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. With 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. There, it branches out to deliver freshly oxygenated blood to your lower limbs. A constriction or narrowing of this important artery can result in decreased flow of oxygen.
In CoA, the constricted part is generally near the top of the aorta and 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.
CoA is generally diagnosed and treated shortly after birth through surgery. These children usually grow up to lead normal, healthy lives. However, if your child is not diagnosed with CoA until he or she is older, your child is at risk for high blood pressure and heart problems. He or she may require close medical monitoring.
Without treatment, CoA patients generally die in their 30s to 40s of heart disease or from complications of chronic high blood pressure.
CoA is one of several common types of congenital heart malformations. CoA may occur alone, or together with other abnormalities in the heart. CoA is seen more frequently in boys than girls. It is also associated with other congenital heart defects, such as Shone’s complex and DiGeorge syndrome. While it is known that CoA begins during fetal development, its causes are still not fully understood.
In the past, doctors thought that CoA occurred more often in whites 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 and 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. CoA affects only about 6 to 8 percent of all children born with heart defects. And congenital heart defects only occur in approximately .009 percent of all babies born each year.
Symptoms in Newborns
Symptoms in newborns vary with the severity of the constriction of the aorta. About half of newborns with CoA exhibit no symptoms. The rest may have trouble breathing and be poor feeders. Other symptoms are sweating, high blood pressure, and congestive heart failure.
Symptoms in Older Children and Adults
In mild cases, children may exhibit 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
- dizziness or fainting
CoA is usually discovered during the newborn’s first examination. Your 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 CoA is suspected, your doctor may order additional tests, such as an echocardiogram, magnetic resonance imaging (MRI), or cardiac catheterization (aortography) to get a more accurate diagnosis.
CoA is generally treated soon after birth using 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. The surgeon may instead choose to bypass the constriction with a graft or 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 may be needed to the weak area of the aortic wall. Left untreated, persons 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, aneurysms, stroke, and premature coronary artery disease. Chronic high blood pressure can also lead to kidney and liver failure, and loss of eyesight through retinopathy. Patients with CoA may need to take drugs, such as ACE (angiotensin-converting-enzyme) inhibitors and beta-blockers to control high blood pressure.
CoA patients should follow a healthy lifestyle. Moderate daily aerobic exercise is helpful for maintaining healthy weight, cardiovascular health, and controlling blood pressure. Strenuous exercise, such as weightlifting, put additional stress on the heart and should be avoided. CoA patients should minimize their intake of dietary salt and fat. Anyone with CoA should NEVER smoke any kind of tobacco products.
Written by: Janet Barwell and Matthew Solan
Medically reviewed by George Krucik, MD