A congenital heart defect, coarctation of the aorta is a narrowing in the aorta, one of the large blood vessels attached to the heart that carries oxygen-rich blood to smaller vessels to be taken throughout the body. A narrower passage in the aorta, the body’s largest artery, means your heart has to work harder to pump the same amount of blood through a smaller space. Shaped like a candy cane, narrowing can happen at any point in the aorta, though it is most common just after the aortic arch.
Wellness & Prevention
Often coarctation of the aorta develops without any discernible cause, though genetics, a chromosome abnormality or environmental exposure may cause COA. Families who have a history of left-sided heart problems and children with specific genetic abnormalities tend to be at a higher risk. Most people who have COA are born with the defect. In rare cases, aortic coarctation may develop in adulthood from an injury or a condition that affects the arteries.
With a narrower aorta, the left ventricle in the heart compensates by working harder to push blood through the vessel and blood flow may be reduced. As a result of being overworked, the muscle in the left ventricle can weaken, thicken and fail to function properly.
Aortic coarctation also leads to higher blood pressure right before and after the narrow portion. The greater pressure in blood vessels in the head may cause headaches in older children. Inadequate blood flow can cause cramps in the legs or abdomen and the kidneys may not produce adequate urine if they don’t receive enough blood at the right pressure.
Without treatment, high blood pressure from COA may weaken arteries in the head or arms, causing tears that could trigger a stroke or bleeding.
Children are more likely to have symptoms and exhibit symptoms earlier when the narrowing is more severe. Some children may show symptoms as babies. Others may not have any symptoms until they are in elementary school or adolescence. Symptoms may include:
- Heavy or rapid breathing
- Pain in lower legs while walking
- Circulatory collapse
- Poor growth or weight gain
- Heavy sweating
- Trouble feeding in infants
- Infection in the intestines
- Tiredness with exercise
- Pale skin
- Cold extremities
Aortic coarctation symptoms may resemble other conditions. Talk to your child’s doctor and see a pediatric cardiologist if any abnormalities are detected.
Your child’s doctor is often the first medical professional to notice COA. She may hear a heart murmur caused by abnormal blood flow and recommend seeing a pediatric cardiologist. In some cases, aortic coarctation can be detected with fetal echocardiography (ultrasound) before your baby is born. The test can be performed when the fetus is at least 16 weeks old.
There are several different ways that pediatric cardiologists diagnosis aortic coarctation after birth.
- Chest X-ray or MRI: An X-ray or MRI produces an image of tissue, organs and bones in the child’s chest.
- Electrocardiogram (ECG or EKG): Electrocardiograms are used to record the electrical activity in the heart. An ECG can show abnormal rhythms and stress on the heart.
- Echocardiogram: Using an ultrasound, an echocardiogram makes an image of the heart to check the function and structure of the heart.
- Cardiac catheterization: A tiny catheter can be inserted through a larger blood vessel, typically in the groin, and threaded into the heart to take blood pressure and oxygen measurements throughout the heart and in the aorta and pulmonary artery.
Treatment plans to repair the narrowed vessel can vary based on your child’s age, health, medical history, the level of aortic coarctation and the prognosis. Your pediatric cardiologist may prescribe medication to control blood pressure prior to surgery and babies may be given medication to keep the blood vessel between the pulmonary artery and the lungs open.
Options to repair coarctation of the aorta include:
- Cardiac catheterization: Using the same method as for diagnosis, a small tube can be inserted through a blood vessel in the groin and guided to the heart. A balloon can be pushed through the tube and inflated in the aorta to stretch the narrow portion. A stent may be added after the balloon is removed to ensure the aorta stays open.
- Surgery: A pediatric cardiac surgeon may perform a surgical repair utilizing different methods, such as removing the narrow part, widening it with a patch or part of another artery or bypassing the section with a plastic tube.
After resting and recuperating, your child should be able to resume sports and physical activities without any limitations. Ongoing care from a pediatric cardiologist is recommended to ensure that your child remains in good health. Even after successful treatment, coarctation of the aorta requires meticulous follow up care through adulthood.