Coarctation Of The Aorta

Coarctation of the aorta is a birth defect in which a part of the aorta, the largest blood vessel in the body, is narrowed. Narrowing of the blood vessel forces the heart to pump blood harder. Symptoms of coarctation of the aorta range from mild to critical. Mild cases of narrowing often go unnoticed until adulthood. Severity of symptoms depend on the extent of narrowing of the blood vessel.

Severe form of narrowing may lead to serious problems, and need immediate treatment. Narrowing of aorta may happen at different parts of the blood vessel. It is most often seen in the region where the arteries branch off to head and arms. If left untreated, coarctation of the aorta may lead to heart failure. 

Symptoms of coarctation of the aorta depend on the severity of narrowing. Many people remain asymptomatic and is detected only during adulthood.

Severe form of coarctation show symptoms soon after birth of the child. The most common symptoms are:

• Irritability
• Sweating
• Difficulty in breathing
• Difficulty in feeding
• Pale skin

If left untreated coarctation may lead to heart failure or death. Mild forms may not show any symptoms. When present, hypertension is the most common symptom of the condition. The blood pressure in arms is higher, while that of legs is lower. The common symptoms are:

• Headache
• Muscle weakness
• Leg cramps
• Nose bleed
• Pressure or pain in the chest

The actual cause of coarctation of the aorta is not known. Narrowing of blood vessel may happen in any part of the aorta, but is mostly seen in the region where the blood vessel branches off to head and neck. Coarctation is mostly congenital, but in some cases it may develop later. Some other possible causes of narrowing of artery include atherosclerosis, traumatic injury, and inflammation of arteries.

As narrowing is often seen in the branch to the upper body, the blood pressure in the arms is higher. Legs and ankles will have lower blood pressure. As the heart pumps harder to push blood through the narrow artery, the blood pressure in the left ventricle is often higher. This often leads to thickening of the wall of left ventricle. Major risk factors for coarctation are:

• Bicuspid aortic valve
• Patent ductus arteriosus, a condition in which the blood vessel between left pulmonary artery and aorta remains after birth.
• Holes in between the left and right chambers of the heart
• Aortic valve stenosis, or narrowing of the valve that connects left ventricle and aorta
• Aortic valve regurgitation, in which blood from aorta leaks back into the ventricle
• Mitral valve stenosis, or narrowing of valve between the left auricle and left ventricle
• Mitral valve regurgitation, in which mitral valve does not close tightly

This condition is found to be more common among people with genetic conditions like Turner syndrome.

Severe form of coarctation of the aorta is diagnosed soon after birth. Milder form of the condition may not have any specific symptoms and is usually diagnosed when there is high blood pressure in arms, with a pressure difference between arms and legs. Legs record a delay in pulse. Heart murmur during physical examination also help in diagnosis of the condition.

Some tests used in the diagnosis of coarctation include:

• Echocardiogram
• Electrocardiogram
• Chest x-ray
• MRI
• CT scan
• Cardiac catheterization

Treatment of aorta coarctation depends on the severity and the age of onset of symptoms. Balloon angioplasty and surgery are the two methods used in the treatment of coarctation. Different surgical options for the condition include: 

• Resection – in this procedure the narrow part of the blood vessel is removed and the two ends joined together.
• Subclavian flap aortoplasty – a small portion of the subclavian artery is used to expand the narrow part of aorta
• Bypass graft repair – the narrow part of the blood vessel is bypassed by a graft
• Patch aortoplasty – in this procedure the narrow area is cut and a patch of synthetic material is used to widen aorta.
• Balloon angioplasty – in this procedure a small catheter is inserted into an artery and guided to the narrow region of aorta. An uninflated balloon is then placed in the narrow region of the aorta. Balloon is then inflated to widen the aorta. In some cases a stent is kept in the narrow region of the blood vessel to widen it.

Medications are used to control blood pressure. In case of severe case of coarctation, medication helps to keep the ductus arteriosus open.

As it is a congenital disease, coarctation of the aorta cannot be prevented. But early detection is very important, particularly if the child has any of the risk factors of the disease.

There are very few known complementary and alternative remedies for coarctation of aorta.

There are different ways to adapt your lifestyle in coping with coarctation of the aorta.

Regular follow-up is very important to evaluate the condition. Regular exercise is useful to keep blood pressure under control.

Take care to prevent endocarditis, or inflammation of the inner lining of the heart.

Most of the complications of aorta coarctation are caused by high blood pressure. This includes stroke, aneurysm or bulging of blood vessel, coronary artery disease, aortic rupture, heart failure, and hemorrhage.