Coarctation of the Aorta
Coarctation, a common defect in children, is a narrowing of the aorta -- the main vessel that supplies the body with blood. The aorta, shaped like a candy cane, leaves the heart heading up towards the head, then makes a 180 degree curve in the upper chest and starts to head down the chest and into the abdomen. During this curve, the aorta gives off three big branches to supply the head, neck, and arms with blood. Coarctation of the aorta is a narrowing at the point in the upper chest where the aorta is just starting to head down towards the lower body, just after the third branch to the head and arms.
Symptoms of Coarcation of the Aorta
Mild to moderate coarctations may have no symptoms at all. Doctors may discover it by hearing a murmur in the area. Since the narrowed portion occurs just after the branches to the arms, it is common to find high blood pressure in the arms and lower blood pressure in the legs.
Treatment of Coarcation of the Aorta
Having to squeeze blood through this narrowed area is an extra stress on the heart, so it is usually recommended that children with mild to moderate coarctations have surgery to widen the blood vessel. In severe cases, which usually occur in the newborn period, there isn't enough blood that can get through the narrowed portion to keep the lower part of the body healthy. These babies may need urgent surgery to fix their coarctation.
Surgery for coarctation of the aorta involves widening the narrowed portion and is usually done through an incision in the left side of the chest, although there are occasions when it may be done through a vertical incision in the front of the chest ("open heart" incision).
The surgical repair can be done in one of two ways:
- Narrowed segment is cut out - there is enough "give" in the aorta to put the two good ends back together.
- Incision is made along the length of the narrowed segment and a patch is placed to widen it.
Neither method has proved to be superior to the other. The particular technique is chosen by the surgeon based on the characteristics of that individual coarctation as well as his/her personal experience or preference.
The results of surgery are typically good - the complication rate is low, and the narrowing can usually be widened satisfactorily. Whichever technique is used, approximately 5% of patients will redevelop narrowing in that area over the first few months to years. It is also possible that the high blood pressure which many of these children have before surgery may not go away after surgery. The reasons for this are unclear.
Some patients with coarctation (or a coarctation that came back after surgery) can have the coarctation repaired by stretching it with a balloon. This procedure is done in the cardiac catheterization room and does not involve open surgery. Your cardiologist and surgeon will be able to help guide you as to whether this is a possibility.
Coarctation of the aorta may occur as an isolated defect but commonly occurs along with other heart defects. The most common defect associated with coarctation is a hole between the two main pumping chambers of the heart (ventricular septal defect). The presence of another defect may greatly impact the treatment of the coarctation.
Note: This page is meant to be a helpful, informative introduction on the subject of coarctation of the aorta. The information may not be applicable to all cases, especially if there are additional defects. It is not meant to replace the opinion of a personal physician.