Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, the body’s largest artery responsible for transporting oxygen-rich blood to the rest of the body. When this artery is narrowed, it becomes difficult for the heart to pump blood efficiently to other parts of the body.

Causes of Coarctation of the Aorta

Scientists have not identified a specific cause for coarctation of the aorta. This condition typically occurs during fetal development in the womb without a clear reason. Infants with coarctation of the aorta may also experience other heart problems, including:

• Aortic valve stenosis
• Hypoplastic left heart syndrome
• Atrial septal defect
• Bicuspid aortic valve

There are also some risk factors that increase the likelihood of a child developing this condition, such as genetic changes, having Turner syndrome, or the mother having one of the following factors:

• Use of certain prescribed medications, such as anticonvulsants
• Being over 35 years old
• Having diabetes
• Contracting rubella during pregnancy

Coarctation of the aorta rarely occurs in adulthood; when it does, it may be due to:

• Injuries
• Atherosclerosis
• A rare type of swelling and inflammation of the blood vessels in the heart known as Takayasu arteritis

Coarctation of the Aorta Symptoms 

The appearance of symptoms for this condition depends on the severity of the aortic narrowing. In some cases, if the narrowing is mild, there may be no symptoms at all. However, if a baby is born with severe coarctation of the aorta, some signs may include:

• Difficulty breathing
• Difficulty feeding
• Excessive sweating
• Changes in skin color
• Distress in the baby

If symptoms appear later in childhood, they may include:

• Chest pain
• High blood pressure
• Cold feet
• Muscle weakness
• Leg cramps
• Nosebleeds
• Headaches

Diagnosis of Coarctation of the Aorta

This condition is usually diagnosed at birth or later during childhood, depending on the severity of symptoms. For infants with moderate to severe symptoms, diagnosis occurs immediately after birth. In contrast, children with mild symptoms or no symptoms may be diagnosed later in childhood when signs like high blood pressure appear.

Some newborns are diagnosed before any clear symptoms emerge when pulse oximetry shows low oxygen levels in their blood. Low oxygen levels can indicate a serious heart defect like coarctation of the aorta, so further testing is conducted to identify the specific problem.

Most children and infants are diagnosed with coarctation of the aorta when a physical examination reveals warning signs, which may include:

• High blood pressure in the arms and upper body but low blood pressure in the legs and lower body
• Differences in pulse when measured at the neck compared to the thigh
• A distinctive, harsh heart murmur heard by the doctor using a stethoscope on the child’s back

After these warning signs are observed, the doctor may recommend additional tests to diagnose coarctation of the aorta, such as:

• Echocardiogram
• CT scan of the heart
• Chest X-ray

Treatment of Coarctation of the Aorta

The choice of the most appropriate treatment for this condition depends on various factors, including the child’s overall health, the location and size of the narrowing, and whether there are related disorders such as heart valve diseases. Below are examples of some available treatment options:

1) Medications

Infants with severe symptoms immediately after birth may require medications before surgery. A medication called prostaglandin is used to keep the ductus arteriosus open, allowing the baby to receive enough oxygen and stabilize for surgery. Some infants may need medications to help the heart pump blood effectively.

2) Surgical Procedures

Here are some examples of surgical options that may be employed to treat coarctation of the aorta:

• End-to-End Anastomosis: If the narrowing is relatively small, the surgeon may remove the narrowed section of the aorta. This procedure is known as end-to-end anastomosis and is often the preferred surgical option for treating aortic coarctation.
• Patch Aortoplasty: When there is a narrowing in the arch of the aorta, the surgeon can remove the narrowed part of the aorta and connect the lower portion to an enlarged patch of the aorta.
• Subclavian Aortic Aneurysm: This method involves widening the narrowed section of the aorta in the child by using tissue from the subclavian artery to expand the aorta. This type of repair is rarely performed today as it compromises the artery supplying blood to the child’s left arm.

3) Cardiac Catheterization

Cardiac catheterization is a suitable option for older children with mild coarctation and is also used for children and adults who experience restenosis (narrowing of the aorta again after repair). This procedure is less invasive than surgery and includes options such as:

• Balloon Angioplasty: A catheter with a balloon is inserted into the narrowed area, and the balloon is inflated to widen the aorta.
• Stenting: A stent can be placed at the site of the narrowing after balloon angioplasty to help keep the artery open.

In conclusion, coarctation of the aorta is a type of congenital heart defect that typically appears at birth or later in childhood. Early diagnosis of this condition can help manage associated symptoms and improve the quality of life for children.