Health Encyclopedia

Coarctation of the aorta

Definition

Aortic coarctation is a narrowing of part of the aorta (the major artery leading out of the heart). It is a type of birth defect. Coarctation means narrowing.

Alternative Names

Aortic coarctation

Causes, incidence, and risk factors

The aorta carries blood from the heart to the vessels that supply the body with blood and nutrients. If part of the aorta is narrowed, it is hard for blood to pass through the artery.

Aortic coarctation is more common in persons with certain genetic disorders, such as Turner syndrome. However, it can also be due to birth defects of the aortic valves.

Aortic coarctation is rare. It is usually diagnosed in children or adults under age 40.

Symptoms

Symptoms depend on how much blood can flow through the artery. Other heart defects may also play a role. In severe cases, symptoms are seen when the baby is very young. In milder cases, symptoms may not develop until the child has reached adolescence. Symptoms include:

Dizziness or fainting
Shortness of breath
Pounding headache
Chest pain
Cold feet or legs
Nosebleed
Leg cramps with exercise
Hypertension (high blood pressure) with exercise
Decreased ability to exercise
Failure to thrive
Poor growth

Note: There may be no symptoms.

Signs and tests

The health care provider will perform a physical exam and take your blood pressure in your arms and legs. Your pulse will be checked. The pulse in the femoral (groin) area is weaker than the carotid (neck) pulse. Sometimes, the femoral pulse may not be felt at all.

The doctor will use a stethoscope to listen to your heart and check for murmurs. People with aortic coarctation have a harsh-sounding murmur that can be heard from the back. Other types of murmurs may also be present.

Coarctation is often discovered during a newborn's first examination or a well-baby exam. Taking the pulses in an infant is an important part of the examination since there may not be any other symptoms or findings until the child is older.

Tests to diagnose this condition may include:

Both Doppler ultrasound and cardiac catheterization can be used to see if there are any differences in blood pressure in different areas of the aorta.

Treatment

Surgery is usually recommended. The narrowed part of the aorta will be removed or opened. If the problem area is small, the two free ends of the aorta may be re-connected. This is called anastomosis. If a large part of the aorta was removed, a Dacron graft (a synthetic material) or one of the patient's own arteries is used to fill the gap. A tube graft connecting two parts of the aorta may also be used.

Sometimes, balloon angioplasty may be done instead of surgery.

Expectations (prognosis)

Coarctation of the aorta can be cured with surgery. Symptoms quickly get better after surgery.

However, there is an increased risk for death due to heart problems among those who have had their aorta repaired. But, without treatment, most people die before age 40. For this reason, doctors usually recommend that the patient has surgery before age 10. Most of the time, surgery to fix the coarctation is done during infancy.

Complications

Aortic aneurysm
Aortic dissection
Aortic rupture
Severe hypertension
Endocarditis
Intracerebral hemorrhage
Stroke
Heart failure
Premature development of coronary artery disease (CAD)
Paraplegia (rare complication of surgery to repair coarctation)
Injury to the nerve to the larynx
Residual narrowing of the aorta

Calling your health care provider

Call your health care provider if you or your child have symptoms of coarctation of the aorta.

Call your health care provider if fainting or chest pain develops; these may be signs of a serious problem.

Prevention

There is no known way to prevent this disorder, however, awareness of risk may make early diagnosis and treatment possible.

References

Webb GD, Smallhorn JF, Therrien J, et al. Congenital heart disease. Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007. http://www.mdconsult.com/about/book/83821525-2/instruct.html?DOCID=1549. Accessed December 11, 2007.

Review Date:12/11/2007
Reviewed By:David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; and Mark A Fogel, MD, FACC, FAAP, Associate Professor of Pediatrics and Radiology, Director of Cardiac MR, The Children's Hospital of Philadelphia.

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