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Coarctation of the aorta is a birth defect where part of the aorta (a major artery) is narrower than usual.
If the narrowing is severe enough and undiagnosed, a baby may have serious problems and may need surgery or other procedures. For this reason, coarctation of the aorta is often considered a critical congenital heart defect.
The narrowing, or coarctation, blocks normal blood flow to the body. This can back up flow into the heart's left ventricle, making the muscles in this ventricle work harder to get blood out of the heart.
The narrowing of the aorta is usually located after arteries branch to the upper body. This can lead to normal or high blood pressure in the head and arms and low blood pressure and weak pulses in the legs and lower body.
If the condition is very serious, enough blood may not get through to the lower body. The extra work on the heart can cause the heart's walls to become thicker as it pumps harder. This makes the heart muscle weaker. If the aorta is not widened, the heart may weaken enough that it leads to heart failure. Coarctation of the aorta often occurs with other congenital heart defects.
Early signs usually include:
The causes of heart defects like coarctation of the aorta are usually unknown. Some babies have heart defects because of changes in their genes or chromosomes. Some heart defects are caused by a combination of genes and things the mother comes into contact with in the environment, what the mother eats or drinks, or medicines she uses.
Coarctation of the aorta is usually diagnosed after a baby is born. Diagnosis usually depends on how mild or serious the symptoms are.
In infants and older individuals, the pulse will be noticeably weaker in the legs or groin than it is in the arms or neck. A heart murmur—an abnormal whooshing sound caused by disrupted blood flow—may be heard through a doctor’s stethoscope. Older children and adults with coarctation of the aorta often have high blood pressure in the arms.
An echocardiogram is the most common test to confirm the diagnosis. An echocardiogram is an ultrasound of the heart that can show problems with the heart's structure and blood flow, and how well the heart is working. It will show the location and severity of the coarctation and whether any other heart defects are present.
Other tests to measure heart function include chest X-ray, electrocardiogram (EKG), magnetic resonance imaging (MRI), and cardiac catheterization.
CCHDs also can be detected with pulse oximetry. This is a simple bedside test to determine the amount of oxygen in a baby’s blood. Newborn screening using pulse oximetry can identify coarctation of the aorta before any symptoms appear.
No matter what age the defect is found, the narrow aorta will need to be widened once symptoms are present. This can be done with surgery or balloon angioplasty.
Balloon angioplasty is a procedure that uses a thin, flexible tube, called a catheter, which is inserted into a blood vessel and directed to the aorta. When the catheter reaches the aorta's narrow area, a balloon at the tip is inflated to expand the blood vessel.
Sometimes a mesh-covered tube (stent) is inserted to keep the vessel open. During surgery to correct a coarctation, the narrow portion is removed, and the aorta is reconstructed or patched to allow blood to flow normally.
Children and adults with coarctation of the aorta need to follow up regularly with a cardiologist (heart doctor) to check for any heart and health problems that might develop as they get older. Even after surgery, children with coarctation of the aorta often have high blood pressure that they need to treat with medicine.
Presbyterian’s Pediatric and Congenital Cardiology team has many different options to help you manage your or your child’s heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans. Depending on the type of heart condition your child has and its underlying cause, the team can recommend a wide variety of treatment options. Our pediatric cardiologists, pediatric interventional cardiologists, and pediatric cardiovascular surgeons work closely together for cases in which cardiac repair or surgery is the best treatment option.