Coarctation of the aorta (CoA) is a congenital malformation of the aorta. The condition is also known as aortic coarctation. Either name indicates a constriction of the aorta.
The aorta is the largest artery in your body. It has a diameter about the size of a garden hose. The aorta leaves the left ventricle of the heart and runs through the middle of your body, through the chest and into the abdominal area. It then branches out to deliver freshly oxygenated blood to your lower limbs. A constriction or narrowing of this important artery can result in a decreased flow of oxygen.
The constricted part of the aorta is generally near the top of the heart, where the aorta exits the heart. It acts like a kink in a hose. As your heart tries to pump oxygen-rich blood to the body, the blood has trouble getting through the kink. This causes high blood pressure in the upper parts of your body and reduced blood flow to the lower parts of your body.
A doctor will generally diagnose and surgically treat CoA shortly after birth. Children with CoA usually grow up to lead normal, healthy lives. However, your child is at risk for high blood pressure and heart problems if their CoA isn’t treated until they’re older. They may need close medical monitoring.
Untreated cases of CoA are usually fatal, with people in their 30s to 40s dying from heart disease or complications of chronic high blood pressure.
Symptoms in Newborns
The symptoms in newborns vary with the severity of the constriction of the aorta. According to KidsHealth, most newborns with CoA show no symptoms. The rest may have trouble breathing and feeding. Other symptoms are sweating, high blood pressure, and congestive heart failure.
Symptoms in Older Children and Adults
In mild cases, children may show no symptoms until later in life. When symptoms do begin to show, they can include:
- cold hands and feet
- chest pain
- shortness of breath
- high blood pressure
CoA is one of several common types of congenital heart malformations. CoA may occur alone. It can also occur with other abnormalities in the heart. CoA appears more frequently in boys than girls. It also occurs with other congenital heart defects, such as Shone’s complex and DiGeorge syndrome. CoA begins during fetal development, but doctors don’t fully understand its causes.
In the past, doctors thought that CoA occurred more often in Caucasian people than in other races. However, more recent research suggests that differences in the prevalence of CoA may be due to different rates of detection. Studies suggest that all races are equally likely to be born with the defect.
Fortunately, the chances of your child being born with CoA are fairly low. KidsHealth states that CoA affects only about 8 percent of all children born with heart defects. According to the Centers for Disease Control, about 4 out of 10,000 newborns have CoA.
A newborn’s first examination will usually reveal CoA. Your baby’s doctor may detect differences in blood pressure between the baby’s upper and lower extremities or hear characteristic sounds of the defect when listening to your baby’s heart.
If your baby’s doctor suspects CoA, they may order additional tests, such as an echocardiogram, MRI, or cardiac catheterization (aortography) to get a more accurate diagnosis.
Common treatments for CoA after birth include balloon angioplasty or surgery.
Balloon angioplasty involves inserting a catheter inside the constricted artery and then inflating a balloon inside the artery to widen it.
Surgical treatment may involve removing and replacing the "crimped" portion of the aorta. Your baby’s surgeon may instead choose to bypass the constriction by using a graft or by creating a patch over the narrowed portion to enlarge it.
Adults who received treatment in childhood may require additional surgery later in life to treat any reoccurrence of CoA. Additional repairs to the weak area of the aortic wall may be necessary. If CoA is left untreated, people with CoA generally die in their 30s or 40s of heart failure, ruptured aorta, stroke, or other conditions.
Chronic high blood pressure associated with CoA increases the risks of:
- heart damage
- an aneurysm
- a stroke
- premature coronary artery disease
Chronic high blood pressure can also lead to:
- kidney failure
- liver failure
- a loss of eyesight through retinopathy
People with CoA may need to take drugs, such as angiotensin converting enzyme (ACE) inhibitors and beta-blockers to control high blood pressure.
If you have CoA, you should maintain a healthy lifestyle by doing the following:
- Perform moderate daily aerobic exercise. It’s helpful for maintaining a healthy weight and cardiovascular health. It also helps control your blood pressure.
- Avoid strenuous exercise, such as weightlifting, because it puts additional stress on your heart.
- Minimize your intake of salt and fat.
- Never smoke any tobacco products.
Written by: Janet Barwell and Matthew Solan
Medically reviewed on Jan 11, 2016 by Debra Sullivan, PhD, MSN, RN, CNE, COI