The aorta is the main artery of the body and carries blood from the heart to the rest of the body. Coarctation is an abnormal narrowing in the aorta that is present at birth, causing congenital heart disease.
It is not known why coarctation of the aorta occurs. The narrowing in the aorta decreases the amount of blood that can flow through it. The worse the narrowing, the worse the symptoms. Severe cases may lead to symptoms in early infancy. Milder cases may not be discovered until adulthood.
Symptoms of coarctation of the aorta may be mild or severe. In severe cases, symptoms usually begin shortly after birth. The main symptoms are due to congestive heart failure, as the heart cannot pump blood through the narrowed passage. Congestive heart failure in children can cause: a rapid heartbeatswelling in the abdomenswelling in the legstrouble breathing or fast breathing
If symptoms do not occur until later in life, they may include: cold legsheadacheshigh blood pressure in the arms with low blood pressure in the legsleg crampsnosebleedssymptoms of congestive heart failure, including swelling of the legs and shortness of breathan upper body that is stronger and better developed than the lower body
Most of these symptoms tend to get worse with exercise. They are mostly due to the fact that blood can flow more easily to the upper body, which is above the narrowed portion of the aorta. The lower body, which is below the narrowed section of aorta, does not get as good a blood supply, so it does not grow as well.
The cause of coarctation of the aorta is unknown. Males are more commonly affected than females. Others at increased risk are: those with Turner syndrome, a condition present at birth that affects only females and is caused by an abnormal number of chromosomesthose with other heart defects present at birth, often called congenital heart disease
There are no known ways to prevent coarctation of the aorta.
The diagnosis of coarctation of the aorta may be suspected from the medical history and physical exam. Abnormalities on a heart tracing (ECG) or on, a chest X-ray may give clues to the diagnosis. An ultrasound test of the heart, called echocardiography, can confirm the diagnosis. The defect is also visible on a chest MRI or chest CT scan.
An X-ray procedure called cardiac catheterization may be done in some cases. In this test, a thin tube is inserted through the skin and into an artery, usually in the groin. The tube is then advanced along the artery and up into the heart. A contrast agent can then be squirted through the tube and into the blood. X-ray pictures of the contrast agent can be taken as it flows through the heart and aorta.
In severe cases, newborns with coarctation of the aorta can die without immediate treatment. Effects that can occur at any time over the long-term include: bleeding into the braincongestive heart failurehigh blood pressureinfections of the heartrupture or tearing of the aorta, which is called aortic dissection
Adults rarely survive past the age of 40 without treatment because of these long-term effects. Timely treatment can prevent most of them.
Coarctation of the aorta poses no risks to others.
Severely affected infants with coarctation of the aorta may need surgery shortly after birth. Before surgery, these infants may need aggressive treatment in the intensive care unit. This may include powerful medicines and an artificial breathing machine called a ventilator.
For those with no symptoms at birth, surgery is often advised later in childhood or in early adulthood when symptoms or heart damage begin. The goal of surgery is to remove or bypass the narrowed part of the aorta. Recently, more cases of coarctation are being sucessfully treated by widening the affected section of aorta with a balloon on a catheter.
Surgery carries a risk of bleeding, infections, allergic reactions to anesthesia, and sometimes even death.
After recovering from surgery, most people do well. Long-term follow-up care is needed to watch for and treat high blood pressure, which is common after surgery. Narrowing in the aorta can recur, especially in children less than 5 years old. In the absence of high blood pressure, most people can resume a normal life after recovery.
Long-term monitoring of blood pressure is needed. Other types ofmonitoring may be needed if heart damage or other heart defects are present before surgery. Any new or worsening symptoms should be reported to the healthcare provider.
Merck Manual, 1999
Current Medical Diagnosis and Treatment, 1996
Harrison's Principles of Internal Medicine, 1991
Heart Disease: A Textbook of Cardiovascular Medicine, 1980