Coarctation of the aorta
Coarctation of the aorta is a narrowing, or constriction, in a portion of the aorta. The condition forces the heart to pump harder to get blood through the aorta and on to the rest of the body.
The aorta is the largest artery in your body. It moves oxygen-rich blood from your heart to the rest of your body. Narrowing of the aorta (aortic coarctation, pronounced ko-ahrk-TAY-shun) forces your heart to pump harder to move blood through the aorta.
Coarctation of the aorta is generally present at birth (congenital). Although the condition can affect any part of the aorta, the defect is most often located near a blood vessel called the ductus arteriosus. Symptoms can range from mild to severe. It might not be detected until adulthood, depending on how much the aorta is narrowed.
Coarctation of the aorta often occurs along with other heart defects. Though treatment is usually successful, the condition requires careful lifelong follow-up.
Coarctation of the aorta symptoms depend on the severity of the condition. Most people don't have symptoms. Mild coarctation may not be diagnosed until adulthood.
Babies with severe coarctation of the aorta may begin having symptoms shortly after birth. These include:
- Pale skin
- Heavy sweating
- Difficulty breathing
- Difficulty feeding
People with coarctation of the aorta may also have signs or symptoms of other heart defects, which often occur with the condition.
Signs or symptoms of coarctation of the aorta after infancy commonly include:
- High blood pressure
- Muscle weakness
- Leg cramps or cold feet
- Chest pain
When to see a doctor
Seek medical help if you or your child has the following signs or symptoms:
- Severe chest pain
- Sudden shortness of breath
- Unexplained high blood pressure
While having these signs or symptoms doesn't always mean that you have a serious health condition, it's best to get checked out quickly. Early detection and treatment might help save your life.
Doctors aren't certain what causes coarctation of the aorta. The condition is generally present at birth (congenital). Congenital heart defects are the most common of all birth defects.
Rarely, coarctation of the aorta develops later in life. Conditions or events that can narrow the aorta and cause this condition include:
- Traumatic injury
- Severe hardening of the arteries (atherosclerosis)
- Inflamed arteries (Takayasu's arteritis)
Coarctation of the aorta usually occurs beyond the blood vessels that branch off to your upper body and before the blood vessels that lead to your lower body. This can often lead to high blood pressure in your arms but low blood pressure in your legs and ankles.
With coarctation of the aorta, the lower left heart chamber (left ventricle) of your heart works harder to pump blood through the narrowed aorta, and blood pressure increases in the left ventricle. This may cause the wall of the left ventricle to thicken (hypertrophy).
Coarctation of the aorta often occurs along with other congenital heart defects. Certain heart conditions are often associated with coarctation, including:
- Bicuspid aortic valve. The aortic valve separates the lower left chamber (left ventricle) of the heart from the aorta. A bicuspid aortic valve has two flaps (cusps) instead of the usual three. Many people with coarctation of the aorta have a bicuspid aortic valve.
- Sub-aortic stenosis. Sub-aortic stenosis occurs when there is a narrowing of the area below the aortic valve that obstructs blood flow from the left ventricle to the aorta. This narrowing may be in the form of a fibrous membrane.
- Patent ductus arteriosus. The ductus arteriosus is a blood vessel that connects a baby's left pulmonary artery to the aorta. It allows blood to bypass the lungs while the baby is growing in the womb. Shortly after birth, the ductus arteriosus usually closes. If it remains open, it's called a patent ductus arteriosus.
- Holes in the wall between the left and right sides of the heart. Some people are born with a hole in the wall (septum) between the upper heart chambers (atrial septal defect) or the lower heart chambers (ventricular septal defect).This causes oxygen-rich blood from the left side of the heart to mix with oxygen-poor blood in the right side of the heart.
- Congenital mitral valve stenosis. The mitral valve is between the upper and lower left heart chambers. It lets blood flow through the left side of your heart. In mitral valve stenosis, the valve is narrowed. As a result, the movement of blood between the upper and lower left heart chambers is reduced, increasing the pressure in the upper left chamber (atrium). The oxygen-rich blood from the lungs returns to the heart through veins that attach to the upper left chamber. Increased pressure in the left atrium may result in symptoms of lung congestion. These symptoms include shortness of breath, difficulty breathing during exercise and shortness of breath when lying flat.
Coarctation of the aorta is more common in males than in females, as well as in those who have certain genetic conditions, such as Turner syndrome.
Without treatment, coarctation of the aorta frequently leads to complications. In babies, it may lead to heart failure or death.
High blood pressure is the most common long-term complication of coarctation of the aorta. Blood pressure usually drops after the aortic coarctation has been repaired, but may still be higher than normal.
Other complications of coarctation of the aorta may include:
- A weakened or bulging artery in the brain (brain aneurysm) or bleeding in the brain (hemorrhage)
- Aortic rupture or tear (dissection)
- Enlargement in a section of the wall of the aorta (aneurysm)
- Heart failure
- Premature coronary artery disease — narrowing of the blood vessels that supply the heart
If the coarctation of the aorta is severe, your heart might not be able to pump enough blood to your other organs. This can cause heart damage and may lead to kidney failure or other organ failure.
Complications are also possible after treatment for coarctation of the aorta. They include:
- Aorta re-narrowing (re-coarctation, possibly years after treatment)
- High blood pressure
- Aortic aneurysm or rupture
You will need lifelong follow-up for coarctation of the aorta, and you may require additional treatments.
Coarctation of the aorta can't be prevented, because it's usually present at birth. However, if you or your child has a condition that increases the risk of aortic coarctation, such as Turner syndrome, bicuspid aortic valve or another heart defect, or a family history of congenital heart disease, early detection can help. Discuss the risk of aortic coarctation with your doctor.