Coarctation of the Aorta

What is coarctation of the aorta?

Coarctation of the aorta is a problem children are born with. The big artery that goes from the heart to the body (the aorta) is so narrow that it makes it hard for the blood to flow from the heart to the lower part of the body. The blood backs up above the narrow area, causing high blood pressure (hypertension) in the right arm and the blood vessels going to the head.

In severe cases, no blood can get through the narrow area. Severe coarctation of the aorta in the newborn infant is a medical emergency that can result in death if not treated.

How does it occur?

The cause is unknown. Coarctation of the aorta may be the only heart defect children have, but they may also have other heart problems.

What are the symptoms?

If the narrowing is severe at birth, the baby will soon develop symptoms that may include:

• poor feeding
• pale color
• rapid breathing.

The lack of blood flow to the lower part of the body may cause the baby to stop making urine.

Babies with minor narrowing often will not develop symptoms until later in childhood. Most children with coarctation of the aorta, however, will have high blood pressure in their arms and in the blood vessels going to their head. They will have a lower blood pressure in their legs. Often the pulse in the legs cannot be felt.

How is it diagnosed?

The baby may have an echocardiogram, which uses sound waves to make pictures of the aorta and surrounding blood vessels. Cardiac catheterization may also be done. In this procedure, a small tube is placed in the artery of the leg, a special dye is inserted, and X-ray pictures are taken of the aorta and surrounding blood vessels.

How is it treated?

Even when there are no symptoms, surgery is needed to prevent high blood pressure from getting worse over time.

The surgery may be done in one of several ways:

• The narrow part of the aorta may be removed and the 2 ends reconnected.
• A piece of man-made material may be grafted across the blockage.
• A tiny balloon may be inserted into the aorta to stretch it.

No matter which method is used, regular follow-ups are needed. The blockage comes back in a few children as they grow older. They are also at risk for getting an infection in the repaired area of the aorta and should take antibiotics before any dental work or surgery. Some children will still have high blood pressure that needs to be treated.

What are the results of treatment?

Most children who have had coarctation treated successfully have no further symptoms and lead normal lives.