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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Coarctation of the aorta

Aortic coarctation

Last reviewed: December 1, 2011.

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.

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.

Aortic coarctation is one of the more common heart conditions that are present at birth (congenital heart conditions). It is usually diagnosed in children or adults under age 40.

This condition may be related to cerebral aneurysms, which can increase the risk for stroke.

Coarctation of the aorta may be seen with other congenital heart defects, such as:

  • Bicuspid aortic valve
  • Defects in which only one ventricle is present
  • Ventricular septal defect

Symptoms

Symptoms depend on how much blood can flow through the artery. Other heart defects may also play a role.

Around half of newborns with this problem will have symptoms in the first few days of life.

In milder cases, symptoms may not develop until the child has reached adolescence. Symptoms include:

Note: There may be no symptoms.

Signs and tests

The health care provider will perform a physical exam and take the blood pressure and pulse in the arms and legs.

  • The pulse in the groin (femoral) area or feet will be weaker than the pulse in the arms or neck (carotid). Sometimes, the femoral pulse may not be felt at all.
  • The blood pressure in the legs is usually weaker than in the arms. Blood pressure is usually higher in the arms after infancy.

The doctor will use a stethoscope to listen to the 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 well-baby exam. Taking the pulse in an infant is an important part of the examination, because there may not be any other symptoms 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

Most newborns with symptoms will have surgery either right after birth or soon afterward. First they will receive medications to stabilize them.

Children who are diagnosed when they are older will also need surgery. Usually, the symptoms are not as severe, and more time will be taken to plan for surgery.

During surgery, 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 an end-to-end anastomosis. If a large part of the aorta is removed, a Dacron graft (a man-made material) or one of the patient's own arteries may be used to fill the gap. A tube graft connecting two parts of the aorta may also be used.

Sometimes, doctors will try to stretch open the narrowed part of the aorta by using a balloon that is widened inside the blood vessel. This type of procedure is called a balloon angioplasty. It may be done instead of surgery, but it has a higher rate of failure.

Older children usually need medicines to treat high blood pressure after surgery. Some will need lifelong treatment for this problem.

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. 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.

Narrowing or coarctation of the artery can return after surgery. This is more likely in persons who had surgery as a newborn.

Complications

Complications that may occur before, during, or soon after surgery include:

Long-term complications include:

  • Continued or repeated narrowing of the aorta
  • Endocarditis 
  • High blood pressure

Calling your health care provider

Call your health care provider if:

  • You or your child has symptoms of coarctation of the aorta
  • You develop fainting or chest pain (these may be signs of a serious problem)

Prevention

There is no known way to prevent this disorder. However, being aware of your risk may lead to early diagnosis and treatment.

References

  1. Fraser CD Jr., Carberry KE. Congenital heart disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 60.
  2. In: Anderson RH, Baker EJ, Macartney FJ, Rigby ML, eds. Paediatric Cardiology. 3rd. Philadelphia, Pa: Churchill Livingstone Elsevier;2009:chap 46.
  3. Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 65.

Review Date: 12/1/2011.

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Treatments for coarctation of the thoracic aorta
    Coarctation of the aorta (CoA) is a congenital narrowing of the lumen in a section of the aorta. The narrowing is most commonly in the upper thoracic aorta but can occur in the abdominal aorta. It is present at birth and males are more often affected than females. Clinical symptoms are variable and depend on the position, degree and extent of the narrowed segment of the aorta. Other congenital heart abnormalities may also be present. In general, the diagnosis is made by finding a difference in pulsations and blood pressure between the upper body and arms and the lower body and legs. If left unrepaired, average survival is 31 years. The treatment of CoA is intended to improve life expectancy and quality of life by reducing the incidence of aortic and cardiac disabling conditions such as aneurysm (dilation) of the ascending aorta, coronary artery disease, high blood pressure, and aortic and mitral valvular disease. The treatment of CoA consists of enlarging of the narrowed segment. Traditionally this required open heart surgery. Balloon angioplasty became available as an alternative treatment in the 1980s but recurrence, aneurysm and aortic dissection (a tear in the inner wall of the aorta causing blood to flow between the layers of the blood vessel wall) remained disadvantages of both treatments. In the early 1990s, endovascular stents were introduced and have become an alternative approach to surgical repair. The present review looked at the available evidence for the effectiveness of open surgery compared with placing a stent in the coarctation of the thoracic aorta. The review authors searched the medical literature but they did not found any studies that compared open surgery and stent placement for the treatment of coarctation of the thoracic aorta. The treatment of CoA is a challenging procedure and the centers that perform this treatment have a well‐established strategy for patients with CoA; the strategy is in accordance with the experience of involved professionals and local resources. In both situations experience and resources have improved the results of the treatment. However a more concrete and long‐term analysis of these strategies is needed.
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