Coarctation of the Aorta

Coarctation is the term used to describe a narrowing in the wall of a vessel. Coarctation of the aorta is narrowing of the aorta, the main artery that delivers oxygen-rich blood from the heart, around the body.

This constricted segment obstructs the flow of blood to the body, meaning the lower left chamber of the heart ventricle needs to pump much harder than usual to force blood through the narrowed vessel and around the body. This can lead to hypertrophy (thickening) of the left ventricle wall, which can cause the heart to enlarge.

The first branches of the aorta supply the upper body with oxygenated blood, after which blood is transported to the lower body. Coarctation of the aorta can increase blood pressure in the head and arms and lower blood pressure in the legs, as well as place a great amount of strain on the heart.

The condition is usually a congenital defect and therefore present at birth. It can range from mild to severe and depending on the extent of the vessel narrowing, it may not be detected until adulthood. In rare cases, coarctation of the aorta develops later in life. It may develop as a result of traumatic injury, atherosclerosis, or a condition called Takayasu’s arthritis, which causes inflammation in the arteries and may narrow the aorta.

Generally, coarctation exists as an isolated defect, but it can occur along with other defects such as subaortic stenosis or ventricular septal defect. Depending on how severe the coarctation and whether or not other defects are present, surgery may be required to correct the defect. Treatment is usually successful, but careful follow-up is required throughout adulthood.

Symptoms

Symptoms of coarctation of the aorta depend on how narrowed the artery is and therefore how much blood can flow through it. If the narrowing is severe, signs and symptoms may appear earlier in life, while milder cases may not be detected until adulthood.

In around half of cases, babies born with this condition have coarctation severe enough to cause problems in the first few days of life. The symptoms babies may develop shortly after they are born include the following:

• Irritability
• Increased sleepiness
• Excessive sweating
• Pale skin
• Problems eating
• Breathing quickly

In these cases, babies are at risk of heart failure and death, if the condition is left untreated.

Adults with the condition often don’t experience any symptoms, but if symptoms do arise, the most common one is raised blood pressure in the arms. The blood pressure in the legs and ankles is often low. Some of the other symptoms these individuals may develop include the following:

• Headache
• Pain in the chest
• Raised blood pressure
• Cold feet or legs
• Cramp in the legs
• Nosebleed
• Difficulty exercising
• Dizziness
• Shortness of breath

A person who experiences these symptoms may not necessarily have a serious problem, but should still seek a medical check because early detection may help to save their life.

Prognosis

This condition can be treated with surgery, after which symptoms rapidly resolve. However, there is an increased risk of heart problems when a person has had their aorta repaired and these individuals require careful life-long follow-up.

If coarctation of the aorta is not treated, people usually die before the age of 40 and surgery is therefore usually recommended before the age of 10. In most cases, corrective surgery is performed during infancy.