measurement: Comparing arms and legs reveals the characteristic difference.
- CT or MRI scan: Provide detailed pictures of the aorta.
- Chest X-ray and ECG: Show heart size and electrical activity, and may reveal changes from long-standing high pressure.
- Pulse checks: Comparing the timing and strength of pulses in the arms and legs supports the diagnosis.
Treatment
The narrowed segment is treated to restore normal blood flow and relieve strain on the heart.
- Surgery: The narrowed part of the aorta is removed or widened and the vessel reconnected, often the preferred option in infants.
- Catheter procedure: A balloon, sometimes with a stent, can widen the narrowed area through a blood vessel in older children and adults.
- Medication: Used to control blood pressure before and sometimes after the procedure.
After treatment, lifelong follow-up is important because high blood pressure can persist or the area can re-narrow, and timely monitoring keeps the heart healthy. Even after a successful repair, some people continue to have high blood pressure and need medication to control it, which protects the heart, brain, and kidneys over time. Doctors also watch for re-narrowing of the treated segment and, in some people, for weakening or bulging of the aorta wall. Because coarctation often occurs with other heart problems such as a bicuspid aortic valve, ongoing care includes checking the heart valves as well. With modern treatment and regular monitoring, most people with coarctation lead full and active lives.
When to See a Doctor
See a doctor if a child has high blood pressure, weak leg pulses, or symptoms such as headaches, cold feet, or leg cramps with activity. Seek emergency care immediately if a newborn:
- Has trouble breathing or feeds very poorly
- Becomes pale, gray, or unusually sleepy
- Is irritable and not improving
- Shows signs of collapse or severe distress
Frequently Asked Questions
Why does coarctation of the aorta cause high blood pressure?
The narrowing restricts blood flow, so the heart pumps harder and pressure builds up in the arteries before the narrowed segment, typically those supplying the arms and head. This often produces high blood pressure in the upper body and lower pressure in the legs.
How is coarctation of the aorta repaired?
It can be treated with surgery to remove or widen the narrowed part of the aorta, or with a catheter procedure that uses a balloon and sometimes a stent to open the narrowing. The choice depends on age and the specifics of the narrowing.
Can coarctation come back after treatment?
Yes, the area can sometimes re-narrow after repair, especially when treated in infancy. High blood pressure can also persist. This is why lifelong follow-up with a heart specialist is recommended after treatment.
Is coarctation of the aorta detected at birth?
Severe coarctation often causes symptoms within the first days of life and is detected early. Milder narrowing may go unnoticed until childhood or adulthood, when high blood pressure or weak leg pulses lead to the diagnosis.
When is coarctation an emergency?
A newborn with severe coarctation can become critically ill as a fetal blood vessel closes, with poor feeding, breathing trouble, and pale or gray skin. This is a medical emergency requiring immediate care.
References
- Centers for Disease Control and Prevention (CDC). Coarctation of the Aorta.
- Mayo Clinic. Coarctation of the aorta.
- MedlinePlus, U.S. National Library of Medicine. Coarctation of the aorta.