Patient CareAdult cardiac, endovascular, and thoracic aortic surgeryPatient 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.