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Coarctation of the Aorta

Heart Defect Present at Birth

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Updated November 19, 2008

Coarctation of the aorta

Coarctation of the aorta

Photo © A.D.A.M.
The largest blood vessel in the body, and the main one that carries blood away from the heart to the body, is the aorta. In coarctation of the aorta, a heart defect present at birth, a section of the aorta is very narrow (constricted). This makes it harder for the heart to pump blood out to the body.

Coarctation of the aorta occurs in 5-8% of children who are born with heart defects (called congenital heart disease). It occurs twice as often in boys as in girls. Coarctation of the aorta occurs because the vessel did not develop properly during the first eight weeks of pregnancy. This heart defect is more common in persons with certain genetic disorders such as Turner syndrome. It is usually diagnosed in children and adults under age 40.

Symptoms

The aorta is shaped like a candy cane, with the curved part toward the head and the straight part pointing down in the body. Coarctation of the aorta can occur anywhere in the vessel but it tends to occur just after the C-shaped curve at the top (called the aortic arch). This means that blood may have a hard time getting out to the body. Also, the blood pressure will be high before the narrowed section but low after it. Therefore, children with coarctation of the aorta may have symptoms such as:
  • headaches from high blood pressure in the head
  • cold feet or legs
  • cramps in the legs with exercise
  • abnormal heart sounds (heart murmur)
  • dizziness or fainting
  • babies may have difficulty feeding and poor weight gain
The more severe the narrowing, the more severe the symptoms will be. Mild narrowing may not cause symptoms.

Diagnosis

Sometimes coarctation of the aorta is found during a newborn baby’s first examination or during a routine check-up with the pediatrician. Sometimes symptoms such as a heart murmur, headaches, or poor circulation to the legs will suggest the diagnosis. A children’s heart specialist (pediatric cardiologist) will give the child a complete heart examination, including checking the pulse and blood pressure in the arms and legs. In coarctation of the aorta, the pulse will be weaker and the blood pressure lower in the legs than in the arms.

A chest x-ray may show the narrowed section of the aorta. The most helpful procedure will be an ultrasound of the heart (echocardiogram). In this procedure, the cardiologist will be able to look at the heart structure and see the coarctation of the aorta. Sometimes other tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scan may be needed to confirm the diagnosis.

Treatment

Coarctation of the aorta is treated by repairing the narrowed section of the vessel. Most children will have this repair done in infancy, and almost all will have it repaired before age 10 years. There are two ways it can be repaired: by balloon angioplasty and by open-heart surgery.

Balloon angioplasty – In this procedure, a long flexible tube (called a catheter) is inserted into a large blood vessel in the groin and threaded up to the heart to where the aorta is narrowed. The catheter has a small deflated balloon on the end of it. When it gets to the narrowed section, the balloon is inflated and the narrowed part is stretched open. A small device called a stent may be placed there to help keep the aorta open.

Surgery – The narrowed part of the aorta is cut out and the healthy ends are joined together. If the section removed is large, synthetic material or one of the child’s own blood vessels is used to bridge the gap.

Most children live healthy lives after repair of the coarctation. Sometimes narrowing of the aorta may happen again. In this case a balloon angioplasty or additional surgery may be needed to repair it.

Sources:

"Coarctation of the Aorta (CoA)." My Child Has.... Children's Hospital Boston. 5 Nov 2008

Zieve, David. "Coarctation of the aorta." MedlinePlus Medical Encyclopedia. 11 Dec 2007. U.S. National Library of Medicine. 5 Nov 2008

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