Coarctation (ko-ahrk-TAY-shun) of the aorta â or aortic coarctation â is a narrowing of the aorta, the large blood vessel that branches off your heart and delivers oxygen-rich blood to your body. When this occurs, your heart must pump harder to force blood through the narrowed part of your aorta.
Coarctation of the aorta is generally present at birth (congenital). The condition can range from mild to severe, and 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. While treatment is usually successful, the condition requires careful lifelong follow-up.
Coarctation of the aorta care at Mayo Clinic
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Coarctation of the aorta symptoms depend on the severity of the condition. Most people don't have symptoms. Children with serious aortic narrowing may show signs and symptoms earlier in life, but mild cases with no symptoms might not be diagnosed until adulthood. People may also have signs or symptoms of other heart defects that they have along with coarctation of the aorta.
Babies with severe coarctation of the aorta may begin having signs and symptoms shortly after birth. These include:
Left untreated, aortic coarctation in babies might lead to heart failure or death.
Older children and adults with coarctation of the aorta often don't have symptoms because their narrowing may be less severe. If you have signs or symptoms that appear after infancy, you most commonly will have high blood pressure (hypertension) measured in your arms. However, your blood pressure is likely to be lower in your legs. Signs and symptoms might include:
Seek medical help if you or your child has the following signs or symptoms:
While experiencing these signs or symptoms doesn't necessarily mean that you have a serious problem, it's best to get checked out quickly. Early detection and treatment might help save your life.
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Doctors aren't certain what causes coarctation of the aorta (aortic coarctation). For unknown reasons, mild to severe narrowing develops in part of the aorta. Although aortic coarctation can occur anywhere along the aorta, the coarctation is most often located near a blood vessel called the ductus arteriosus. The condition generally begins before birth (congenital). Congenital heart defects are the most common of all birth defects.
Rarely, coarctation of the aorta develops later in life. Traumatic injury might lead to coarctation of the aorta. Rarely, severe hardening of the arteries (atherosclerosis) or a condition causing inflamed arteries (Takayasu's arteritis) can narrow the aorta, leading to aortic coarctation.
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).
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The age at which coarctation of the aorta is diagnosed depends on the severity of the condition. If the aortic coarctation is severe, it's usually diagnosed during infancy. Testing for coarctation of the aorta before birth often isn't possible.
Adults and older children who are diagnosed with coarctation of the aorta may have milder cases and not have symptoms. They may often appear healthy until a doctor detects:
Tests to confirm a diagnosis of coarctation of the aorta may include:
Echocardiogram. Echocardiograms use high-pitched sound waves to produce an image of your heart. Sound waves bounce off your heart and produce moving images that can be viewed on a video screen.
An echocardiogram can often detect the location and severity of the aortic coarctation and show other heart defects, such as a bicuspid aortic valve. Doctors often use echocardiograms to diagnose coarctation of the aorta and determine the most appropriate treatment options for you.
Electrocardiogram (ECG). An ECG records the electrical activity in your heart each time it contracts. During this procedure, you will have patches with wires (electrodes) placed on your chest, wrists and ankles. The electrodes measure electrical activity, which is recorded on paper or a computer monitor.
If the coarctation of the aorta is severe, the ECG may show that the walls of the lower heart chambers are thickened (ventricular hypertrophy).
Magnetic resonance imaging (MRI). An MRI uses a powerful magnetic field and radio waves to produce detailed images of your heart and blood vessels.
An MRI can reveal the location and severity of the coarctation of the aorta, determine whether it affects other blood vessels in your body, and detect whether you have other heart defects. Doctors may also use this test to determine your treatment options.
Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of your body.
In a CT angiogram, your doctor injects a dye into a blood vessel to highlight blood flow in your arteries and veins. A CT angiogram allows your doctor to see the location and severity of the coarctation of the aorta, determine whether it affects other blood vessels in your body, and detect other heart defects. Your doctor may also use this test to determine your treatment options.
Cardiac catheterization. During this procedure, your doctor inserts a long, thin tube (catheter) into an artery or vein in your groin, arm or neck and threads it to your heart using X-ray imaging.
Your doctor may inject a dye through the catheter to make your heart structures visible on X-ray pictures. The dye can also measure pressures and oxygen levels in the chambers of the heart and in the blood vessels. Cardiac catheterization can help determine the severity of the aortic coarctation.
This test isn't often used to diagnose coarctation of the aorta, but your doctor may use it to help plan surgery or other treatment, if you need it. Catheter procedures may be used to perform certain treatments for coarctation of the aorta.
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Untreated coarctation of the aorta frequently leads to complications. Some complications may be a result of long-standing high blood pressure caused by the aortic coarctation. Complications are also possible after treatment for coarctation of the aorta.
Complications of coarctation of the aorta may include:
In addition, 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 damage to your heart and also can result in kidney failure or other organ failure.
If your coarctation of the aorta was treated when you were young, you have a risk of the aorta re-narrowing (re-coarctation) over time. You also have a higher risk of developing high blood pressure. You will need lifelong follow-up for coarctation of the aorta, and you may require additional treatments.
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Coarctation of the aorta can't be prevented, because it's usually present at birth (congenital). 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.
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Although coarctation of the aorta may be repaired, you'll need careful follow-up throughout life in order for doctors to monitor you for complications and recurrences.
Your doctor may suggest that you have regular follow-up appointments with a doctor who specializes in congenital heart disease. In follow-up appointments, your doctor may evaluate you and order imaging tests to monitor your condition. Your doctor will also check your blood pressure and treat it as needed.
Here are a few tips for managing your condition:
Get regular exercise. Regular exercise helps lower blood pressure. Talk to your doctor about whether you need to restrict certain physical activities, such as weightlifting, which can temporarily raise your blood pressure.
Your doctor may evaluate you and conduct exercise tests prior to deciding if you should participate in competitive sports or weightlifting.
Consider pregnancy carefully. Before becoming pregnant, talk to your doctor to determine if you can undergo pregnancy safely. Women with coarctation of the aorta, even after repair, may have a higher risk of aortic rupture, aortic dissection or other complications during pregnancy and delivery. Doctors will also evaluate whether your blood pressure is controlled.
If you have had aortic coarctation repair and are considering becoming pregnant, careful management of your blood pressure is important to help keep you and your baby healthy.
Prevent endocarditis. Endocarditis is an inflammation of the inner lining of the heart or of its structures, caused by a bacterial infection.
You generally won't need to take antibiotics before certain dental procedures to prevent endocarditis. However, if you've had endocarditis in the past, or if you had a stent placed or had valve replacement surgery, then your doctor may recommend antibiotics.
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Coarctation of the aorta often occurs along with other congenital heart defects, although doctors don't know what causes multiple heart defects to form together. The condition is more common in males than in females. You or your child may be more likely to have aortic coarctation if certain heart conditions exist, including:
Patent ductus arteriosus. Before birth, the ductus arteriosus is a blood vessel connecting the left pulmonary artery to the aorta â allowing blood to bypass the lungs.
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. You may have a hole in the wall (septum) between the upper chambers of the heart (atrial septal defect) or the lower chambers of the heart (ventricular septal defect) when you're born.
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.
Aortic valve stenosis. This is a narrowing of the valve that separates the left ventricle of the heart from the aorta (aortic valve). This means your heart has to pump harder to get adequate blood flow to your body.
Over time, this can cause your heart muscle to thicken and lead to symptoms such as chest pain, fainting spells and breathlessness, or heart failure.
Mitral valve stenosis. This is a narrowing of the valve (mitral valve) between the upper left heart chamber (left atrium) and the left ventricle that lets blood flow through the left side of your heart.
In this condition, blood may back up into your lungs, causing shortness of breath or lung congestion. Like aortic valve stenosis, this condition can also lead to heart failure.
Coarctation of the aorta is also more common in people who have certain genetic conditions, such as Turner syndrome. Women and girls with Turner syndrome have 45 chromosomes, with one missing or incomplete X chromosome, instead of 46. About 10 percent of women and girls with Turner syndrome have aortic coarctation.
Talk to you doctor if you or your child has of any of these risk factors or a family history of congenital heart disease.
Source: http://www.mayoclinic.com
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