Patient CareAdult cardiac, endovascular, and thoracic aortic surgery
Patient information & resources
Coarctation: Coarctation of the aorta is a birth defect in which the aorta, the major artery from the heart, is narrowed. The narrowing results in high blood pressure before the point of coarctation and low blood pressure beyond the point of coarctation. Most commonly, coarctation is located so that there is high blood pressure in the upper body and arms and low blood pressure in the lower body and legs. Symptoms can include localized hypertension, cold feet or legs, decreased exercise performance, and heart failure.
Causes, incidence, and risk factors:
Aortic coarctation causes low blood pressure and low blood
flow in the arteries that branch off below the narrow spot; high blood
pressure occurs in the arteries that branch off closer to the heart. As
a result, aortic coarctation often leads to high blood pressure in the
upper body and arms (or one arm) and low blood pressure in the lower
body and legs.
Aortic coarctation is more common in some genetic conditions, such as Turner's syndrome, but it can also be associated with congenital abnormalities of the aortic valve, such as a bicuspid aortic valve.
Aortic coarctation occurs in approximately 1 out of 10,000 people. It is usually diagnosed in children or adults under 40.
Symptoms: There may be no symptoms. Symptoms are dependent on the severity of blood flow restriction. In severe cases, symptoms are present during infancy; in milder cases, symptoms may not develop until adolescence. Symptoms include decreased exercise performance, cold feet or legs, and shortness of breath. Other symptoms include:
- dizziness or fainting
- pounding headache
- nodding-like head movements accompanying heart beats
- nosebleed
- leg cramps with exercise
- hypertension (high blood pressure) with exercise
Signs and tests: An examination reveals high blood pressure in the arms and low blood pressure in the legs, with a significant blood pressure difference between the arms and legs. The femoral (groin) pulse is weaker than the carotid (neck) pulse, or the femoral pulse may be totally absent.
Listening to the heart through a stethoscope reveals a murmur that is harsh and can be heard in the back. There may be signs of left-sided heart failure (especially in infants) or signs of aortic regurgitation.
Coarctation is often discovered during a newborn infant's first examination or during a well-baby exam. The health care provider will detect that the femoral pulses are absent or very weak. Taking the pulses in an infant is an important part of the examination as there may not be any other symptoms or findings until the child is older.
Coarctation of the aorta can be confirmed by:
- X-ray of the chest (may also show abnormal ribs or "notching" of ribs caused by enlargement of the rib arteries)
- ECG that indicates left ventricle enlargement
- echocardiography
- Doppler ultrasound of the aorta
- chest CT
- MRI of the chest
- cardiac catheterization and aortography
Both Doppler ultrasound and cardiac catheterization can detect an aortic pressure gradient, that is, a difference in pressure within the aorta, caused by the coarctation.
Treatment: Surgery is usually advised. Occasionally, balloon angioplasty (using a technique similar to that used to open the coronary arteries, but performed on the aorta) may be an alternative to surgical repair.
With surgery, the narrowed segment of the aorta is removed, then repaired by anastomosis (placing the two free ends of the aorta back together) if the segment with the coarctation was short. If a longer segment must be removed, a Dacron graft (a synthetic material) is used to fill the gap.
Prognosis: Coarctation of the aorta is curable with surgery, and rapid improvement of symptoms often occurs after the repair. There is an increased risk for death caused by cardiovascular problems among patients who have undergone aortic repair; however, without treatment, most people with this condition die before they reach the age of 40.
Early surgical intervention (before 10 years old) is usually advised. Today, diagnosis of a coarctation and subsequent surgical repair typically occur during infancy.
Back to patient care page | Services | Patient forms | Diagnostic tools | Glossary | Web resources | Support groups | Top of Page
